July/August 2024

JULY / AUGUST 2024

Official Publication of SDCMS

Dr. Steve Koh Becomes 2024–2025 SDCMS President 2024 SDCMS and Champions for Health Gala

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The CMA Insurance Program is administered by Lockton Affinity, LLC d/b/a Lockton Affinity Insurance Brokers LLC in California #0795478. Coverage is subject to actual policy terms and conditions. Policy benefits are the sole responsibility of the issuing insurance company. The California Medical Association will receive a royalty fee for the licensing of its name and trademarks as part of the insurance program offered to the extent permitted by applicable law. Not available in all states.

Contents JUL/AUG

Editor: James Santiago Grisolia, MD Editorial Board: James Santiago Grisolia, MD; David E.J. Bazzo, MD; William T-C Tseng, MD; Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM Marketing & Production Manager: Jennifer Rohr Art Director: Lisa Williams Copy Editor: Adam Elder

VOLUME 111, NUMBER 7

OFFICERS President: Steve H. Koh, MD President–Elect: Preeti S. Mehta, MD Immediate Past President: Nicholas (dr. Nick) J. Yphantides, MD, MPH Secretary: Maria T. Carriedo-Ceniceros, MD Treasurer: Karrar H. Ali, DO, MPH GEOGRAPHIC DIRECTORS East County #1: Catherine A. Uchino, MD East County #2: Rachel Van Hollebeke, MD Hillcrest #1: Kyle P. Edmonds, MD Hillcrest #2: Stephen R. Hayden, MD (Delegation Chair) Kearny Mesa #1: Anthony E. Magit, MD, MPH Kearny Mesa #2: Dustin H. Wailes, MD La Jolla #1: Toluwalase (Lase) A. Ajayi, MD La Jolla #2: David E.J. Bazzo, MD, FAAFP North County #1: Arlene J. Morales, MD (Board Representative to the Executive Committee) North County #2: Christopher M. Bergeron, MD, FACS North County #3: Nina Chaya, MD South Bay #1: Paul J. Manos, DO South Bay #2: Latisa S. Carson, MD AT–LARGE DIRECTORS #1: Rakesh R. Patel, MD, FAAFP, MBA (Board Representative to the Executive Committee) #2: Kelly C. Motadel, MD, MPH #3: Irineo (Reno) D. Tiangco, MD #4: Miranda R. Sonneborn, MD #5: Daniel D. Klaristenfeld, MD #6: Alexander K. Quick, MD #7: Karl E. Steinberg, MD, FAAFP #8: Alejandra Postlethwaite, MD ADDITIONAL VOTING DIRECTORS Young Physician: Emily A. Nagler, MD Retired Physician: Mitsuo Tomita, MD Medical Student: Kenya Ochoa

DEPARTMENTS

CMA OFFICERS AND TRUSTEES Trustee: William T–C Tseng, MD, MPH Trustee: Sergio R. Flores, MD Trustee: Timothy A. Murphy, MD

Briefly Noted: Public Health • Physician Wellness

AMA DELEGATES AND ALTERNATE DELEGATES District I: Mihir Y. Parikh, MD District I Alternate: William T–C Tseng, MD, MPH At–Large: Albert Ray, MD At–Large: Robert E. Hertzka, MD At–Large: Theodore M. Mazer, MD At–Large: Kyle P. Edmonds, MD At–Large: Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM At–Large: David E.J. Bazzo, MD, FAAFP At–Large Alternate: Sergio R. Flores, MD At–Large Alternate: Bing Pao, MD CMA DELEGATES District I: Steven L.W. Chen, MD, FACS, MBA District I: Vikant Gulati, MD District I: Eric L. Rafla-Yuan, MD District I: Ran Regev, MD District I: Quinn Lippmann, MD District I: Kosala Samarasinghe, MD District I: Thomas J. Savides, MD District I: Mark W. Sornson, MD District I: Wynnshang (Wayne) C. Sun, MD District I: Patrick A. Tellez, MD, MHSA, MPH District I: Randy J. Young, MD

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement

by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org. All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

2 FEATURES

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Steve Koh, MD, MPH, MBA SDCMS President 2024 Gala Speech

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Dr. Michael Krelstein: James T. Hay, MD Award

By Nicholas “dr. Nick” Yphantides, MD, MPH

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Champions for Health Gala Awards

By Adama Dyoniziak

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United in Wellness Gala Photos

16

Looking for the Open Door

By Helane Fronek, MD, FACP, FASVLM, FAMWA

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New Alzheimer’s Mimic Identified

By Judy George

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Sexual and Gender Minorities Twice as Likely to Report Epilepsy

By Sophie Putka

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Classifieds SANDIEGOPHYSICIAN .ORG

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PUBLIC HEALTH

Dr. Wilma Wooten Retires as San Diego County Public Health Officer, Dr. Eric McDonald Retires as County’s Immunization Director SAN DIEGO County’s Public Health Officer, Dr. Wilma Wooten, announced her retirement in June after 23 years of service for the 3.3 million people in San Diego County. She spent the last 17 as the county’s lead doctor and public face of numerous media stories, none greater or more tumultuous than the 2020 COVID-19 pandemic.

In addition, Dr. Eric McDonald, who spent nearly 15 years as a county medical director, most of them running San Diego County’s Epidemiology and Immunization Services branch, announced his retirement at the end of July.

Dr. McDonald previously served 24 years in emergency medicine in the Navy, including two deployments to Iraq. He was at the center of the county’s medical response to COVID-19 and also one of the public faces who excelled at explaining complicated medical issues to the public during the pandemic.

During Dr. Wooten’s career, she prioritized the prevention and control of infectious disease, protection from environmental hazards, and promoted injury prevention. She worked to publicly reinforce healthy choices and lifestyles, as well as emergency preparedness, and fought to eliminate health disparities in traditionally underserved communities.

With a focus on planning and process, Dr. Wooten put in place tools to address health

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and information access in special-needs populations, built partnerships to improve population health, and formed close relationships with local, state, federal, and binational partners to advance border health initiatives.

She has been a strong supporter of national standards for public health departments and accreditation, and serves on multiple professional boards and committees to advance the field of public health.

When asked by local television station ABC 10 News about the greatest challenge she faced during COVID-19, she responded, “The lockdown. And just the challenges that it caused to individuals with their jobs, with businesses … just the entire fabric of our society. We recognize that it was a tremendous cost, but a necessary action to take,” she said.

“I don’t regret anything. The things that we did, they were necessary, and I’m grateful that we were able to implement them,” she said.

Wooten also commended the collaboration of organizations countywide during that time and the life-saving measures they put in place together.

The San Diego County Medical Society is one of those organizations, and we thank Dr. Wooten for all she has done for the people of San Diego County and our region’s medical community. She has spent her career working to eliminate health disparities in traditionally underserved communities. She’s now retiring as a role model to future generations of medical professionals, particularly women of color.

SDCMS wishes Dr. Wooten and Dr. McDonald all the best for their well-deserved retirements earned after lengthy years of distinguished public service for the people of San Diego County.

PHYSICIAN WELLNESS

CMA Urges Medical Board to Revise Licensure Application to Prioritize Physicians Seeking Mental Healthcare THE CALIFORNIA MEDICAL Association (CMA) is requesting that the Medical Board of California revise questions on its licensure application that may inadvertently discourage physicians from seeking mental and behavioral health treatment.

CMA is urging the medical board to narrow this section of the application to a single question asking, “Do you currently have any condition that impairs your ability to practice medicine safely?” and to clarify that applicants should respond “no” if they are receiving appropriate treatment for any conditions, if as a result of the treatment the condition does not impair their ability to safely practice medicine.

“Narrowing this section of the application to one question that focuses solely on conditions impairing an applicant’s ability to practice medicine safely eliminates two unnecessary questions and reduces stigmatizing language inappropriately comparing various conditions,” CMA stated in its letter to the medical board.

This change aligns with CMA-sponsored AB 2164, authored by Assemblymember Marc Berman, which would eliminate the obligation for physicians to disclose personal medical information that does not impact their ability to practice medicine. Removing this barrier would make it more likely for physicians to seek the mental health support they need, benefiting both themselves and their patients. AB 2164 is currently moving through the legislature unopposed and has been supported by the medical board.

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2024 GALA

Steve Koh, MD, MPH, MBA SDCMS President | 2024 Gala Speech DEAR COLLEAGUES, IT IS AN HONOR TO TAKE on the role of SDCMS president. As Dr. Bob Hertzka alluded to in his generous introduction of me, it has been quite a journey to be here today. During the week leading up to the Gala, I have had many friends and colleagues give me advice on what I should say and address. I would like to mention a couple of those.

The first advice was: “Steve, don’t forget to thank your family and, for all that is holy, do NOT forget to thank your wife.” So with that … my parents are in attendance and I cannot say enough about what they have taught me over the years. My in-laws are also here, and they have raised an amazing daughter who chose me to be her husband and who became the mother to my son, Everett Soo-Jin Koh. I have learned more from him than he will ever know, and I cannot

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imagine how my life was before him. As for my wife, what can I say? If there is indeed a multiverse and alternative lives, I know that in every single one of them, I will wish for her to choose me, and I will be resigned to the fact that even my closest friends will always pick her over me.

The second piece of advice was: “Koh, you know how you can get at these things when you have to talk. You tend to drag on and on. Keep it short.” Well … as many of you may know, there are generally two types of psychiatrists: (1) those who listen very well, process the information for a long time, and say little. And (2) those who tend to get the information and give advice, and then tend to talk a bit more. I will leave it up to everyone here to decide which type I might be. However, it is a special evening, and so I want to be respectful to my advisers for the evening, and just tell one folk tale that I grew up with.

Long ago in a small village in Korea, there was a single mother who raised her only son while cutting rice cakes to sell in the market. She worked from dawn to dusk in getting the cakes ready and cut them to size for sale. Difficult work, to be sure. She never complained and considered this to be her craft to ensure that she can send her son to school. Back then, a key skill or craft for those educated was calligraphy. Her son eventually became a celebrated scholar with his calligraphy skills. He went away to the capital while leaving his mother in the village. Over time, he became more focused on the fame, trials, challenges, rewards and other such things than his chosen craft. After years apart, he came back to the village with much fanfare. His mother, who had continued to make, cut, and sell her rice cakes, day in and day out, in the market, watched her son being celebrated in the village in silence.

Later that evening, after everyone was gone, she asked him how his calligraphy was going. He proceeded to talk to her about how his work in the capital was going — all of his triumphs and challenges. She slowly nodded and listened. When he was finished, she asked again how his calligraphy was going. He dismissively responded that it was even better than what she remembered and certainly better than anything she can do. The mother then asked her son to bring out his brush and ink to write while she would make and cut rice cakes. As they began, she blew out the candle and they each did their respective craft in darkness. When they were done, the candle was re-lit to reveal she had perfectly cut rice cakes while her son’s calligraphy likely resembled what my own handwriting is these days. She proceeded to tell him that all the accolades and perceived challenges in his life are all meaningless if he cannot adhere to the fundamental craft that he has chosen.

This story was first told to me by my father in childhood, and has stayed with me over the decades since. At every

critical moment in my life, especially during those challenging times that Bob alluded to, I think about that story. And each time, it holds a different meaning for me.

As I stand before you today, and reflect, my mind goes to what unites us all. Physicians, allied health providers, healthcare administrators, healthcare volunteers, and sponsors of the work that we do. What is our true craft and true north? It seems that every month and every year, we face increasing challenges to healthcare. From budget cuts, often illogical policy changes, decreases to physician fees, increasing bureaucracy, and higher costs of care delivery, we are struggling every day. And the “wins” often seem to be focused on a contract that we negotiated, a grant that we were awarded, a paper that was published, or avoiding what we thought was going to be a disaster.

I know that many are often discouraged with our professions and our craft. And yet, even in the middle of the pandemic, and even in the most challenging of times, I have never seen a physician colleague not show up to treat patients, our health systems close their doors, or our allied health professionals stop working side by side with us.

From large hospitals to federally qualified health centers to nonprofit organizations, day in and day out, we show up to practice our craft, despite the accolades or challenges.

Our true north is taking care of our patients. At the end of the day, what unites us and what makes us well together is keeping to this core foundation, craft, and true north. It is the common thread that binds us together, despite our differences.

It is my honor and privilege to be part of our society. It is with humility and commitment toward our shared true north that I take on the stewardship of the presidency. I appreciate and thank all of you.

SDCMS President Dr. Steve Koh with his in-laws Jim and Pam Sietsma, his wife, Alexandra Sietsma, his son, Everett Soo-Jin Koh (aka Mighty Baby Koh), and his parents Jin Sook Koh and Chung Soo Koh.

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2024 GALA

San Diego County Medical Society’s Gala Award

Dr. Michael Krelstein: James T. Hay, MD Award

By Nicholas “dr. Nick” Yphantides, MD, MPH

Jim Hay, MD, Michael Krelstein, MD, and Nick Yphantides, MD

THE SAN DIEGO COUNTY MEDICAL SOCIETY has a long tradition of giving an annual award to a physician with distinguished community service. In 2020 the board of directors of SDCMS named the award the James T. Hay, MD Award to honor the living legacy of Dr. James T. Hay, a longtime member, leader, and public servant who exemplifies the model of a physician passionate about the wellbeing of the broader community.

This year’s James T. Hay, MD Award goes to Dr. Michael Krelstein, a local psychiatrist and the longtime clinical director for behavioral health for San Diego County!

Dr. Krelstein is a champion of the safety net! His whole career focus has been on those in our community with the greatest need going through their most severe crisis. As the director of the San Diego County Psychiatric Hospital, he embraced that the facility was the “mothership” for the behavioral health system of San Diego and he always prioritizes the importance of the safety net to care for those experiencing the most difficult moments of their lives.

He is a passionate champion for quality of care and he always recognizes the integrity, worth, and value of every patient served by the San Diego County Psychiatric Hospital and the entire regional behavioral health system. Michael pursues justice and equity in quality for all!

Dr. Krelstein is a champion for integrating broader community support in the care of his patients. He has always seen himself as more than a “hospitalist” and is a passionate

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believer in the broader community-based system of care with a focus on addressing the myriad of behavioral health conditions that have an impact on the wellbeing of his patients.

He is a passionate champion of servant leadership who supported, mentored, and tactfully corrected when necessary those who worked for him in advocating for the highest quality care possible for their patients. He developed deep “trust capital” with many private hospitals, and their medical and administrative leaders, toward the common mission of meeting their psychiatric needs regardless if they were on Medi-Cal, private health plans, or completely indigent and uninsured.

Finally, Michael is my champion for being one of the most compassionate, gracious, and humble physicians I know. In the public sector, the limelight often shines brightest on the political and administrative agents, and Dr. Krelstein has faithfully and quietly served this community for a very long time. He is loved and admired by his staff, colleagues, and all the regional advocates in behavioral health because of his passion and servant-minded approach. I am so thankful to call him my friend and I am honored to share the announcement that this year’s James T. Hay, MD Award goes to Dr. Michael Krelstein!

Dr. Jim Hay congratulating Dr. Michael Krelstein

A DV E R T I S E M E N T

Sharp Mesa Vista Offers Unique Treatment Option With Cognitive Behavioral Therapy People experiencing high levels of stress, combined with previous mental health diagnoses such as depression or anxiety, often don’t know where to turn. Some need support beyond one-on-one therapy but something more flexible than inpatient treatment. That’s where Sharp Mesa Vista Hospital can help.

For over 40 years, the Cognitive Behavioral Therapy Intensive Outpatient Program (COG IOP) at Sharp Mesa Vista has helped adults who are experiencing acute distress from a mental health condition. In this intensive short-term therapy program, patients receive education, group therapy and medication management for eight to 10 weeks.

Many of the patients are facing work, family or

An outdoor gathering space for patients at Sharp Mesa Vista

personal challenges, with each experiencing a mental health condition, such as depression, anxiety, profound

During CBT, patients practice skills that can reduce

grief, obsessive-compulsive disorder or post-traumatic

distressing symptoms and improve relationships. They work

stress disorder. Patients find both relief and support by

with various board-certified clinicians, such as psychiatrists,

participating in group therapy.

psychologists, licensed clinical social workers and marriage

“We have found that group therapy is a very effective modality, as patients discover that they can relate to their

and family therapists.

One component of this therapy involves examining

peers and provide each other feedback,” says Raymond

“distorted thinking,” such as catastrophizing and mind

Fidaleo, MD, clinical director of COG IOP.

reading, both of which can impact one’s mood and

Patients engage in cognitive behavioral therapy (CBT),

relationships. With the guidance of clinicians, group

an evidence-based form of psychotherapy developed

members learn to build awareness of their thoughts and

by renowned psychiatrist Aaron Beck, MD, whom Dr.

become mindful of their judgments or interpretations.

Fidaleo trained with before establishing COG IOP at

The program offers a support group for loved ones

Sharp Mesa Vista.

CBT works by showing a person how their thoughts affect their emotions, which influence their behavior.

of patients who are receiving treatment, as well as a free educational lecture series.

COG IOP is a unique offering at Sharp Mesa Vista.

Numerous studies have found CBT can be more effective

Numerous community mental health services refer to Sharp

than other forms of therapy when paired with psychiatric

Mesa Vista’s program to supplement a patient’s care and

medications.

treatment.

Each treatment session lasts three hours, and patients

Recent research shows that an average of 15 to 20

begin by attending five days a week. The number of sessions

sessions are needed for 50% of patients to recover, as

decreases as the program progresses.

indicated by self-reported symptom measures. While most

“When you’re going through a mental health issue, your

talk therapy sessions are held once a week, patients in

relationships can be strained,” says Colleen Auth, LCSW, a

COG IOP participate in more frequent sessions, potentially

licensed clinical social worker at COG IOP. “Our program

accelerating their recovery.

equips patients with tools, such as effective conflict

“We’re proud to continue our legacy of serving as a

resolution skills, anger management methods and ways to

trusted mental health care provider that our community

communicate assertively.”

can rely on,” says Dr. Fidaleo.

If you or a colleague know of a patient who can benefit from this program or other services offered by Sharp Mesa Vista, 7

you can make a referral by calling 858-836-8309 or visiting sharp.com/mesavista.

MAY 2024

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2024 GALA

2024 Champions for Health Gala Awards

By Adama Dyoniziak, Champions for Health executive director

Champion of the Year: Dr. Hernan Goldsztein Every physician volunteer undoubtedly deserves an award.

Dr. Hernan Goldsztein truly stands out among our many champion volunteers. A Project Access otolaryngologist volunteer since 2014, Hernan Goldsztein has provided 137 medical appointments and 25 surgeries pro bono to 29 patients.

He goes above and beyond in caring for underserved, uninsured patients as well as referring his own cash pay patients to Project Access to then continue their care pro bono. Patients are frequently saying that he has made a difference, provided assurance, and feel relief that they could be helped with Project Access.

As the chair of the Physician Recruitment Committee and a CFH board member, Hernan Goldsztein has connected Project Access with healthcare resources that created significant benefits to our program. Thanks to his dedication, we were able to secure a partnership with Palomar Health, and he has helped the committee in recruiting 18 physicians to be volunteers. He attends these meetings while on lunch, on vacation or at home. He is very supportive of Champions for Health and Project Access, and attends meetings and events even after a long surgery day. It is my pleasure to present the Project Access Champion of the Year award to Dr. Hernán Goldsztein.

Project Access Partner of the Year: Whole Person Care Clinic (WPCC) Our next awardee is a community clinic that has been referring patients to Project Access since March 2014 when they sent their first referral as CSU San Marcos Student Healthcare Project. They also transformed internally into Southern California Community Clinic, and most recently into the Whole Person Care Clinic (WPCC). During this time, they have referred 57 patients in 24 different specialties. Mary Baker and the entire Whole Person Care Clinic team have consistently supported Project Access with ideas, resources, program recognition, and in-person support at events.

WPCC staff have always been incredible advocates for their patients. They fully understand the multiple critical needs of the patients in their community. The WPCC staff

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Nicolett Danns accepting the Partner of the Year Award for Whole Person Care Clinic

are a pleasure to communicate with as they are responsive and very easy to talk to regarding the needs of our mutual patients. WPCC clients have expressed to us the trust they have in their clinic and fondness for the clinic staff.

When WPCC referred a gynecology patient to Project Access who was unhoused and with a young son, we worked together to ensure that the necessary surgery for her uterine fibroids and her recovery would be successful. The clinic worked with a church that raised funds to have the patient and her son stay at an Airbnb during her recovery, as well as provide gift cards for food for that time period since the patient wouldn’t be able to work. The clinic team’s attitude was heartwarming and genuinely appreciated by the patient and by our team.

This collective synergy transforms patients’ lives and makes Whole Person Care Clinic the Project Access Partner of the Year.

President’s Award: IGO Medical Group Our next awardee is IGO Medical Group, whose gynecologists have volunteered with Project Access since 2010. The nine specialists have served 180 patients with 562 medical

appointments and 110 surgeries. The physicians of IGO go the extra mile for their patients. They communicate with Project Access staff regularly to ensure that the patient is getting everything she needs. The entire office staff is always so helpful and knowledgeable. Project Access patients that are referred to IGO have suffered a long time with their health issues, frequented the ER very often for heavy bleeding and anemia, and are in a great deal of pain. IGO provides the patients with a great experience. At the completion of their treatment and surgeries, the patients are beyond grateful Adama Dyoniziak — not just for the change in their presenting Champion of the Year Award to physical symptoms and pain reHernan Goldsztein, MD lief, but also the overall improvement in their health and life.

Patients always give great feedback from their office visits, and many have commented that IGO doctors are not just good doctors, they are good people too. When Project Access staff provide medical interpretation during appointments, the doctors all have a great bedside manner. They reassure

Wendy Buchi, MD, accepting the President’s Award for IGO Medical Group

the patient regarding their concerns and fears, and explain all the surgery details in a relatable manner, with dignity and kindness. They make the patients feel comfortable. To all of the physicians and staff of IGO, you have made an impact on all of us with your kindness and compassion. It is our distinct pleasure to present you with the President’s Award.

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2024 GALA

United in Wellness Gala

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2024 GALA

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2024 GALA

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PLACE YOUR AD HERE Contact Jennifer Rohr 858.437.3476 Jennifer.Rohr@SDCMS.org

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PERSONAL AND PROFESSIONAL DEVELOPMENT

Looking for the Open Door

By Helane Fronek MD, FACP, FASVLM, FAMWA

AT A RECENT MUSIC WORKSHOP, I MET GARY Hoey, a professional rock guitarist — not the usual type of person I encounter in my life. With Gary’s electric intensity and theatrical stage presence, one could easily miss the underlying sensitivity and thoughtfulness that form the foundation of his career and life. Pausing to take questions from the workshop participants, Gary was asked who his biggest inspirations were. Surprisingly, he shared that it was his mother. He explained that, growing up in Boston and passionate about music, he asked to attend Berklee College of Music. “Gary, we have no money for that,” his mom replied.

“But why don’t you go there, hang around, and see if you can learn something?”

Gary went to Berklee’s bookstore, approached a young man with a full backpack, and asked if he was a student

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there. When the man replied that he was about to graduate that year, Gary asked if he would be willing to give guitar lessons. In debt and needing money, the man enthusiastically agreed. Thus began Gary’s indirect Berklee musical education: he traveled to the school weekly and was taught by a knowledgeable and motivated young musician with a Berklee curriculum inside him.

Helen Keller once remarked that “When one door of happiness closes, another opens; but often we look so long at the closed door that we do not see the one which has been opened for us.”

Examples of this from my own life easily come to mind.

After suffering a heartbreaking loss of an election to be president of a local high school organization, I realized that a higher office — president of the regional organization — might be possible. After winning that election, I spent a year traveling, speaking to groups of young women, honing skills that later served me well as a physician and leader, and allowing me to focus the efforts of thousands of people on a worthwhile cause. Years later, after finishing internal medicine training, my goal was to become a critical care specialist. My first job was so unsettling that I inadvertently found myself learning about and then treating varicose veins. This led to an unexpectedly fulfilling career. I was able to contribute to the development of a new medical specialty, working with others to educate physicians about superficial venous disease, creating a foundation to fund education and research and a board exam to craft standards in this new field, and meeting countless people as passionate as I was about addressing the needs of the millions of patients with these disorders.

Our lives are full of disappointments and challenges. We often find doors we intended to pass through closed. But life can also offer what we want or need in forms that we don’t immediately recognize. The opportunity is to look around and see what else might be open to us. When I encounter these setbacks, I try to remember the question a wise friend of mine poses at times like this: “And what does this make possible?”

Dr. Fronek is an assistant clinical professor of medicine at UC San Diego School of Medicine and a Certified Physician Development Coach, CPCC, PCC.

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NEUROLOGY

New Alzheimer’s Mimic Identified Memory-Loss Syndrome Predominantly Affects Limbic System By Judy George

Key Takeaways A NEW MEMORY-LOSS SYNDROME THAT MIMICS

the clinical features of Alzheimer’s disease was identified, researchers said.

“We propose a set of clinical criteria for a limbic-predominant amnestic neurodegenerative syndrome [LANS] that is highly associated with limbic-predominant age-related TDP43 encephalopathy [LATE] but also other pathologic entities,” wrote David Jones, MD, of the Mayo Clinic in Rochester, Minnesota, and co-authors in Brain Communications.

LATE — also known as LATE-NC (neuropathological change) — is a TDP-43 proteinopathy defined in 2019 based on autopsy findings and molecular characteristics of brain tissue.

“LANS and LATE are related, but not identical,” Dr. Jones said. “Most patients with LANS have LATE, but some patients with LANS may have Alzheimer’s disease or other causes of memory impairment,” he told MedPage Today.

“LANS can be diagnosed in living patients, while LATE can only be confirmed after death,” Dr. Jones noted.

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• New criteria were proposed for a syndrome that mimics the clinical features of Alzheimer’s disease.

• Researchers called this disorder limbic-predominant amnestic neurodegenerative syndrome (LANS).

• Unlike Alzheimer’s, LANS symptoms are restricted to memory loss and don’t involve other cognitive domains.

Tau-negative neurodegenerative disorders like LANS can masquerade as Alzheimer’s dementia, but occur later in life. Unlike Alzheimer’s, LANS symptoms are restricted to memory loss and don’t involve other cognitive domains.

“In our clinical work, we see patients whose memory symptoms appear to mimic Alzheimer’s disease, but when you look at their brain imaging or biomarkers, it’s clear they don’t have Alzheimer’s,” Dr. Jones said.

“Until now, there has not been a specific medical diagnosis to point to, but now we can offer them some answers,” he added. “This research creates a precise framework that other medical professionals can use to care for their patients. It has major implications for treatment decisions, including amyloid-lowering drugs and new clinical trials, and counseling on prognosis, genetics, and other factors.”

The proposed criteria incorporate features like older age at evaluation (generally, age 75 and older), mild clinical syndrome, disproportionate hippocampal atrophy, impaired semantic memory, limbic hypometabolism, the absence of neocortical

degeneration, and a low likelihood of neocortical tau.

Dr. Jones and colleagues applied their criteria to 218 autopsied patients with an antemortem predominant amnestic syndrome in two cohorts — 165 patients from the Mayo Clinic Study of Aging and Alzheimer’s Disease Research Center cohort and 53 from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort — who had Alzheimer’s neuropathological change, LATE-NC, or both pathologies at autopsy.

The neuropathology-defined groups accounted for 35%, 37%, and 4% of cases in the Mayo cohort, respectively, and 30%, 22%, and 9% of cases in the ADNI cohort. The criteria effectively categorized these cases, with Alzheimer’s disease having the lowest likelihoods of LANS, LATE having the highest likelihoods, and both pathologies having intermediate likelihoods. In the Mayo cohort, age at death for those with Alzheimer’s neuropathological change was 82.4 years; for those with LATE-NC, it was 91.6 years.

Patients with high likelihoods had a milder, slower clinical course and more severe temporo-limbic degeneration compared with those who had low likelihoods. Stratifying patients with both Alzheimer’s neuropathological change and LATE-NC from the Mayo cohort according to their likelihoods showed that those with higher likelihoods had more temporo-limbic degeneration and a slower rate of decline, while those with lower likelihoods had more lateral temporo-parietal degeneration and a faster rate of decline.

“It is important to reiterate that while LANS is highly associated with LATE-NC, it can be associated with other pathologic entities that selectively target the limbic system,” Dr. Jones and co-authors emphasized.

“One example that can be a potential source of clinical conundrums is the limbic variant Alzheimer’s disease, where tau predominantly localizes to the limbic system and therefore qualifies for LANS,” they pointed out. “In this scenario, the advanced LANS criteria in combination with visual assessment of tau-PET can help in determining which pathology has the highest likelihood of driving clinical symptoms.”

The low number of people with LATE-NC in the study is a limitation, the researchers acknowledged.

“Prospective studies are required to further assess the value of the LANS criteria in predicting underlying pathologies predominantly driving limbic versus neocortical degeneration,” they wrote. “This study is retrospective in nature.

The implementation of the LANS criteria in clinical settings and prospective studies are needed to further validate and refine this set of criteria.”

Judy George is deputy managing editor for MedPage Today, where this article first appeared, and covers neurology and neuroscience news, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy,

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NEUROLOGY

Sexual and Gender Minorities Twice as Likely to Report Epilepsy Reasons Behind the Findings Are Unclear By Sophie Putka INDIVIDUALS WHO IDENTIFIED WITH A SEXUAL or gender minority were more than twice as likely to report having epilepsy compared with the general population, survey data showed.

Active epilepsy was reported by 2.4% of the population who identified with a sexual orientation other than heterosexual or did not identify with their gender assigned at birth, compared with 1.1% among others, researchers led

by Emily Johnson, MD, MPH, of Johns Hopkins University School of Medicine in Baltimore, said in a JAMA Neurology brief report. Overall, 3.5% of transgender individuals reported having epilepsy, followed by gender-diverse individuals (1.5%), and LGBQ+ individuals (2.4%).

After adjusting for age, race, ethnicity, income, and education, individuals of a sexual or gender minority were twice as likely to report active epilepsy (adjusted OR 2.14, 95% CI 1.35–3.37), the researchers noted.

“I think it’s important for providers to be aware of all aspects of a person’s life which may affect the ability to access care and have social supports,” Dr. Johnson told MedPage Today, noting the importance of creating a welcoming atmosphere for people who may have had negative healthcare experiences.

That’s certainly the case for epilepsy, said Gwen Zeigler, DO, of Albany Medical College in New York, who was not involved in the study.

“This finding emphasizes an increased need for access to medical care for [this] serious, yet highly treatable medical condition of epilepsy,” Dr. Zeigler told MedPage Today.

However, it’s not clear what kind of mechanism might be linking epilepsy to sexual and gender identity, Dr. Zeigler cautioned.

“Minority stress theory has been posited to explain disparities in the sexual and gender minority communities, which may explain part of what we are seeing,” Dr. Johnson wrote in an email. “But, we need more research to understand other factors.”

The minority stress theory posits detrimental physical and mental health effects of chronic stress, which could be brought on by tangible threats of violence or harassment, internalized stigma, or diminished access to gender-affirming care.

The risk of physical assault or substance abuse also may be higher in this population, which could contribute to brain injury and epilepsy incidence, Johnson and co-authors noted.

Functional neurologic symptoms, including nonepileptic seizures, may be elevated in sexual and gender minority

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populations and could lead to self-reported epilepsy diagnosis, they added.

Hormone therapy might theoretically be another factor, the researchers suggested. While the epilepsy link hasn’t been well studied, hormone therapy used by transgender women has been tied to other disorders like multiple sclerosis and stroke. Another study found chronic mental health and neurologic conditions, including epilepsy, were elevated in transgender people on Medicare without looking specifically at hormone use.

Johnson’s group studied data from the nationally representative 2022 National Health Interview Survey (NHIS), which randomly selects adults from all U.S. states. The in-person survey included questions about demographics, medical conditions, and social factors. Of the 27,624 survey respondents, 54% were women, 12% were Black persons, and the mean age was 48.2 years.

The 2022 survey asked participants about their current gender identity and sex assigned at birth. The sexual and gender minority category included 6.6% of participants who reported

LGBQ+ sexual orientation.

People who reported sexual or gender minority status were younger than the overall population.

The NHIS also asked participants whether they had epilepsy or seizure disorder, whether they use medication to treat it, and how many seizures they had in the past year. Active epilepsy was defined as a diagnosis of epilepsy and the use of an antiseizure medicine or at least one seizure in the past year.

Those with epilepsy were more likely to report white or other or multiracial race, non-Hispanic identity, lower educational attainment, and lower household income. Transgender people represented 0.67% of the population; they had a high prevalence of depression (67% vs 18% in cisgender individuals, P<0.001), as did those who reported epilepsy overall (44% vs 18% in people without epilepsy, P<0.001).

An important limitation of the study is that epilepsy was self-reported.

Participants may have been reluctant to report their sexual or gender minority status to an interviewer, even if their answers were anonymous.

The cross-sectional design of the study prevented analysis of associations over time between epilepsy and sexual and gender minority identity. Neurologic comorbidities were not included, and there were no subgroup analysis.

Sophie Putka is an enterprise and investigative writer for MedPage Today, where this article first appeared.

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