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January 15, 2019; 92 (3) Article

Lifestyle and neurocognition in older adults with cognitive impairments

A randomized trial

James A. Blumenthal, Patrick J. Smith, Stephanie Mabe, Alan Hinderliter, Pao-Hwa Lin, Lawrence Liao, Kathleen A. Welsh-Bohmer, Jeffrey N. Browndyke, William E. Kraus, P. Murali Doraiswamy, James R. Burke, Andrew Sherwood
First published December 19, 2018, DOI: https://doi.org/10.1212/WNL.0000000000006784
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Article Information

vol. 92 no. 3 e212-e223
DOI: 
https://doi.org/10.1212/WNL.0000000000006784
PubMed: 
30568005
Published By: 
Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology
Print ISSN: 
0028-3878
Online ISSN: 
1526-632X
History: 
  • Received May 19, 2018
  • Accepted in final form September 18, 2018
  • First Published December 19, 2018.

Article Versions

Copyright & Usage: 
© 2018 American Academy of Neurology

Author Disclosures

    1. James A. Blumenthal, PhD,
    2. Patrick J. Smith, PhD,
    3. Stephanie Mabe, MS,
    4. Alan Hinderliter, MD,
    5. Pao-Hwa Lin, PhD,
    6. Lawrence Liao, MD,
    7. Kathleen A. Welsh-Bohmer, PhD,
    8. Jeffrey N. Browndyke, PhD,
    9. William E. Kraus, MD,
    10. P. Murali Doraiswamy, MBBS,
    11. James R. Burke, MD, PhD and
    12. Andrew Sherwood, PhD
  1. James A. Blumenthal, PhD,
    2. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. (1) NHLBI (HL109219), Principal Investigator, 2012-2018 (2) NHLBI (HL125522), Principal Investigator 2013-2018 (3) NHLBI (HL122836), Principal Investigator 2013-2018

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  2. Patrick J. Smith, PhD,
    3. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  3. Stephanie Mabe, MS,
    4. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. (1)NIH,R01HL109219, Exercise Physiologist/Study Coordinator, 2011-2017

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  4. Alan Hinderliter, MD,
    5. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. National Institutes of Health R01 ES025124-01A1 Gamma tocopherol chemoprevention for wood smoke PM2.5-induced airway inflammation Co-Investigator 2016-2021 National Institutes of Health R01 HL122836-01A1 Facility and Web-based Approaches to Lifestyle Change in Resistant Hypertension Co-Investigator 2014-2019 National Institutes of Health R01 HL122836-01A1 Facility and Web-based Approaches to Lifestyle Change in Resistant Hypertension Co-Investigator 12/01/14-11/30/19

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  5. Pao-Hwa Lin, PhD,
    6. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. "Nutrition, lifestyle and hypertension" in the book titled "Nutrition in the Prevention and Treatment of Disease" published by the Academic Press, 2017.

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. (1) NIH/NHLBI, 1R01 HL, Blumenthal (PI), investigator, 03/01/2015-12/31/2019 (2) UNIV OF PITT SUBAWARD #0041597(125465-3) Lin (PI) 12/1/14 ? 11/30/18

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  6. Lawrence Liao, MD,
    7. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. (1) NIH 5R01-HL122836-03 Coinvestigator 12/1/2016 - 11/30/2017 (2) NIH 5R01-HL125522-02 Coinvestigator 8/1/17 - 7/31/18

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  7. Kathleen A. Welsh-Bohmer, PhD,
    8. Scientific Advisory Boards:

    1. 1) Zinfandel Pharmaceuticals (2010-2011); 2) Takeda Phamaceuticals (2012-2018) 3) NeuroCog Trials (2018)

    Gifts:

    1. NONE

    Funding for travel or speaker honoraria:

    1. 1) Takeda: travel to consulting meetings 2) NeuroCog Trials: travel to AD international meetings

    Editorial Boards:

    1. (1) Alzheimer's & Dementia, Editorial Advisory Board, 2005-present; (2)Journal International Neuropsychological Society, Editorial Board, 1999-present; (3) Aging, Neuropsychology, and Cognition, Consulting Editor, 1999-present; (4) Neuropsychology, Consulting Editor, 1992-present

    Patents:

    1. (1) Use patent, April 28, 1999 filed; Feb 23, 2005 issued; Patent #6867236; Appl #09/300,789

    Publishing Royalties:

    1. Geriatric Neuropsychology: Assessment and Intervention. Deborah K. Attix & Kathleen A. Welsh-Bohmer (Eds). Guildford Publications: New York, 2006.

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. Zinfandel and Takeda Pharmaceutical companies & NeuroCog Trials

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. Contract support to Bryan ADRC from Zinfandel/Takeda pharmaceutical companies and in 2018 new contract from NeuroCog Trials

    Research Support, Government Entities:

    1. NIA, AG11380, PI of study, 2002-2011; NIA, AG028377, PI of study, 2006-2016 NIA, AG047866, PI of subcontract REVEAL NIA, AG010483, PI of subcontract EXERT

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  8. Jeffrey N. Browndyke, PhD,
    9. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NIH NHLBI U01-HL088942, co-investigator, 6 yrs. NIH NHLBI R01-130443, co-investigator, 2 yrs. NIH NHLBI R01-122836, co-investigator, 4 yrs. NIH NHLBI R01-109219, co-investigator, 4 yrs.

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  9. William E. Kraus, MD,
    10. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. Flexion therapeutics Glaxo-Smith-Klein

    Research Support, Government Entities:

    1. NIH/NIA 1U24AG047121 (Kraus W.; Pieper C.) Role: Co-PI 7/15/2015- 5/30/2020 Biomarkers of Caloric Restriction in Humans: The CALERIE Biorepository The CALERIE study was designed to assess the effects of two years of sustained and significant caloric restriction without enforced changes in dietary composition in human subjects in the setting of a randomized controlled trial. With this award, we will support the following for four years: maintenance of the data repository at Duke University, maintenance of the biorepository at the University of Vermont, the ability to link clinical data with biological samples, the committee of CALERIE investigators who steward use of the samples, so as to be able to provide access to collected data and samples to present and future investigators investigating caloric restriction in humans. NIH/NHLBI 2P01-HL036587-25 (Project 4) (Williams, R.) Role: Project PI 6/01/2016-5/31/21 Clinical Interventions & Gene-by-Stress Effects on Cardiometabolic Endophenotypes Project 4 will evaluate the most promising gene variants identified as moderators of behavioral intervention effects on cardiometabolic disease endophenotypes using data in completed clinical trials; there will be an experimental study to evaluate effects of pharmacologic agents on cardiometabolic endophenotype expression in persons with high-risk gene variants. NIH/NIAMS 1U01AR071128 (PI, Kraus, WE) 12/6/16-11/30/22 Molecular Transducers of Physical Activity and Health: NC Consortium Clinical Site The goal is to determine the response of molecular transducers to a single acute bout of either aerobic or resistance training, .to determine the responses of molecular transducers to a chronic exercise training program of either aerobic or resistance training and to determine the responses of molecular transducers to a detraining period following either aerobic or resistance training. NIH/NHLBI R01 HL122836 (Blumenthal JA, PI) Role: Co-I 12/01/2014- 11/30/19 Facility and Web-based Approaches to Lifestyle Change in Resistant Hypertension This is a study to understand the effects of improving aerobic fitness, greater adherence to the DASH diet, and greater weight loss after 4 months compared to SEPA controls; regression of LV hypertrophy; improvements in CVD risk biomarkers of arterial stiffness, baroreceptor reflex sensitivity, insulin resistance, and inflammatory markers after 4 months; on clinic and ambulatory BP CVD biomarkers at 1 year follow-up. NIH/NHLBI R01 HL125522 (Blumenthal JA, PI) Role: Co-I 08/01/2015- 07/31/20 Exercise and Pharmacotherapy for Anxiety in Cardiac Patients We will examine the following hypotheses in a population of CHD patients with elevated symptoms of anxiety: (1) Both exercise training and medication will reduce anxiety symptoms to a greater extent than a placebo; (2) Exercise training will improve autonomic regulation, vascular endothelial function, and inflammation more than either medication or placebo; (3) The relationship between exercise training and both anxiety and biomarkers of cardiovascular risk will be mediated by improved aerobic capacity (i.e., increased VO2peak). NIH/NIA 1P30 AG028716 (Schmader, PI); Role: Co-I 7/1/16 ? 06/30/21 Claude D Pepper Older Americans Independence Centers (OAICs) Biologic Studies Core The goal of this project is to provide a comprehensive understanding of the biochemical, metabolic and genetic bases for physical resilience and reserve in older Americans. NIH/NIBIB UG3TR002142 (Truskey GA, PI); Role: Co-I 7/1/17 ? 6/30/22 Systemic Inflammation in Microphysiological Models of Muscle and Vascular Disease The purpose of this project is to develop and test a micro-anatomic integrated muscle and vascular tissue system to be used for testing drug toxicity in vitro. NIH/NIA 1UH2AG056925-01 (Colon-Emeric, PI); Role: Co-I 7/1/17-6/30/22 Title: Physical Resiliencies: Indicators and Mechanisms in the Elderly Collaborative: Focus: We will examine whether mechanisms associated with one or more of the seven ?Pillars of Aging,? which have been described by the trans-NIH Geroscience Interest Group, underlie a more generalized capacity for recovery that applies across multiple stressor/response scenarios.

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. American Heart Association American College of Sports Medicine

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  10. P. Murali Doraiswamy, MBBS,
    11. Scientific Advisory Boards:

    1. 1) Cognoptix, 2) Neuronix, 3)Genomind, 4) NeuroPro

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. 1) Living Media, 2) World Economic Forum

    Editorial Boards:

    1. 1) Men's Health, editorial advisory board

    Patents:

    1. Co-inventor on patents filed by Duke relating to biomarkers for Alzheimer's.

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. Research grants to Duke university from 1) Avid, 2)Avanir

    Research Support, Government Entities:

    1. NIH

    Research Support, Academic Entities:

    1. 1) USC 2) UCSD 3) Northern California Research Institute

    Research Support, Foundations and Societies:

    1. Alzheimer Drug Discovery Foundation Cure Alzheimer's Foundation

    Stock/Stock Options/Board of Directors Compensation:

    1. 1) Evidation, 2) Advera Health Analytics, 3) Turtle Shell Technologie

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  11. James R. Burke, MD, PhD and
    12. Scientific Advisory Boards:

    1. Commercial 1. Abbvie 2. T3D

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  12. Andrew Sherwood, PhD
    13. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. Following NIH grants: R01 HL121708 07/15/14 ? 06/30/19 Depression and Heart Failure Disease Progression The study proposed in this application is designed to further our understanding of the behavioral and biological effects of depression in patients with heart failure, so that appropriate treatments can be developed. Role: Principal Investigator R01 HL122836 12/01/14 ? 11/30/19 Facility and Web-based Approaches to Lifestyle Change in Resistant Hypertension This single site clinical trial will evaluate the efficacy of a cardiac rehabilitation program of exercise and DASH dietary intervention to achieve blood pressure control in patients with treatment resistant hypertension. Role: Co-Principal Investigator. R01HL125522 09/01/15 ? 06/30/20 Exercise and Pharmacotherapy for Anxiety in Cardiac Patients. This study will evaluate the effectiveness of exercise training and anxiolytic medication in reducing anxiety in vulnerable cardiac patients, and examine changes in autonomic nervous system dysregulation, vascular endothelial dysfunction, and chronic inflammation. Role: Co-Investigator R01AG005552 09/15/15 ? 05/31/20 Social Cognition and Aging. This study examines age-related changes in motivation and their relationship with older adult?s participation in cognitively demanding everyday activities. The proposed research will focus on identifying personal and situational factors that influence the motivation to participate. Role: Co-Investigator R01HL130322 2/6/2016 - 1/31/2021 The Effect of Reducing Posttraumatic Stress Disorder Symptoms on Cardiovascular Risk. The proposed research is relevant to public health because the findings will indicate whether autonomic nervous system dysfunction, inflammation, and vascular endothelial dysfunction are the direct result of PTSD symptoms or an indirect effect secondary to behaviors related to trauma exposure. Role: Co-Investigator R01 HL130237 01/01/16-12/31/19 Neurocognition, Lifestyle Modification, and Treatment Resistant Hypertension The objective of this study is to examine the effects of DASH diet and weight loss on neurocognitive performance, mechanisms of neurocognitive improvement, and maintenance of neurocognitive improvements in patients with resistant hypertension. Role: Co-Investigator

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  1. From the Departments of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., K.A.W.-B., J.N.B., P.M.D., A.S.), Medicine (P.-H.L., L.L., W.E.K., P.M.D.), and Neurology (K.A.W.-B., J.R.B.), Duke University Medical Center, Durham; and Department of Medicine (A.H.), University of North Carolina at Chapel Hill.
  1. Correspondence
    Dr. Blumenthal James.Blumenthal{at}duke.edu
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