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On Mediation Models in Clinical Neurology Studies—Reply

On Mediation Models in Clinical Neurology Studies—Reply Letters 4-6 ticulous protocols. Because of this, the true prevalence of about associations between variables beyond bivariate asso- circadian symptoms in PD remains unknown and, as no accu- ciations and to uncover potential mechanisms. As this tech- rate clinical information on circadian activity was available for nique becomes increasingly popular, 2 considerations are the patients in our study, we believe that any potential clini- important. copathological correlation is ambitious. First, it must be noted that many causal effects probably The severity of SCN Lewy pathology in our cases did not operate through more than one mechanism, so there is a pos- correlate with the global neuropathological stage of the dis- sibility that another factor that was associated with the pre- ease. This demonstrates that the histologic involvement of the dictor that was not included in the model is also causally linked SCN is independent of the stereotyped progression of the Lewy to the outcome. For this reason, mediation models cannot dis- pathology stages, which is consistent with previous clinical cern “complete” from “partial” mediation effects. Kim et al con- studies showing that circadian dysfunction can be seen even clude “complete mediation” because the direct association was in patients with http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Neurology American Medical Association

On Mediation Models in Clinical Neurology Studies—Reply

JAMA Neurology , Volume 76 (1) – Jan 10, 2019

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Publisher
American Medical Association
Copyright
Copyright 2018 American Medical Association. All Rights Reserved.
ISSN
2168-6149
eISSN
2168-6157
DOI
10.1001/jamaneurol.2018.3887
Publisher site
See Article on Publisher Site

Abstract

Letters 4-6 ticulous protocols. Because of this, the true prevalence of about associations between variables beyond bivariate asso- circadian symptoms in PD remains unknown and, as no accu- ciations and to uncover potential mechanisms. As this tech- rate clinical information on circadian activity was available for nique becomes increasingly popular, 2 considerations are the patients in our study, we believe that any potential clini- important. copathological correlation is ambitious. First, it must be noted that many causal effects probably The severity of SCN Lewy pathology in our cases did not operate through more than one mechanism, so there is a pos- correlate with the global neuropathological stage of the dis- sibility that another factor that was associated with the pre- ease. This demonstrates that the histologic involvement of the dictor that was not included in the model is also causally linked SCN is independent of the stereotyped progression of the Lewy to the outcome. For this reason, mediation models cannot dis- pathology stages, which is consistent with previous clinical cern “complete” from “partial” mediation effects. Kim et al con- studies showing that circadian dysfunction can be seen even clude “complete mediation” because the direct association was in patients with

Journal

JAMA NeurologyAmerican Medical Association

Published: Jan 10, 2019

References