We examined the interrater (IRR) of clinical ratings of neuropsychological (NP) impairment and neurocognitive diagnoses in HIV. Thirty participants with advanced HIV-infection who were enrolled in a multicenter HIV brain banking research project underwent comprehensive NP and neuromedical evaluations. Using a standardized system of guidelines, neuropsychologists from six participating sites independently assigned clinical ratings of NP impairment, as well as multilevel diagnoses reflecting the inferred etiology of the impairments and their effects on everyday functioning. Findings indicated excellent IRR in rating the presence and severity of NP impairment, but overall modest IRR for neurocognitive diagnoses. Not surprisingly, most diagnostic disagreements concerned the etiology of impairments in persons with medical and neuropsychiatric risk factors in addition to HIV.

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Objective-To determine whether older persons are at increased risk for progressive functional decline after traumatic brain injury (TBI). Design-Longitudinal cohort study. Setting-Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers.Participants-Subjects enrolled in the TBIMS national dataset. Interventions-Not applicable.Main Outcome Measures-Disability Rating Scale (DRS), FIM instrument cognitive items, and the Glasgow Outcome Scale-Extended.Results-Participants were separated into 3 age tertiles: youngest (16-26y), intermediate (27-39y), and oldest (≥40y). DRS scores were comparable across age groups at admission to a rehabilitation center. The oldest group was slightly more disabled at discharge from rehabilitation despite having less severe acute injury severity than the younger groups. While DRS scores for the 2 younger groups improved significantly from year 1 to year 5, the greatest magnitude of improvement in disability was seen among the youngest group. Additionally, after dividing patients into groups according to whether their DRS scores improved (13%), declined (10%), or remained stable (77%) over time, the likelihood of decline was found to be greater for the 2 older groups than for the youngest group. A multiple regression model demonstrated that age has a significant negative influence on DRS score 5 years post-TBI after accounting for the effects of covariates.Conclusions-This study supported our primary hypothesis that older patients show greater decline over the first 5 years after TBI than younger patients. Additionally, the greatest amount of improvement in disability was observed among the youngest group of survivors. These results suggest TBI survivors, especially older patients, may be candidates for neuroprotective therapies after TBI.Reprint requests to Ramon Diaz-Arrastia, MD, PhD, 5323 Harry Hines Blvd, Dallas, TX 75390-9036, e-mail: ramon.diazarrastia@utsouthwestern.edu. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. The resulting injuries range from mild disability to longterm disabilities or death. 3 It has been observed that particular subpopulations recover differently from similar injuries. One characteristic felt to have an impact on the degree of recovery is age: in general, the older the patient the worse the outcome. 7-12 Issues of TBI and aging are important to study because of the large and growing number of older people who are affected by TBI, which has a bimodal age distribution peaking in late adolescence/early adulthood and again after age 70. 3 NIH Public AccessTBI may interact negatively with aging in at least 2 ways: (1) recovery after TBI is more limited for older than younger survivors; and (2) older individuals who have suffered a TBI are at higher risk for progressive cognitive decline. First, advanced age at the time of injury may result in less complete recovery comp...

Levodopa therapy, rather than PD, is a cause of hyperhomocysteinemia in patients with PD. Deficiency of folate or vitamin B(12) levels does not explain the elevated homocysteine levels in these patients. To our knowledge, this is the first report that levodopa-related hyperhomocysteinemia is associated with increased risk for CAD. These findings have implications for the treatment of PD in patients at risk for vascular disease, and potentially for those at risk for dementia and depression.

Mesial temporal lobe epilepsy can result from TBI in adolescents and adults as well as in children, and can often be bilateral and associated with multifocal injury. This information may be useful in developing prophylactic therapy for posttraumatic epilepsy.