Several factors have been reported to predict death and institutionalization in demented patients, even if the results of the studies are often conflicting. We conducted a study on a group of 86 consecutive noninstitutionalized probable Alzheimer disease (AD) patients, to evaluate clinical and social factors predicting mortality and institutionalization 1 year after discharge from the Alzheimer Dementia Unit at ''Sacro Cuore Fatebenefratelli’ Hospital, Brescia, Italy. The 1-year mortality rate was 13.9% and the 1-year rate of admission to a nursing home was 34%. Our data indicate that the number of lost functions on the Activity of Daily Living scale is the most important predictor of short-term mortality, independently of the degree of cognitive impairment, the duration of the dementia, the age of the patients and the number of chronic diseases. Our data also demonstrate that, in a short period of observation, behavioral disturbances (and in particular insomnia) and availability of social Services play a major role in the decision to institutionalize AD patients.

We found that focal lesions in the frontal areas were the only variable that appeared to be significantly and independently associated with delusional disorders.

We evaluated the presence and type of vascular lesions with computerized tomography (CT) in 94 cognitively impaired elderly patients who had been defined as degenerative (Alzheimer’s disease, AD) or vascular (multi-infarct dementia, MID) dementia patients on the basis of clinical data. Twenty-six percent of the 77 AD, but only 59% of the 17 MID patients had vascular lesions. The most represented vascular lesions were leukoaraiosis in AD and hemispherical cortical lesions in MID patients. Age, signs indicative of, and risk factors for vascular disease were associated with vascular lesions on CT. We conclude that CT scan is a necessary complement to historical and clinical data in the detection of vascularity in demented patients.

The surgical treatment of syringomyelia is still debatable and the result are often poor. Several surgical procedures, based on various proposed etiopathologies, have been developed but in many cases have proved completely ineffective. We have evaluated the follow-up of 69 syringomyelic patients, some operated on, some not, in the search for clues to the management of the disease. For this purpose we devised a rating system, which we describe. 31 patients underwent surgery while 38 received no treatment. We found that half of the patients deteriorated, whether they were operated on or not; only 1 in 5 improved and the rest remained stable. For surgical treatment to be successful, the disease must be in rapid evolution but without definite paraparesis.

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