Follow-up observations were made of 92 white patients with early-onset Alzheimer's disease to determine the demographic, clinical, and neuropsychological factors predictive of institutionalization or death. The cumulative mortality rate 5 years after entry into the study was 23.9%, compared with an expected rate of 9.5%. The 5-year cumulative rate of admission to nursing homes was 62.8%. The language ability of the patients on entry to the study, their scores on a brief screening test of cognitive function, and their overall ratings of clinical dementia were found to be predictors of subsequent institutional care and death. The age of the patients had a significant modifying effect on these predictive factors, resulting in a greater risk of institutionalization and death in younger patients with severe cognitive impairment as compared with older individuals with the same degree of dysfunction.
A prospective study was made of the morbidity and mortality from ischemic heart disease in 390 patients with focal TIA caused by atherosclerotic vascular disease. The 5-year cumulative rate of myocardial infarction or sudden death in these patients was 21.0%, a rate only slightly less than that of fatal or nonfatal cerebral infarction (22.7%). Risk factors including diabetes, angina, and ECG abnormalities were associated with an increase in morbidity and mortality from ischemic heart disease. A major factor associated with these cardiac events was the presence of atherosclerotic obstructive or ulcerative lesions in the carotid arteries. These observations indicate that focal TIA caused by carotid atherosclerosis is a predictor not only of cerebral infarction, but also of serious cardiac disease and death.
There are standardized criteria to assist in the diagnosis of Alzheimer's disease (AD), a disorder that lacks unique clinical, morphologic, or biochemical features. Diagnostic reliability of single groups of investigators using these criteria is moderate to substantial. In this study, seven clinicians at separate sites established a criteria-based diagnosis in 42 consecutive memory disorder patients participating in a national genetic epidemiologic study using a quantitative multiaxis AD rating scale (ADRS) that incorporates NINCDS/ADRDA criteria, reliability of information, and comorbidity. Reliability, measured by a generalized kappa statistic for more than two raters, was substantial (0.63 +/- 0.13) when the subjects were grouped as "AD" (probable or possible) versus "not AD," but somewhat lower (0.52 +/- 0.10) when subjects were classified as probable AD, possible AD, or not AD. There was unanimous agreement for two-thirds of the subjects using a dichotomous classification scheme. These findings suggest that the ADRS is a useful diagnostic instrument for multicenter studies.
During the past seven years 347 patients have been entered into a data bank at the Duke University Medical Center for evaluation of transient neurologic ischemia. One hundred fifty eight of these patients had carotid endarterectomies of whom 24 (15.1%) developed 26 (16.4%) peripheral cranial nerve palsies. Injury to the peripheral portion of the hypoglossal nerve was noted in 13 patients, to the cervical branch of the facial nerve in five and to the recurrent laryngeal nerve branch of the vagus in eight. Complete recovery of nerve function usually occurred within four months but residual deficit was present at one year in two patients with facial nerve and four with hypoglossal nerve involvement. Even though these complications of carotid endarterectomy are generally benign and transient, the frequency of occurrence can be reduced if careful attention is given to anatomic localization of the cranial nerves during surgery.
A computerized information system has been developed for storing and retrieving the clinical, demographic and laboratory data on 267 patients with transient cerebral ischemia admitted to Duke University Hospital during the past 4 years. The major objective of this computer system is to improve patient care by providing the clinician with immediate information for decision-making and prognostication, based on experience with prior patients with cerebral ischemia similar to those under the clinician's care. The data bank also provides a resource for clinical investigation for transient cerebral ischemia, and represents a repository of detailed information not available in the usual printed sources of medical instruction.
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