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Quantification of cardiac chamber size, ventricular mass and function ranks among the most clinically important and most frequently requested tasks of echocardiography. Over the last decades, echocardiographic methods and techniques have improved and expanded dramatically, due to the introduction of higher frequency transducers, harmonic imaging, fully digital machines, left-sided contrast agents, and other technological advancements. Furthermore, echocardiography due to its portability and versatility is now used in emergency rooms, operating rooms, and intensive care units. Standardization of measurements in echocardiography has been inconsistent and less successful, compared to other imaging techniques and consequently, echocardiographic measurements are sometimes perceived as less reliable. Therefore, the American Society of Echocardiography, working together with the European Association of Echocardiography, a branch of the European Society of Cardiology, has critically reviewed the literature and updated the recommendations for quantifying cardiac chambers using echocardiography. This document reviews the technical aspects on how to perform quantitative chamber measurements of morphology and function, which is a component of every complete echocardiographic examination.

Background-We evaluated the amounts of amyloid-beta (Aβ) peptides in the central nervous system (CNS) and in reservoirs outside the CNS and their potential impact on Aβ plasma levels and Alzheimer's disease (AD) pathology.

Objectives-We conducted a quantitative investigation of brain arterial atherosclerotic damage and its relationship to sporadic Alzheimer's disease (AD). Methods and Results-Fifty-four consecutive autopsy cases, 32 AD and 22 nondemented control subjects, were examined to establish the degree of arterial stenosis. Vessel external and lumenal area measurements were taken from 3-mm arterial cross-sections to calculate a stenosis index. AD patient circle of Willis arteries possessed a significant degree of stenosis as a consequence of multiple and severe atherosclerotic lesions. These lesions were significantly more severe in AD cases than in age-matched controls (PϽ0.0001), and the number of stenoses and the index of occlusion (Rϭ0.67; PϽ0.00001) were positively correlated. In addition, the index of stenosis significantly correlated with the following measures of AD neuropathological lesions: total plaque score, neuritic plaque score, neurofibrillary tangle score, Braak stage score, and white matter rarefaction score. Conclusions-Our study reveals an association between severe circle of Willis atherosclerosis and sporadic AD that should be considered a risk factor for this dementia. 38 and AD subjects exhibit positive correlations between brain A␤ n-42 levels and total serum cholesterol, LDL cholesterol, and apolipoprotein (Apo) B-100 and a negative correlation with HDL cholesterol levels. 38 Elevated total and LDL cholesterol have been reported in very old patients with AD. 39 Likewise, in a meta-analysis study, patients with probable or possible early-stage AD were found to possess elevated total cholesterol values compared with a ND population. 40 In addition to the wellestablished association between vascular disease risk factors and sporadic AD, the present study provides, for the first time, a rigorous and significant neuropathological association between circle of Willis atherosclerosis and sporadic AD. See page 1951 and cover MethodsSubjects were voluntary participants in the Brain Donation Program at Sun Health Research Institute (Sun City, Ariz). Rapid autopsies (2.5-hour average postmortem delay) were performed to remove and preserve the brain. All individuals examined were Caucasian. The degree and extent of arterial stenosis was quantified in 54 consecutive autopsy cases, in which neuropathologic examination indicated presence of either AD or normal aging changes only; the latter cases were considered ND controls if the neuropsychologic profile was within normal age limits.The sample subjected to computer-based quantitative analysis contained 22 ND control cases, consisting of 14 women and 8 men with mean ages of 87.1 and 82.6 years, respectively, and 32 AD cases, 18 women and 14 men with mean ages of 84.4 and 86.4 years, respectively. History of cardiovascular disease, in particular the presence or absence of hypertension, myocardial infarction, coronary artery disease, valvular heart disease, disorders of rhythm and conduction, cardiomyopathy, cardiorespiratory failure, and peripher-

Quantified lesion scores derived from MRI correlate significantly with neuropsychological testing in patients with multiple sclerosis (MS). Variables used to reflect disease severity include total lesion area (TLA), ventricular-brain ratio, and size of the corpus callosum. We used these general measures of cerebral lesion involvement as well as specific ratings of lesion involvement by frontal, temporal, and parieto-occipital regions to quantify the topographic distribution of lesions and consequent effects upon cognitive function. Lesions were heavily distributed in the parieto-occipital regions bilaterally. Neuropsychological tests were highly related to all generalized measures of cerebral involvement, with TLA being the best predictor of neuropsychological deficit. Mean TLA for the cognitively impaired group was 28.30 cm2 versus 7.41 cm2 for the cognitively intact group (p less than 0.0001). Multiple regression analyses revealed that left frontal lobe involvement best predicted impaired abstract problem solving, memory, and word fluency. Left parieto-occipital lesion involvement best predicted deficits in verbal learning and complex visual-integrative skills. Analysis of regional cerebral lesion load may assist in understanding the particular pattern and course of cognitive deficits in MS.

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Fifty‐six patients diagnosed with definite multiple sclerosis (MS) according to Poser criteria were administered the Mini‐Mental State Examination (MMSE) and a comprehensive battery of neuropsychological tests. Extent of cerebral lesion involvement was determined by quantitative magnetic resonance imaging (MRI) ratings. The MMSE correlated with overall levels of physical disability, but did not correlate with total lesion area on MRI. Sensitivity of the MMSE to the sub cortical dementia of MS was low (28%) when performance on the neuropsychological testing battery was used as the criterion. Impairment on tests of memory, speed of information processing, abstract reasoning, naming/verbal fluency, as well as visuoperceptual organization, were correlated highly with total lesion area on MRI. The low sensitivity of the MMSE to cognitive impairment in MS is discussed in terms of its item composition and the characteristic pattern of deficits found in MS.

The ability of three different Clock Drawing Test (CDT) scoring systems to detect Dementia of the Alzheimer Type (DAT) was investigated. As part of a neuropsychological battery, fifty DAT Type patients and fifty matched controls drew a clock. Each drawing was scored by three independent raters according to three different scoring systems: the 3-Factor system, the Template system, and the Abbreviated system. The CDT scoring systems were able to detect Dementia of the Alzheimer Type when the disease was moderate to severe, but lacked sensitivity in milder dementia. Animal Fluency was a better single predictor of dementia. Clinicians are advised to interpret the results of the Clock Drawing Test cautiously in an outpatient setting, where milder forms of dementia and low base rates are likely.