Objectives-To assess the 1 year prevalence of tension-type headache (TTH), migraine headache (MH), and chronic daily headache (CDH), as well as of headache in general in a rural elderly population. Methods

We designed a randomized, placebo-controlled, multicentre trial involving 51 relapsing-remitting multiple sclerosis patients to determine the clinical efficacy of mitoxantrone treatment over 2 years. Patients were allocated either to the mitoxantrone group (27 patients receiving I.V. infusion of mitoxantrone every month for 1 year at the dosage of 8 mg/m2) or to the placebo group (24 patients, receiving I.V. infusion of saline every month for 1 year) using a centralized randomization system. Disability at entry and at 12-24 months was evaluated by four blinded neurologists trained in the application of the Kurtzke Expanded Disability Scale (EDSS). In addition, the number and clinical characteristics of the exacerbations over the 24 months were recorded by the local investigators. MRI, at 0, 12 and 24 months, was performed with a 0.2 T permanent unit. MRI data were analysed by two blinded neuroradiologists. All patients underwent a clinical evaluation. A statistically significant difference in the mean number of exacerbations was observed between the mitoxantrone group and placebo group both during the 1st and the 2nd year. Although there was no statistically significant benefit in terms of mean EDSS progression over 2 years, the proportion of patients with confirmed progression of the disease, as measured by a one point increase on the EDSS scale, was significantly reduced at the 2nd year evaluation in the mitoxantrone group. Forty-two (23 mitoxantrone, 19 placebo) patients underwent all MRI examinations during the 24-month period. We observed a trend towards a reduction in the number of new lesions on T2-weighted images in the mitoxantrone group. Our study suggests that mitoxantrone might be effective in reducing disease activity, both by decreasing the mean number of exacerbations and by slowing the clinical progression sustained by most patients after 1 year from the end of treatment.

Objectives-To estimate the prevalence of dementia in an elderly rural population and to determine the effects of age, sex, and education. Methods-To obtain prevalence estimates of both cognitive impairment and dementia a door to door two phase population survey was carried out in three rural villages in central Italy. Of 1147 inhabitants older than 64, 968 (84-4%) completed the protocol. Results-The prevalence rates (cases per 100 population over 64) were 8-0 for dementia and 27-3 for cognitive impairment. The prevalence rate for dementia did not differ between men and women (7.9 v 8-2), but increased with age (from 1*1 at age 65-69 to 34-8 at age 90-96). Subjects with less than three years of schooling had a significantly higher prevalence of dementia (14-6; 95% confidence interval (95% CI) 10.2-19.1) than subjects with three or more years of schooling (5.9; 95% CI 4.2-7.7). At the multivariate logistic analysis, the risk related with a low level of education was still present after adjustment for age and sex (OR = 2-0; 95% CI 1.2-3.3).Alzheimer's disease was diagnosed in 64% of the 78 demented patients, vascular dementia in 27%, and other dementing diseases in 9%. Conclusions-In both Alzheimer and vascular dementia subtypes, the prevalence rates did not differ between men and women, but increased with age and were higher in subjects with a low level of education. (7 Neurol Neurosurg Psychiatry 1996;60:628-633) Keywords: dementia; education; rural populationThe progressive aging of the population is associated with a steady increase in all age related diseases. Among these, dementing disorders cause great concern because of their peculiar disabling effects. Despite the interest in this condition, prevalence estimates show pronounced variations due to differences in case ascertainment procedures, diagnostic criteria, age distribution, and the rural or urban location of the populations studied.'8 Furthermore, education and occupation may influence the cognitive performance and increase the risk of dementia.9-'3The present study analyses baseline data obtained in a door to door prospective population survey on cognitive impairment and functional disability of people older than 64 (AQUILA study). Here we report the effects of age, gender, and education on the prevalence of dementia. MethodsWe selected three rural villages (Poggio Picenze, Scoppito, Tornimparte) near the town of L'Aquila (central Italy) because of their population size (a total of 1147 people over 64), population stability (only 0-2% of people over 59 had moved elsewhere in the five years preceding the prevalence day), and the active collaboration offered by family doctors.The study was conducted on all persons over 64 residing in the selected villages on the prevalence day (1 March 1992). The ascertainment of cases was made between March 1992 and February 1993 by means of a door to door two phase design. Four lay interviewers (MLB, MC, CG, and GM) and four doctors (ARC, CF, MTL, and PC) conducted the first (screening interview) and the s...

Background and Purpose: The etiology of stroke in the young is different from that in older patients and remains unknown in almost one third of the cases. To gain further insight into both pathogenic and etiologic determinants, we prospectively studied a large number of consecutive young adults with focal cerebral ischemia.

No abstract