This study examines the intra-individual stability of cerebrospinal fluid (CSF) biomarkers for Alzheimer's disease (AD) over 2 years in 83 patients with mild cognitive impairment (MCI) and 17 cognitively healthy control individuals. All participants underwent clinical and neuropsychological evaluation and lumbar puncture at baseline and after 2 years at a university hospital memory clinic. CSF was analyzed for total tau (T-tau), phospho-tau181 (P-tau181) and amyloid-β1−42 (Aβ1−42). During the 2-year observational time, 12 MCI patients progressed to AD and 3 progressed to vascular dementia, while 68 remained stable. Baseline T-tau and P-tau181 levels were elevated in the MCI-AD group as compared to the stable MCI patients and the control group (p < 0.01), while baseline Aβ1−42 levels were lower (p < 0.001). Stable MCI patients were biochemically indistinguishable from controls. The biomarker levels at baseline and after 2 years showed Pearson R values between 0.81 and 0.91 (p < 0.001) and coefficients of variation of 7.2 to 8.7%. In conclusion, intra-individual biomarker levels are remarkably stable over 2 years. Thus, even minor biochemical changes induced by treatment against AD should be detectable using these biomarkers, which bodes well for their usefulness as surrogate markers for drug efficacy in clinical trials.

EXECUTIVE SUMMARY Background Hospital readmission in older persons is common and reported as a post-discharge adverse outcome from hospitalization. Readmission relates to a mix of factors associated with increasing age, living conditions, progression of disease as well as factors related to the processes of care. To allow health professionals to focus more intensively on patients at risk of readmission, there is a need to identify the characteristics of those patients. Objectives To identify and synthesize the best available evidence on risk factors for acute care hospital readmission within one month of discharge in older persons in Western countries. Inclusion criteria Types of participants Participants were older persons from Western countries, hospitalized and discharged home or to residential care facilities. Types of intervention(s)/phenomena of interest The factors of interest considered generic factors related to socio-demographics, health characteristics and clinical and organizational factors related to the care pathway. Types of studies The current review considered analytical and descriptive epidemiological study designs that evaluated risk factors for acute care hospital readmission. Outcomes The outcome was readmission to an acute care hospital within one month of discharge. Search strategy A three-step search was utilized to find published and unpublished studies in English, French, German, Norwegian, Swedish or Danish. Five electronic databases were searched from 2004 to 2013, followed by a manual search for additional studies. Methodological quality Methodological quality was assessed independently by two reviewers, using the standardized Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) critical appraisal tool. Data extraction Data were extracted verbatim using a data extraction form, which identified the components from the standardized JBI data extraction tool from JBI-MAStARI and was adapted to the needs of the present review. Data synthesis Due to the clinical and methodological heterogeneity of the studies included, a narrative summary and metasynthesis of the quantitative findings was conducted. Results Based on a review of nine studies from ten Western countries, we found several significant risk factors pertaining to readmission to an acute care hospital within one month of discharge in persons aged 65 years and over. Factors associated with higher risk of hospital readmission covered socio-demographics such as higher age, male gender, ethnicity, living conditions, health characteristics such as poor overall condition and functional disability as well as prior admissions. Organizational factors including length of hospital stay, method of referral and discharge destination were associated with increased risk of acute care hospital readmission. Conclusion We found several significant, but inconsistent, associations between readmission to an acute care hospital within one month of discharge in persons aged 65 years and over. These associations involved a mix of socio-demographic factors, factors related to health and illness, previous hospitalizations, length of stay as well as clinical and organizational determinants related to the index admission. Although more studies concluded that certain diagnoses or comorbid conditions affected the risk of readmission, they did not agree on any disease in particular. Due to the breadth and diversity of variables examined and the lack of comparability of findings, the impact of these varying factors and their value as risk adjusters and application in different settings and populations are limited.

Mild cognitive impairment (MCI) is regarded as the prodromal stage of dementia disorders, such as Alzheimer's disease (AD).Objective: To compare the neuropsychological profiles of MCI subjects with normal concentrations of total tau (T-t) and Ab42 in CSF (MCI-norm) to MCI subjects with deviating concentrations of the biomarkers (MCI-dev). MCI-norm (N 5 73) and MCI-dev (N 5 73) subjects were compared to normal controls (N 5 50) on tests of speed0attention, memory, visuospatial function, language and executive function.Results: MCI-norm performed overall better than MCI-dev, specifically on tests of speed and attention and episodic memory. When MCI-dev subjects were subclassified into those with only high T-tau (MCI-tau), only low Ab42 (MCI-Ab) and both high T-tau and low Ab42 (MCI-tauAb), MCI-tauAb tended to perform slightly worse. MCI-tau and MCI-Ab performed quite similarly.Conclusions: Considering the neuropsychological differences, many MCI-norm probably had more benign forms of MCI, or early non-AD forms of neurodegenerative disorders. Although most MCI-dev performed clearly worse than MCI-norm on the neuropsychological battery, some did not show any deficits when compared to age norms. A combination of CSF analyses and neuropsychology could be a step toward a more exact diagnosis of MCI as prodromal AD. (JINS, 2008, 14, 582-590.)

The Journal of International Advanced Otology (J Int Adv Otol) is an international, peer reviewed, open access publication that is fully sponsored and owned by the European Academy of Otology and Neurotology and the Politzer Society. The journal is published triannually in April, August, and December and its publication language is English.The scope of the Journal is limited with otology, neurotology, audiology (excluding linguistics) and skull base medicine.The Journal of International Advanced Otology aims to publish manuscripts at the highest clinical and scientific level. J Int Adv Otol publishes original articles in the form of clinical and basic research, review articles, short reports and a limited number of case reports. Controversial patient discussions, communications on emerging technology, and historical issues will also be considered for publication.Target audience of J Int Adv Otol includes physicians and academics who work in the fields of otology, neurotology, audiology and skull base medicine.

Researchers have put serious efforts into identifying youth at high risk of joining gangs. Their main focus has been on street gangs, whereas risk factors for joining adult gang criminal groups have received less attention. This study examines crime specialization and crime seriousness prior to gang initiation among 564 adult gang members, 800 outlaw bikers and matched comparison groups of offenders (up to three offenders convicted of the same number of offences) who stayed out of such gangs. The data stem from Statistics Denmark and the Police Intelligence Database. The study findings demonstrate that the gang members and the outlaw bikers commit more serious offences than their non-gang counterparts, but the study also provides evidence that it is difficult-most likely impossible-to identify upcoming members of gangs by paying attention to crime patterns only.