Ascertainment bias in dementias: a secondary to tertiary centre analysis in Central Italy and conceptual review.

BACKGROUND AND AIMS: Ascertainment bias (AB) indicates a bias of an evaluation centre in estimating the prevalence/incidence of a disease due to the specific expertise of the centre. The aim of our study was to evaluate classification of different types of dementia in new cases appearing in secondary and tertiary centres, in order to evidence possible occurrence of AB in the various (secondary to tertiary) dementia centres. METHODS: To assess the mechanism of AB, the rates of new cases of the different forms of dementia reported by different centres were compared. The centres involved in the study were 11 hospital-based centres including a tertiary centre, located in the University Department of Clinical Neurology. The tertiary centre is endowed with state-of-the-art diagnostic facilities and its scientific production is prominently focused on dementia with Lewy bodies (DLB) thus suggesting the possible occurrence of a bias. Four main categories of dementia were identified: Alzheimer's disease (AD), DLB, fronto-temporal dementia (FTD), vascular dementia (VaD), with other forms in a category apart. The classification rate of new cases of dementia in the tertiary centre was compared with rates reported by secondary centres and rates of recoding were calculated during a follow-up of 2 years. RESULTS: The study classified 2,042 newly diagnosed cases of dementia in a population of 1,370,000 inhabitants of which 315,000 were older than 65. AD was categorized in 48-52 % of cases, DLB in 25-28 %, FTD in 2-4 % and VaD in 17-28 %. During the 2-year follow-up the diagnosis was re-classified in 40 patients (3 %). The rate of recoding was 5 % in the tertiary centre, 2-8 % in referrals from secondary to tertiary centre, 2-10 % in recodings performed in secondary centres and addressed to tertiary centre. Recoding or percentages of new cases of AD or DLB were not different in the comparison between secondary or between secondary and tertiary centres. FTD and VaD were instead significantly recoded. CONCLUSION: The results of the study suggest that in a homogeneous area, AB is not interfering with diagnosis of AD or DLB.

[Westphal-Strumpell disease. Description of a clinical case]. / La malattia di Westphal Strumpell. Descrizione di un caso clinico.

A case of hepatolenticular degeneration with the clinical pattern of Westphal-Strumpell disease is described. Diagnosis was based on clinical pattern, absence of hepatic impairment, typical biochemical abnormalities of copper metabolism and response (clinical and biochemical) to D-penicillamine.

[Subacute cerebellar degeneration in cystadenopapillary carcinoma of the ovaries]. / Degenerazione cerebellare subacuta in corso di carcinoma cistoadenopapillifero delle ovaie.

A subacute cerebellar degeneration-like paraneoplastic syndrome is reported in a woman with cystoadenopapillar carcinoma involving both ovaries. This syndrome, characterized by remarkable cerebellar ataxia, is an exceptional disorder which pathogenesis is still unknown although there is a hypothesis of a viral infection and autoimmunitary unchaining.

[Lymphotropic retrovirus in multiple sclerosis]. / Retrovirus linfotropi nella sclerosi multipla.

Several viruses have been considered in the etiology of Multiple Sclerosis (MS), but definitive proof have not been given so far. Recently, Gallo and Koprowski (1985) pointed out the retroviruses. In our study serum anti-HTLV I and anti-HTLV III antibodies were determined in 31 MS patients. Anti-HTLV I antibodies were found in the serum of only three MS patients (9.6%); none of the patients had anti-HTLV III antibodies.

[The prognosis of multiple sclerosis: a contribution]. / Prognosi della sclerosi multipla: un contributo.

A number of clinical characteristics of multiple sclerosis that may influence prognosis quo ad valetudinem are considered; onset with optic neuritis and frequency of recurrence less than 0.5/annum in the first three years of disease seem to be associated with a slower degree of deterioration (measured by the progression index). The age of onset, sex and type of disease would not appear to influence the prognosis.

[Lymphocyte subpopulations in multiple sclerosis (MS). A contribution]. / Le sottopopolazioni linfocitarie nella sclerosi multipla (SM). Un contributo.

The characterization of peripheral blood T-cell subpopulations in 29 multiple sclerosis (MS) patients is studied. A direct immunofluorescence assay was performed using monoclonal antibodies (OK series) directed to lymphocytes surface antigens. In transverse study, the patients suffering from progressive MS showed T4+ lymphocytes and T4+/T8+ ratio significantly high (p less than 0.05) compared to controls; furthermore T8+ lymphocyte values were low. T3+ lymphocytes were low (p less than 0.05) during the relapse in the MS remitting relapsing patients. A six month follow-up of the patients showed, during relapse, a reduction and, immediately after, a recovery of T3+ and T4+ lymphocyte values; T8+ lymphocytes didn't show remarkable fluctuations.

[Diagnosis of thyroid nodules]. / Sulla diagnostica del nodulo tiroideo.

The basic features of the most common endocrine pathology, the thyroid nodule are analysed. After a brief assessment of the incidence of the condition the problem of clinical and instrumental diagnosis is tackled with the aim of demonstrating the value and possibility of sub-clinical diagnosis of micronodules. The present work aims to identify the fastest, most efficient and cheapest diagnostic procedure.

Effects of fluoxetine on aggressive behavior of adult inpatients with mental retardation and epilepsy.

Nineteen mentally retarded inpatients with epilepsy and a history of current or recent aggressive behavior were treated with 20 mg of fluoxetine daily. All were concurrently taking other psychotropic medications, including carbamazepine and neuroleptics. A standardized rating scale (MOAS) was used to assess the effects of fluoxetine on aggressive behavior. There were wide individual differences in drug response. In nine patients, fluoxetine treatment was associated with increased aggression, while drug withdrawal led to a decrease to below pretreatment levels. Two hypotheses concerning the apparent association between fluoxetine and increased aggression are discussed: 1) adverse effects secondary to either drug interaction or fluoxetine overmedication; and 2) a specific serotonergically mediated effect on the regulation of aggression. This study suggests that the clinician who treats mentally retarded patients with impulsive aggressive behavior should remain aware that fluoxetine may have diverse effects on aggression that vary over time and interindividually.