Delirium episodes during the course of clinically diagnosed Alzheimer's disease.

A retrospective review was conducted of 122 charts of patients with clinically diagnosed Alzheimer's disease (CDAD) who had participated in a longitudinal dementia study at the Mayo Clinic from 1965 to 1970. DSM-III-R diagnoses were assigned based on the longitudinal description of symptoms detailed in the Mayo Clinic medical records of the hospitalizations; clinic, home, and nursing home visits; and state hospital admissions. Thirty patients (25%) were found to have a delirium episode during their course of CDAD that occurred during inpatient admissions; 50% (15 of 30) of the delirium episode occurred in patients ages 80 to 89. Among patients with a delirium episode, 50% died within one year of the delirium episode and 64% died within two years. Of 13 patients, 10 (77%) had multiple delirium episodes within two years. Admitting diagnoses were mainly primary degenerative dementia of the Alzheimer's type (PDDAT) or PDDAT with delirium. Only 3 (10%) demented patients experienced delirium episodes during a medical admission. No deaths occurred during hospitalization for the years covered by this study. A psychiatric consultation was requested in only 17 (14%) patients; 88% of these patients received diagnoses involving PDDAT, late onset. An additional diagnosis included depressive disorders. Psychopharmacology was the major management strategy (82% of patients with a delirium episode received medication) with a resolution of symptoms within 48 hours. At discharge, only 2 (7%) patients failed to clear the increased degree of confusion.

Cross-cultural cognitive examination: validation of a dementia screening instrument for neuroepidemiological research.

OBJECTIVE: Validation of a new instrument for screening dementia, the Cross Cultural Cognitive Examination (CCCE), is described. DESIGN: Criterion and concurrent validation and cross-cultural comparison of a new instrument. PARTICIPANTS: All individuals over the age of 40 in a village in southern Guam participated in a door-to-door survey. Alzheimer's and Parkinson's Disease patients and healthy controls aged 40-90 participated in the US mainland study. MEASUREMENTS: The CCCE was administered to all subjects. Effects of age, language, education, and gender on test performances and social-cultural differences were assessed. Concurrent validation of the test with respect to other well accepted screening instruments was determined. RESULTS: High specificity (> 94%) and sensitivity (> 99%) for detecting dementia were found in Guam and US mainland samples, and these were not biased by differences in gender, linguistic preference, education, or cultural background. Sensitivity and specificity of the CCCE matched or exceeded that of already accepted dementia screening instruments. CONCLUSIONS: These validation studies support the usefulness of the CCCE for identifying patients with generalized dementia, rather than focal types of cognitive impairment, quickly and reliably in cross-cultural neuroepidemiological research.

Prevalencia de enfermedad cerebrovascular en Santiago - Chile / Prevalence of cerebrovascular disease in Santiago - Chile

Por encargo de la Organización Mundial de la Salud y como parte de una investigación multinacional de países en desarrollo, se realizó una investigación en Santiago de Chile siguiendo las pautas de definición de la OMS para el Accidente Vascular Establecido (AVE) y la Crisis Isquémica Transitoria (CIT). La tasa de prevalencia para AVE fue 5,99% y 2,58% para CIT. El AVE isquémico se observó después de los 50 años, siendo su tasa más alta en mujeres: 5,2 comparado con el hombre: 2,4, mientras que la hemorragia fue 128% más alta en el sexo masculino. Estos hallazgos reflejan la alta prevalencia de CIT en la mujer: 370%, sugiriendo distintos factores de riesgo sexo dependientes, lo que sería significante en programas de prevención para las mencionadas afecciones

Prevalence of headache and migrainous headache in Nigerian Africans: a community-based study.

In a door-to-door survey in a Nigerian town with stable population of about twenty thousand, 18,594 subjects were screened with a questionnaire, which involved a complete census, administered by non-doctor, including primary health care personnel. Migrainous headache was diagnosed on the basis of combination of responses to the questionnaire shown in a pilot study validated by neurological examination to have 92% sensitivity and 99% specificity. Crude life time prevalence ratio of at least one episode of headache unspecified was 51 percent (50% in males and 52% in females). The crude prevalence ratio of migrainous headache was 5.3 per 100 (5 per 100 in males and 5.6 per 100 in females), with peak age-specific prevalence ratios in the first decade in both males and females. Migrainous headache was three times as common in females as in males in the second and third decades. Prevalence of migrainous headache in Nigerian Africans appears less than in Caucasians. No social status was at special risk to developing migrainous headache.

Clinical risk factors for Alzheimer's disease: a population-based case-control study.

Using information on clinical risk factors provided through the medical record linkage system of the Rochester Epidemiology Project, we conducted a population-based case-control study of Alzheimer's disease (AD). During the period 1960 to 1974, we identified 415 newly diagnosed cases of AD among residents of Rochester, Minnesota, and matched one community control to each case based on age, sex, and duration of community medical record. We estimated odds ratios using conditional logistic regression for several potential clinical risk factors of AD. Among more than 20 clinical risk factors that were evaluated, the only statistically significant findings were for episodic depression, personality disorder, and hypertension.

Risk factors for febrile seizures in the People's Republic of China: a case control study.

A case control study was conducted to investigate the association of family history of febrile seizures (FS) and history of maternal, pregnancy and delivery, and postnatal factors with FS. Information was gathered by door-to-door survey in six major cities in the People's Republic of China. Factors present before the date of onset of FS were assessed in 182 subjects and in an equal number of controls matched for age, sex, and geographic area. The odds ratio for risk of FS in children with a family history of FS in a first-degree relative was 10.0 (confidence interval 2.7-58.6), confirming other observations that familial factors are an important predisposing characteristic for FS. Maternal acute respiratory infection during the first trimester of pregnancy was slightly more frequent in children with FS (odds ratio, 1.9 confidence interval 1.0-3.9). None of the other examined pregnancy or delivery factors was associated with an increased risk, suggesting that birth history is not an important factor predisposing to FS.

Psychiatric symptoms in cases of clinically diagnosed Alzheimer's disease.

All incident cases of clinically diagnosed Alzheimer's disease were identified through the unique record linkage system of the Mayo Clinic. Thirty-nine (32%) of the sample of 122 had a psychiatric history that preceded the onset of CDAD by at least 3 years. Twenty-five percent of the study population had had an episode of delirium within 2 years of the onset of CDAD. Eighty-four percent of the cases had psychiatric symptoms in the course of CDAD that were documented in their medical records. Specific symptom patterns included agitation, combativeness, confusion and disorientation, depression, psychosis, and wandering. These symptoms occurred more frequently in clusters than singularly.

Prevalence survey of headache in a rural Mexican village.

Prevalence of headache was studied by house-to-house survey of a small remote Mexican village where the population was characterized by a low income and high rate of illiteracy. Severe headache was found in 8.9% of the male population and in 10.6% of the females. Approximately half of these individuals gave a history suggestive of headache with aura, but reinterview by a neurologist revealed that in one third of such histories the visual phenomena were probably not true aurae. Only in the over 35-year age-group was headache more prevalent in females. 'Incapacitating' headache was usually equated with 'severe' headache and was 10 times as frequent in the over 55-year age-group as in younger people. Sophisticated interviewers (neurologists) obtained different results from less trained interviewers.

Relatives' recall of a psychiatric interview.

One hundred seventeen patients from the Burke Rehabilitation Center (White Plains, NY) with clinically diagnosed dementia of the Alzheimer type (DAT) were identified for a case-control study (CCS) designed to assess risk factors for DAT. A psychiatric evaluation was part of the Burke dementia workup. The study sample was composed of 96 relatives who (a) were present with the patient at the psychiatric evaluation and (b) were interviewed for the CCS. The data for this study were the relatives' responses to the question "Did your relative (patient with DAT) ever see a psychiatrist?" The recall of relatives, regardless of relationship category (spouse, adult children, and others) did not exceed the 50% recall predicted by chance. When the age of the relative and length of time between the two interviews were considered, they did not modify these results.

Positron emission tomographic scanning demonstrates a presynaptic dopaminergic lesion in Lytico-Bodig. The amyotrophic lateral sclerosis-parkinsonism-dementia complex of Guam.

We performed positron emission tomography using 18F-6-fluorodopa on four Guamanians with an amyotrophic lateral sclerosis syndrome, eight Guamanians with parkinsonism, and seven clinically normal Guamanians; the results were compared with those of nine Vancouver control subjects. The Guamanian subjects had all been exposed to similar Chamorro lifestyles. The scans were analyzed using a graphic method that calculates a constant for whole striatal 18F-6-fluorodopa uptake. The parkinsonian subjects all had significantly reduced striatal 18F-6-fluorodopa uptake. The group with amyotrophic lateral sclerosis had significantly reduced uptake that was intermediate between that of the control group and the parkinsonian group. Two Guamanian normal subjects had reduced striatal 18F-6-fluorodopa uptake. The nigrostriatal dopaminergic lesion in Guamanian parkinsonism is similar to that found in idiopathic parkinsonism. The nigrostriatal lesions in the subjects with amyotrophic lateral sclerosis and the Guamanian normal subjects are examples of subclinical neuronal damage demonstrable in living subjects with positron emission tomography.

Comparison of case ascertainment by medical record linkage and cohort follow-up to determine incidence rates for transient ischemic attacks and stroke.

During the period 1960-1972, the medical record linkage index method provided an estimated average annual age- and sex-adjusted rate for first transient ischemic attack (TIA) of 134 per 100,000 population for those age 50 years and older. The cohort method estimate was 237 per 100,000 population (95% confidence limits (CL), 165-310). The discrepancy was due to 18 cases of TIA noted at the time of patient visits in the cohort analysis that were not identified from the medical record analysis. The cohort analysis for all strokes at age 50 years and older was not significantly different from the medical record linkage analysis. Although the cohort follow-up method provided better case ascertainment in this study, current indexing procedures provide case ascertainment equal to that of the cohort method and at less cost. No trend was found to suggest that incidence rates for TIA were decreasing in the period 1955-1979, in contrast to stroke in Rochester, Minn.

Pilot study of the prevalence of major neurologic disorders in a rural population of India.

A study of the prevalence of major neurologic diseases will be carried out in a rural population near Ballabgarh. India, using the World Health Organization protocol for epidemiologic studies of neurologic disorders and other internationally standardized survey techniques, screening procedures, and diagnostic criteria. Before applying any protocol developed in one population to another population, it must be intensively tested. Here, we describe the adaptation of the WHO protocol to the local conditions in rural Ballabgarh, and the findings of the pilot study conducted to test the protocol.

Head trauma with loss of consciousness as a risk factor for Alzheimer's disease.

We identified all incident cases of clinically diagnosed Alzheimer's disease among the population of Rochester, MN, with onset from 1965 through 1974. A control (selected from the same community) was matched to each case by age, race, sex, and length of stay in Rochester. We studied 274 case-control pairs. Using the records linkage system available for residents of this community, we abstracted information on the occurrence of head trauma with loss of consciousness (LOC) from the medical records of both cases and controls. There were 5 pairs in which the case suffered an episode of head trauma with LOC but the control did not, and 4 pairs in which the control suffered an episode of head trauma with LOC but the case did not. We failed to detect a statistically significant difference between the 2 groups. This study overcomes many problems encountered in previous case-control studies reporting this association. The sample size was large; severity of head injury was documented in high-quality medical records; data about head injury were recorded before the onset of dementia: equal quality of data were available for cases and controls; and, since the study was population-based, there was no selection bias for cases or controls.

Environmental factors and Parkinson's disease: a case-control study in China.

We studied the role of environment in the development of Parkinson's disease (PD) in China, where industrialization is relatively recent and the population geographically stable. Using a case-control method, we investigated the relationship between PD and exposure to the following factors before disease onset: place of residence, source of drinking water, environmental and occupational exposure to various agricultural and industrial processes. Occupational or residential exposure to industrial chemicals, printing plants, or quarries was associated with an increased risk of developing PD. In contrast, living in villages and exposure to the common accompaniments of village life, wheat growing and pig raising, were associated with a decreased risk for PD. PD cases and controls did not differ with respect to other factors investigated. These findings are consistent with the hypothesis that environmental exposure to certain industrial chemicals may be related to the development of PD.

Prevalence of neurological diseases in Madrid, Spain.

A pilot study to demonstrate the feasibility of measuring prevalence and prevalence ratios of major neurological disorders was successfully carried out in an urban area of Madrid, Spain, in a population of 961 subjects. The most frequent disorders identified were migraine, epilepsy and peripheral neuropathy.

Inheritance of Alzheimer's disease: epidemiologic evidence.

The available evidence suggests that there may be two subtypes of AD-- inherited and noninherited. Inherited AD may have certain characteristics, e.g. younger age at onset and some clinical signs or symptoms, which distinguish them from noninherited cases. It is possible that the noninherited type of AD may also have a similar genetic defect as the inherited kind, the only difference being that in one case the defect is inherited from the parents and in the other the defect arises de novo during embryogenesis. An environmental factor operating during embryogenesis may be responsible for causing a genetic defect which later manifests as noninherited AD. Currently, however, there is no precise way to separate these two subtypes. The exact proportion of all cases of AD which are inherited on a genetic basis is not known, but it must be small. The mode of inheritance of genetic AD is not known. It must be emphasized that the subtypes of inherited and noninherited AD are not synonymous with the older categorization of AD into presenile and senile AD.

Serum cholesterol, its lipoprotein fractions among survivors of cerebrovascular disease. A case-control study.

A case-control study was conducted in 1983 on 210 cerebrovascular disease (CVD) patients identified from a retrospective cross-sectional door-to-door survey of four cities in the People's Republic of China. One hundred and eleven male (mean age 63.8 +/- 8.9 years) and 99 female (mean age 63.5 +/- 11.1 years) CVD survivors and controls matched for sex, age, race and area were selected. Total serum cholesterol, high-density lipoprotein and low-density lipoprotein cholesterol were measured to see if there were differences between lipids in survivors of CVD and their matched controls. There was a higher level of total cholesterol in cerebral thrombotic patients (n = 114) and a lower level of total cholesterol and high-density lipoprotein cholesterol in cerebral hemorrhagic patients (n = 35) than in controls, although the results were not statistically significant. The only higher level of total serum cholesterol that might be important was in the group of male thrombotic patients of age greater than 70 years (n = 22; nominal p value less than 0.05). The implication of this finding needs further clarification.

Patterns of mortality from hereditary ataxias in the United States, 1971 and 1973-1978.

Mortality rates for deaths 'due to' and 'with' hereditary ataxias are presented for the first time. Age-adjusted mortality rates were higher for whites than for nonwhites of either sex, and for men in both racial groups. Age-specific mortality rates for whites showed a peak for 'hereditary spinal ataxia' in the 20-29 age group. For the other types of ataxias they were low until age 40 and increased thereafter. Heart diseases were a frequent cause of death in people dying 'with' hereditary ataxias. The median survival (from birth) for hereditary spinal ataxia in whites was 35 years.

Conditions associated at death with specific types of completed stroke in patients with and without hypertension: a case-control study.

Potential risk factors for various types of stroke were studied using a case-control study design. All 1978 US death certificates for which the registered underlying cause of death was subarachnoid hemorrhage (SAH), cerebral hemorrhage (CH), or cerebral infarction (CI) were identified. The frequency with which other conditions appeared on the death certificates of cases with and without hypertension was compared with controls. These data provide new information, such as the occurrence of peripheral vascular disease in association with SAH, the risk of CH in epileptic and cirrhotic patients, and the association of benign neoplasms of the nervous system, motor neuron disease, and 'paralysis agitans' with CI.