Two distinctive neuropathologic lesions are characteristic of Alzheimer
disease (AD)—amyloid β-peptide (Aβ)–containing plaques
(Figure 1 , arrow) and neurofibrillary tangles
composed of the protein tau (arrowhead). Using enzyme-linked immunosorbent
assays to determine brain tissue Aβ peptide levels in a postmortem study
of 79 nursing home residents, Näslund and colleaguesArticle found that brain
tissue levels of Aβ peptides were elevated in early dementia (Clinical
Dementia Rating [CDR] score, 0.5) and increased as CDR scores increased. In
the frontal cortex, elevation of Aβ peptides preceded the development
of tau pathology. In an editorial, SelkoeArticle describes the evidence supporting
the amyloid hypothesis of AD and discusses therapeutic approaches based on
inhibiting Aβ peptide production or increasing Aβ peptide clearance.
The National Highway Traffic Safety Administration, to reduce motor
vehicle fatalities associated with teenaged drivers, has recommended graduated
driver licensing systems with 3 levels of licensure—learner's license
requiring supervision at all times; intermediate license with restricted unsupervised
driving; and full-privilege license. In this analysis of data from 3 US federal
sources, Chen and colleaguesArticle report that the risk of a motor vehicle crash
fatal to a 16- or 17-year-old driver increased significantly as the number
of passengers increased, irrespective of time of day or sex of the driver.
In an editorial, FossArticle emphasizes the importance of prohibiting young drivers
from driving with passengers and from driving after 10 PM.
To determine effective outpatient treatment of uncomplicated acute pyelonephritis
in women, Talan and colleagues randomly assigned 378 premenopausal women aged
18 years or older to receive a 7-day course of ciprofloxacin or a 14-day course
of trimethoprim-sulfamethoxazole. At 4 to 11 days after treatment, bacteriologic
and clinical cure rates were significantly higher among women in the short-course
ciprofloxacin group than in the trimethoprim-sulfamethoxazole group. Rates
of bacteriologic and clinical failure in the trimethoprim-sulfamethoxazole
group were significantly higher among patients infected with Escherichia coli with in vitro resistance to trimethoprim-sulfamethoxazole.
Adverse drug events occurred in 46 (24%) of 191 patients treated with ciprofloxacin
and in 62 (33%) of 187 patients treated with trimethoprim-sulfamethoxazole.
In this analysis of data from singleton birth and fetal death certificates
from Georgia, 1980 through 1995, Adams and colleagues found that most women
whose first delivery was preterm did not have a subsequent preterm delivery,
but recurrence of preterm delivery was higher among black women (26.0%) than
among white women (19.9%). For both white and black women, the rate of preterm
delivery in the second pregnancy increased as the length of gestation of the
first pregnancy decreased.
Mrs K, an 82-year-old woman whose recent stroke resulted in left-sided
ataxia-hemiparesis syndrome, has experienced episodic changes in her mood
and behavior beginning 2 months after the stroke. Robinson discusses pathogenesis
of poststroke depression, differential diagnosis and clinical evaluation of
mood change after stroke, and treatment.
Clinical applications of polymerase chain reaction DNA amplification.
The World Health Organization has set 2005 as the target date for global
eradication of polio. Now safe containment of remaining poliovirus must be
Survey results indicate that preparticipation cardiovascular screening
of student-athletes at most US colleges and universities is unlikely to detect
cardiovascular abnormalities that could cause sudden death.
AMA Web site guidelines outline standards in 4 specific areas: content,
advertising, privacy and confidentiality, and e-commerce.
For your patients: Information about urinary tract infections.
This Week in JAMA. JAMA. 2000;283(12):1527. doi:10.1001/jama.283.12.1527