The relationship of plasma β-amyloid levels to cognitive decline and the ability to visually identify and quantify brain β-amyloid in living patients are the focus of 2 articles in this issue. In an analysis of data from a prospective cohort study of older adults without dementia at baseline, Yaffe and colleagues Article found that lower plasma β-amyloid 42/40 (measured in plasma obtained at the year 1 follow-up) was associated with greater cognitive decline during 9 years of follow-up. Clark and colleagues Article report that in vivo positron emission tomographic imaging with florbetapir F 18—a molecular imaging ligand with high affinity to β-amyloid—correlated with the presence and density of β-amyloid pathology at autopsy. In an editorial, Breteler Article discusses the evaluation and utility of potential biomarkers of cognitive decline and Alzheimer disease.
Risks associated with the use of hormonal therapy to manage menopausal symptoms have increased interest in the identification of effective nonhormonal treatments. In a randomized placebo-controlled trial, Freeman and colleagues assessed the efficacy of escitalopram (10-20 mg/d) on the frequency and severity of hot flashes in healthy women who were either in the transition to menopause or postmenopausal. At an 8-week follow-up, the authors found that compared with placebo, use of escitalopram was associated with reductions in the frequency and severity of menopausal hot flashes.
Mr and Mrs B are an elderly couple who lived independently until they were involved in a serious motor vehicle crash. After their acute care hospitalization, they were discharged to a skilled nursing facility, and Mrs B was subsequently able to move to congregant senior housing. A subdural hematoma and coma of 5 weeks' duration left Mr B with significant cognitive impairment, and he requires assistance with most activities of daily living. After 2 years at the skilled care facility, he now resides in an assisted-living group home. Kane discusses the physician's role in long-term care planning, the range of options available, and the evidence regarding care outcomes and quality. Readers may submit comments for online posting at http://www.jama.com. In a commentary, Mor and Besdine discuss policy intended to improve discharge planning to post–acute care settings.
An article in the September Archives of Surgery reported late outcomes of endovascular and open revascularization procedures to treat nonatherosclerotic renal artery disease (NARAD). The authors found that both endovascular and open management were associated with long-term patency of the renal artery or vein graft, reductions in blood pressure and use of antihypertensive medications, and improved renal function and survival. Darling discusses the choice of percutaneous vs open revascularization for patients with NARAD.
“I’m thrilled when anyone remembers anything I taught them yesterday, much less 15 years ago.” From “Impact Factor.”
Scientists are capitalizing on new technologies and advances in neuroscience to develop prosthetics or other technology-assisted therapies for individuals with neurological disorders.
Critical care medicine education and credentialing
Question propagation in research
Patient-centered health information systems
Cole Porter's eventful nights and days
Join Steven J. Jacobsen, MD, PhD, Wednesday, February 16, 2011, from 2 to 3 PM eastern time to discuss herpes zoster in older adults and the risk of subsequent herpes zoster disease. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
For your patients: Information about Guillain-Barré syndrome.
This Week in JAMA . JAMA. 2011;305(3):223. doi:10.1001/jama.2010.2010