Owolabi and colleagues review the current issues related to inadequate neurological care of patients in most of Africa. Increased recruitment and retention of neurologists represent a major challenge. International collaboration and support are needed to increase the number of neurologists and the resources to provide adequate care and conduct research. Editorial perspective is provided by Johan A. Aarli, MD.
Tafti and Ghyselinck provide a critical and clinically valuable review of the essential role that vitamin A derivatives, the retinoids, provide in synaptic plasticity, learning and memory, sleep, schizophrenia, depression, Parkinson disease, and Alzheimer disease. The clinical disorders reviewed with reference to vitamin A function are complex and involve both genetic and environmental factors.
Following a retrospective cohort study, van de Beek et al review the infectious disease complications in 315 patients who underwent heart transplantation. Infections in the central nervous system developed in 8 patients (3%), and all presented within the first 4 years after transplantation. As reported, these infections are rare but devastating.
Corvol and colleagues found that heart valve disease is independently associated with pergolide in patients with Parkinson disease and correlated with its cumulative dose (Figure).
Relationship between risk differences and pergolide cumulative doses. Solid line indicates inverse variance regression line; dotted lines, 95% confidence intervals.
Amdahl et al report that specific combinations of genetic polymorphisms individually associated with myasthenia gravis synergize in predisposing to thymoma and antititin antibodies.
From a prospective, community-based cohort study, Reitz and colleagues provide data indicating that a history of hypertension is related to a higher risk of mild cognitive impairment (MCI). The association is stronger with the nonamnestic than the amnestic component of MCI. Thus, these findings suggest that prevention and treatment of hypertension may have an important impact in lowering the risk of cognitive impairment.
Gómez-Tortosa et al show that there is a wide discrepancy in age at onset of affected siblings that is not clearly explained by a single clinical variable or apolipoprotein E genotype. Maternal transmission of the disease seems to condition a more homogeneous age at onset in siblings, and the risk to develop dementia after the parent's reported age at onset decreases significantly.
Greater participation in prediagnosis leisure activities, and especially intellectual activities, was associated with faster cognitive decline in a study by Helzner et al. These findings support the hypothesis that the disease course in Alzheimer disease may vary as a function of cognitive reserve.
Scarmeas and colleagues provide data showing that disruptive behavior is very common in Alzheimer disease and predicts cognitive decline, functional decline, and institutionalization but not mortality.
Josephs reports that Capgras syndrome, characterized by a delusional belief that a person is replaced by an imposter, can be associated with neurodegenerative diseases, especially Lewy body disease. Forty-seven subjects with Capgras syndrome were evaluated, and more than 80% had a neurodegenerative disease, most commonly Lewy body disease.
França and colleagues report that pain was a significant issue in patients with Machado-Joseph disease. Lower back pain was the most frequently reported location of a chronic pain syndrome. Expanded CAG repeats were higher in patients with pain.
Counts et al found that cholinergic neurons of the nucleus basalis (NB) had a significant up-regulation of α7 nicotinic acetylcholine receptor (nAChR) messenger RNA expression in subjects with Alzheimer disease compared with controls with no cognitive impairment and patients with mild cognitive impairment. α7 nAChR up-regulation may signal a compensatory response to maintain basocortical cholinergic activity during Alzheimer disease progression. Increasing NB α7 nAChR expression may serve as a marker for the progression of Alzheimer disease.
This Month in Archives of Neurology. Arch Neurol. 2007;64(12):1692–1693. doi:10.1001/archneur.64.12.1692