Follow-up observations were made of 92 white patients with early-onset Alzheimer's disease to determine the demographic, clinical, and neuropsychological factors predictive of institutionalization or death. The cumulative mortality rate 5 years after entry into the study was 23.9%, compared with an expected rate of 9.5%. The 5-year cumulative rate of admission to nursing homes was 62.8%. The language ability of the patients on entry to the study, their scores on a brief screening test of cognitive function, and their overall ratings of clinical dementia were found to be predictors of subsequent institutional care and death. The age of the patients had a significant modifying effect on these predictive factors, resulting in a greater risk of institutionalization and death in younger patients with severe cognitive impairment as compared with older individuals with the same degree of dysfunction.

High-field-strength (1.5-1) MR imaging was used to evaluate 47 patients with definite multiple sclerosis and 42 neurologically normal control patients.

No abstract

Abstract-The clinical and radiologic impact of developing neutralizing antibodies (NAbs) to interferon beta (IFN␤) while on this therapy for multiple sclerosis (MS) is assessed. On the basis of Class II and III evidence, it is concluded that treatment of patients with MS with IFN␤ (Avonex, Betaseron, or Rebif) is associated with the production of NAbs (Level A). NAbs in the serum are probably associated with a reduction in the radiographic and clinical effectiveness of IFN␤ treatment (Level B). In addition, the rate of NAb production is probably less with IFN␤-1a treatment than with IFN␤-1b treatment, although the magnitude and persistence of this difference is difficult to determine (Level B). Finally, it is probable that there is a difference in seroprevalence due to variability in the dose of IFN␤ injected or in the frequency or route of its administration (Level B). Regardless of the explanation, it seems clear that IFN␤-1a (as it is currently formulated for IM injection) is less immunogenic than the current IFN␤ preparations (either IFN␤-1a or IFN␤-1b) given multiple times per week subcutaneously (Level A). However, because NAbs disappear in some patients even with continued IFN␤ treatment (especially in patients with low titers), the persistence of this difference is difficult to determine (Level B). Although the finding of sustained high-titer NAbs (Ͼ100 to 200 NU/mL) is associated with a reduction in the therapeutic effects of IFN␤ on radiographic and clinical measures of MS disease activity, there is insufficient information on the utilization of NAb testing to provide specific recommendations regarding when to test, which test to use, how many tests are necessary, or which cutoff titer to apply (Level U).