Objective Age-related cognitive decline trajectories were compared in apolipoprotein E (APOE) e4 homozygotes (HMZ), heterozygotes (HTZ), and noncarriers (NC) in the absence of mild cognitive impairment (MCI) and Alzheimer’s dementia (AD). Background At how young an age memory decline diverges from that of noncarriers in healthy people with elevated genetic risk for late-onset AD due to APOE e4 is unknown. Methods Cognitively normal participants age 21-97 years were recruited with local ads, grouped using an APOE e4 enrichment paradigm, and had longitudinal neuropsychological testing. Anyone who developed MCI or dementia during followup was excluded. Acceleration of the rates of decline for predetermined cognitive measures were compared between APOE e4/4 HMZ, e3/4 HTZ, and e4 NC using a mixed model for longitudinal change with age. Results 79 e4 HMZ, 238 HTZ and 498 NC were included. APOE e4 carriers were younger (mean 58.0 vs 61.4 years, p<0.001) and had more years of followup (5.3 v 4.7 years, p=0.01), with equivalent education (15.4 years) and gender (69% women). With accelerating declines beginning prior to age 60 in e4 carriers, longitudinal decline in memory in e4 carriers accelerated more than in NC (p=0.0253) with a possible e4 gene-dose effect (p=0.0231) in which longitudinal decline in e4 HMZ accelerated more than in NC (p=0.0087). Weaker similar effects were also found on a visuospatial and general mental status measure. Conclusions Age-related memory decline in APOE e4 carriers diverges from NC prior to age 60 and appears most severe in HMZ despite ongoing normal clinical status.

193 basically healthy working-class and middle-class mothers and their infants participated in a 4-year longitudinal study which focused on the relative potency of several clusters of variables for predictions of intellectual and language outcome during the preschool years. The major results were: (1) Measures of perinatal or infant physical status were extremely weak predictors of 4-year IQ or language. (2) Assessments of child performance were poor predictors prior to 24 months, but excellent predictors from 24 months on. (3) Assessments of mother-infant interaction and general environmental quality were among the best predictors at each age tested, and were as good as measures of child performance at 24 and 36 months in predicting IQ and language. (4) Measures of the family ecology (level of stress, social support, maternal education) and parent perception of the child, especially when assessed at birth, were strongly related to child IQ and language within a low-education subsample, but not among mothers with more than high school education. Patterns of prediction were similar for 48-month IQ and 36-month receptive language; predictions were notably weaker for 36-month expressive language.

193 basically healthy working-class and middle-class mothers and their infants participated in a 4-year longitudinal study which focused on the relative potency of several clusters of variables for predictions of intellectual and language outcome during the preschool years. The major results were: (1) Measures of perinatal or infant physical status were extremely weak predictors of 4-year IQ or language. (2) Assessments of child performance were poor predictors prior to 24 months, but excellent predictors from 24 months on. (3) Assessments of mother-infant interaction and general environmental quality were among the best predictors at each age tested, and were as good as measures of child performance at 24 and 36 months in predicting IQ and language. (4) Measures of the family ecology (level of stress, social support, maternal education) and parent perception of the child, especially when assessed at birth, were strongly related to child IQ and language within a low-education subsample, but not among mothers with more than high school education. Patterns of prediction were similar for 48-month IQ and 36-month receptive language; predictions were notably weaker for 36-month expressive language.

Background and Purpose Telemedicine techniques can be employed to address the rural-metropolitan disparity in acute stroke care. The STRokE DOC trial reported more accurate decision making for telemedicine consultations compared with telephone-only, and that the California based research network facilitated a high rate of thrombolysis use, improved data collection, low risk of complications, low technical complications, and favorable assessment times. The main objective of the STRokE DOC AZ TIME trial was to determine the feasibility of establishing, de novo, a single-hub, multi-rural spoke hospital telestroke research network across a large geographical area in Arizona by replicating the STRokE DOC protocol. Methods Prospective, single hub, two spoke, randomized, blinded, controlled trial of a 2-way, site independent, audiovisual telemedicine system designed for remote examination of adult patients with acute stroke versus telephone consultation to assess eligibility for treatment with intravenous thrombolysis. The primary outcome measure was whether the decision to give thrombolysis was correct. Secondary outcomes were rate of thrombolytic use, 90-day functional outcomes, incidence of intracerebral hemorrhages, and technical observations. Results From December 2007 to October 2008, 54 patients were assessed; 27 randomized to each arm. Mean National Institutes of Health stroke scale score at presentation was 7.3 (SD 6.2) points. No consultations were aborted, however technical problems (74%) were prevalent in the telemedicine arm. Overall, the correct treatment decision was established in 87% of the consultations. Both modalities, telephone (89% correct) and telemedicine (85% correct) performed well. Intravenous thrombolytic treatment was used in 30% of the telemedicine and telephone consultations. Good functional outcomes at 90 days were not significantly different. There were no statistically significant differences in mortality (4% in telemedicine and 11% in telephone) or rates of intracerebral hemorrhage (4% in telemedicine and 0% in telephone). Conclusions It is feasible to extend the original STRokE DOC trial protocol to a new state and establish an operational single hub, multi-spoke rural hospital telestroke research network in Arizona. The trial was not designed to have sufficient power to detect a difference between the two consultative modes, telemedicine and telephone-only. Whether by telemedicine or telephone consultative modalities, there were appropriate treatment decisions, high rates of thrombolysis use, improved data collection, low rates of intracerebral hemorrhage, and equally favorable time requirements. The learning curve was steep for the hub and spoke personnel of the new telestroke network as reflected by the frequent technical problems. Overall, the results support the effectiveness of highly organized and structured stroke telemedicine networks for extending expert stroke care into rural remote communities lacking sufficient neurological expertise.