Abstract-Although the major biochemical abnormality due to methylenetetrahydrofolate reductase (MTHFR) deficiency is hyperhomocyst(e)inemia, its pathogenicity appears to involve more than homocysteine toxicity. In patients with severe MTHFR deficiency, a metabolite(s) other than hyperhomocyst(e)inemia also appears to be associated with its clinical manifestation in cerebrovascular disease. To elucidate the specific role of the TT genotype of MTHFR in the development of cerebral infarction with and without cognitive impairment, we determined the prevalence of hyperhomocyst(e)inemia and the C677T genotypes of MTHFR in 143 patients with vascular dementia, 122 patients with cerebral infarction, and 217 healthy subjects matched for age and sex. Prevalence of hyperhomocyst(e)inemia [homocyst(e)ine Ն15 mol/L] was higher in cerebrovascular patients with or without dementia than in normal control subjects (42.6%, 20.5%, and 10.1%, respectively; Pϭ0.001). In contrast, a higher frequency of MTHFR TT genotype was found only in demented patients compared with nondemented patients and healthy controls (25.2%, 9.8%, and 12.0%, respectively; Pϭ0.01). When the study subjects were divided into normohomocyst(e)inemic and hyperhomocyst(e)inemic groups, the TT genotype was significantly associated with the risk for vascular dementia in the hyperhomocyst(e)inemic group (odds ratio 4. Key Words: methylenetetrahydrofolate reductase Ⅲ genes Ⅲ cerebral infarction Ⅲ hyperhomocyst(e)inemia Ⅲ vascular dementia D etermination of plasma homocyst(e)ine (the total of free and protein-bound forms of homocysteine and its derivatives) became an important method in evaluating the risk of cardiovascular and cerebrovascular diseases. It is understood that the severity and duration of hyperhomocyst(e)inemia is closely related to the extent and progress of occlusive vascular disease. Although severe hyperhomocyst(e)inemia (known as homocystinuria) causes thromboembolism and vascular damage in children and young adults, moderate and intermediate hyperhomocyst(e)inemia is believed to be associated with occlusive vascular disease in adults. 1,2 Moderate hyperhomocyst(e)inemia is caused by genetic or environmental factors or a combination of both factors. 1,2 The most common genetic defect is thermolabile methylenetetrahydrofolate reductase (MTHFR), such as the homozygous C677T mutation. 3,4 This mutation causes an increased susceptibility to produce hyperhomocyst(e)inemia. However, the TT genotype of MTHFR requires an additional genetic or environmental factor for persistent hyperhomocyst(e)inemia. 2 This might explain the inconsistent results found when the association between the TT mutation of MTHFR and cerebrovascular disease was evaluated. [5][6][7] In severe hyperhomocyst(e)inemia, neurological and vascular manifestations are more pronounced despite less severe hyperhomocyst(e)inemia in patients with severe MTHFR deficiency compared with patients with severe cystathionine ␤-synthase deficiency. 8,9 This suggests that the pathogenic feature of hyperh...

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falls are a major health problem, and efforts to lower the risk of falling in the community setting are needed, 1 but a fall is also one of the most serious iatrogenic events that an elderly person requiring hospitalization might experience. Approximately 5% to 10% of community-dwelling elderly people who fall sustain a significant injury. 2 It is likely that a greater percentage of falls results in such an injury if the elderly person is acutely ill and unable to protect herself during the fall. Multiple factors, including poor vision, delirium, pharmaceuticals, a hazardous environment, and chronic dementing illness may contribute to a greater risk of falling. 3 One program, the Hospital Elder Life Program, designed to decrease the incidence of delirium in the hospital setting, has been shown to decrease the risk of falls. 4 Notwithstanding such efforts, falls in the hospital setting remain a matter of considerable concern to patients, their families, their physicians, and hospital administrators.To address this, a video monitoring system was put in place at Hackensack University Medical Center on a 33-bed unit that serves the older population almost exclusively. Eight individuals deemed to be at high risk of falling were located in adjoining rooms, and video cameras were directed at their beds. To protect the privacy of the individuals when nursing care was being provided, the monitors were located in such a way that the patient in the bed could not be seen if the curtains were fully drawn.Individuals selected to occupy these beds were aged 70 and older and acutely ill. In addition, they had a diagnosis of delirium or dementia and a history of a fall in the recent past. Initially, a nursing assistant observed all eight beds continuously during the night shift on a single video screen. Each attendant received an educational program targeted to fall prevention. If a patient appeared to be about to fall, the nursing assistant intervened immediately.During the first full year of this program, 72 falls occurred on the 33-bed unit, with more than 50% of them happening at night, but not a single individual in a monitored bed fell at night during the year. Because of its initial success, the monitoring program has been expanded to be in place throughout the 24-hour period. The only fall by a monitored individual during this period occurred when two patients were observed to be ready to fall at the same time, and the assistant was unable to reach the second elder in time.Although no data are available at this time, it seems likely that this video-monitoring program would not only improve outcomes, but would also save money directly, lower legal costs, and improve patient satisfaction. In addition, in the near future, Medicare might not pay for the acute care of an individual who sustains an iatrogenic event, such as a fall-related injury, that occurred during hospitalization.