Cross-sectional studies of normal aging indicate an association between memory and hippocampal volume, and between executive functioning and subcortical-frontal circuits. Much less is known, however, about the relationship between longitudinal MRI changes and cognitive decline. The authors hypothesized that longitudinal change in memory would be best predicted by change in hippocampal volumes, whereas change in executive functioning would be best predicted by cortical atrophy and progression of MRI markers of cerebrovascular disease. For this study, 50 healthy elderly subjects underwent structural MRI and cognitive testing at baseline and again at follow-up, with a mean follow-up interval of 45 months. Volumetric MRI measures were hippocampus, cortical gray matter, white matter signal hyperintensity (WMSH), and lacunae. Neuropsychological measures were psychometrically robust composite scores of episodic memory (MEM) and executive functioning (EXEC). Hierarchical multiple regression indicated that a decrease in hippocampus was associated with a decline in MEM, whereas decreased cortical gray matter and increased WMSH were independently associated with a decline in EXEC. Results suggest that in normal aging, cognitive functioning declines as cortical gray matter and hippocampus decrease, and WMSH increases. The association between WMSH and EXEC further highlights the cognitive sequealae associated with cerebrovascular disease in normal elderly.Correspondence concerning this article should be addressed to Joel H. Kramer , 1997). There are also age-related increases in subcortical ischemic vascular disease that can independently contribute to cognitive decline and dementia (Román, Erkinjuntti, Wallin, Pantoni, & Chui, 2002). Population-based studies have reported "silent" (i.e., asymptomatic) lacunae in 11%-28% of clinically asymptomatic elderly (Longstreth et al., 1998;Price et al., 1997;Vermeer et al., 2003), whereas the prevalence of white matter signal hyperintensities on MRI has ranged from 30% to 100% across studies of healthy elderly samples (Breteler et al., 1994;Longstreth et al., 1998;Ylikoski et al., 2000). Diffusion tensor MRIs have shown a progressive reduction in fractional anisotropy and an increase in diffusivity with age (Charlton et al., 2006).Despite the co-occurrence of age-related cognitive decline and brain changes, associations between brain volume and cognitive ability in healthy subjects have been difficult to establish. Although several studies have reported that hippocampal atrophy is associated with poorer episodic memory performance in older subjects (De Leon et al., 1997;Golomb et al., 1996), an extensive review and meta-analysis by Van Petten (2004) noted considerable variability across studies. The common correlation between hippocampal volume and memory performance across 33 studies was statistically significant but quite low, leading to the conclusion that the evidence for a positive relationship between hippocampal volume and memory performance was weak. Divergent result...

Impaired ability to conduct daily activities is a diagnostic criterion for dementia and a determinant of healthcare services utilization and caregiver burden. What predicts decline in instrumental activities of daily living (IADLs) is not well understood. This study examined measures of episodic memory, executive function, and MRI brain volumes in relation to baseline IADLs and as predictors of rate of IADL change. Participants were 124 elderly persons with cognitive function between normal and moderate dementia both with and without significant small vessel cerebrovascular disease. Random effects modeling showed that baseline memory and executive function (EXEC) were associated with baseline IADL scores, but only EXEC was independently associated with rate of change in IADLs. Whereas hippocampal and cortical gray matter volumes were significantly associated with baseline IADL scores, only hippocampal volume was associated with IADL change. In a model including cognitive and neuroimaging predictors, only EXEC independently predicted rate of decline in IADL scores. These findings indicate that greater executive dysfunction at initial assessment is associated with more rapid decline in IADLs. Perhaps executive function is particularly important with respect to maintaining IADLs. Alternatively, executive dysfunction may be a sentinel event indicating widespread cortical involvement and poor prognosis.

Psoriatic arthritis (PsA) is a chronic, seronegative spondyloarthropathy associated with psoriasis (PsO). Treatment options range from non-pharmacologic measures to NSAIDS, DMARDs, and biologics, depending on patient presentation. Secukinumab (CosentyxÓ) is a new biologic treatment option that was approved for use in treating adult patients with PsA in October 2016. Our paper explores the clinical trial evidence available for secukinumab to examine its safety and efficacy as a therapeutic agent for the treatment of PsA. While indirect comparisons of indicate that secukinumab is as effective as other treatment options, further studies directly comparing available treatments will be necessary to establish its place in treatment guidelines. As these and other trials are conducted, the evidence produced will further elucidate the clinical potential of secukinumab as a treatment option for patients with rheumatologic disease.

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