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Several European studies have suggested a higher prevalence of celiac disease (CD) among infertile women (4% to 8%) compared with the general population (<1%). We screened a cohort of women with unexplained infertility in Northern California for the serum markers of CD, tissue transglutaminase and endomysium antibodies (EMA). Given that only one woman out of 121 (0.8%) screened positive for CD, it appears that CD is about as prevalent in this cohort of infertile women as in the general U.S. population (<1%).

Objective: To describe problems of dementia patients whose spousal caregivers are also cognitively impaired., Design: Retrospective chart review., Setting: The geriatric assessment clinic at University of California, San Diego, which is one center for the California State sponsored Alzheimer's Disease Diagnosis and Treatment Center Program., Patients: During the period from January 1992 through May 1994, 65 patients completed the assessment and met the entry criteria of being demented and having a spousal caregiver. Twelve of the spouses scored six or more error points on the Katzman Short Orientation-Memory-Concentration Test., Measurements: Patient data included age, living situation, other caregivers, use of formal and informal support systems, profiles of medical, cognitive, and functional ability, caregivers interactions, and recommendations from the evaluation., Main Results: Dementia patients with cognitively impaired spouses utilized fewer community resources (P = .021) and experienced difficulty with medication compliance (P = .041) more often than those with cognitively normal spousal caregivers., Conclusions: Older caregivers of patients suffering from dementia should be screened for cognitive problems.

Objective: To determine whether clinical features and rate of cognitive and functional decline differed in cohorts of possible AD (poAD), probable AD (prAD), and mixed dementia (MIX) patients., Design: Cohort study with 1-year follow-up examination, comparing three groups of subjects., Setting: Outpatient evaluation at nine California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC)., Patients: There were 1701 elderly patients who presented for evaluation of memory complaints., Measurements: Historical, physical, and neurological variables for cross-sectional comparisons and 1-year rate of change on the Mini-Mental State Examination (MMSE), Blessed Information-Memory-Concentration test (BIMC), and Blessed Dementia Scale (BDS)., Results: Mean initial MMSE scores for poAD (n = 279), prAD (n = 928) and MIX (n = 430) were 17.9 (+/- 7.4), 13.9 (+/- 7.5), and 15.4 (+/- 7.1). Delusions and psychosis occurred in about one-third of each group, most often in those with moderate dementia (MMSE 11-20). PoAD were distinguished from prAD by significantly more alcohol abuse, physical health problems, and focal motor or sensory findings. MIX differed from AD alone by increased prevalence of cardiovascular disease, hypertension, stroke, TIA, and exposure to general anesthesia, and by a greater frequency on exam of depressed mood, focal motor or sensory findings, and gait disorder. All groups declined by about 2.8 points on the BIMC, 2.9 points on the MMSE, and 1.8 points on the BDS, a functional scale, over 1 year. Neither extrapyramidal signs nor psychosis predicted a more rapid rate of decline., Conclusions: Various features help to distinguish poAD, prAD, and MIX in a large cohort of patients, but do not predict the rate of progression.

To examine the reliability of drug histories of elderly outpatients, records of 122 frail elderly patients in a geriatric outpatient evaluation clinic were reviewed. Drug histories were taken by an internist during an initial clinical evaluation and by a nurse practitioner during a home visit. Home and office drug lists disagreed in 39 cases (32%). Roughly equal numbers of "extra" drugs were listed in the two settings. Number of medications (especially two or more), number of active medical problems (especially four or more), and depression were significant, independent predictors of an unreliable drug history. Neither dementia nor living situation was a significant predictor of an unreliable drug history. The only drugs associated with an unreliable history were megavitamins, beta-blockers, and centrally-acting antihypertensive agents. Using the home list as the reference, there were equal numbers of omission errors and commission errors in the office drug histories. Strategies to optimize the reliability of office drug histories need further investigation.