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Bäckman L, Jones S, Berger A-K, Laukka EJ, Small BJ (Karolinska Institute, Stockholm, Sweden; and University of South Florida, Tampa, FL, USA) Multiple cognitive deficits during the transition to Alzheimer's disease (Key Symposium). J Intern Med 2004; 256: 195–204. The literature on cognitive markers in preclinical AD is reviewed. The findings demonstrate that impairment in multiple cognitive domains is typically observed several years before clinical diagnosis. Measures of executive functioning, episodic memory and perceptual speed appear to be most effective at identifying at-risk individuals. The fact that these cognitive domains are most implicated in normal cognitive aging suggests that the cognitive deficit observed preclinically is not qualitatively different from that observed in normal aging. The degree of cognitive impairment prior to the diagnosis of Alzheimer's disease (AD) appears to generalize relatively well across major study characteristics, including sample ascertainment procedures, age and cognitive status of participants, as well as time to diagnosis of dementia. In episodic memory, there is evidence that the size of the preclinical deficit increases with increasing cognitive demands. The global cognitive impairment observed is highly consistent with observations that multiple brain structures and functions are affected long before the diagnosis of AD. However, there is substantial overlap in the distribution of cognitive scores between those who will and those who will not be diagnosed with AD, hence limiting the clinical utility of cognitive markers for early identification of cases. Future research should consider combining cognitive indicators with other types of markers (i.e. social, somatic, genetic, brain-based) in order to increase prediction accuracy. [ABSTRACT FROM AUTHOR]

Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund L-O, Nordberg A, Bäckman L, Albert M, Almkvist O, Arai H, Basun H, Blennow K, de Leon M, DeCarli C, Erkinjuntti T, Giacobini E, Graff C, Hardy J, Jack C, Jorm A, Ritchie K, van Duijn C, Visser P, Petersen RC (Karolinska Institutet, Stockholm, Sweden; John Hopkins University School of Medicine, Baltimore, MD, USA; Tohoku University Graduate School of Medicine Sendai, Miyagi, Japan; Uppsala University, Sweden; Gothenburg University, Sweden; New York University School of Medicine, New York, NY, USA; University of California at Davis, Sacramento, CA, USA; Helsinki University Hospital, Helsinki, Finland; University of Geneva Medical School, Switzerland; National Institute on Aging/National Institute of Health, Bethesda, MD, USA; Mayo Clinic, Rochester, MN, USA; Australian National University, Canberra, Australia; French National Institute of Medical Research (INSERM), Montpellier, France; Erasmus Medical Center, Rotterdam, The Netherlands; University of Maastricht, The Netherlands). Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment (Key Symposium). J Intern Med 2004; 256: 240–246. The First Key Symposium was held in Stockholm, Sweden, 2–5 September 2003. The aim of the symposium was to integrate clinical and epidemiological perspectives on the topic of Mild Cognitive Impairment (MCI). A multidisciplinary, international group of experts discussed the current status and future directions of MCI, with regard to clinical presentation, cognitive and functional assessment, and the role of neuroimaging, biomarkers and genetics. Agreement on new perspectives, as well as recommendations for management and future research were discussed by the international working group. The specific recommendations for the general MCI criteria include the following: (i) the person is neither normal nor demented; (ii) there is evidence of cognitive deterioration shown by either objectively measured decline over time and/or subjective report of decline by self and/or informant in conjunction with objective cognitive deficits; and (iii) activities of daily living are preserved and complex instrumental functions are either intact or minimally impaired. [ABSTRACT FROM AUTHOR]

Background: Atrioventricular junctional ablation (AVJA) improves symptoms and quality of life in patients with pharmacologically resistant atrial fibrillation (AF). However, long-term right ventricular stimulation has also been reported to lead to deterioration of the left ventricular function. We retrospectively analyzed the incidence of new or aggravated heart failure (HF) during long-term right ventricular stimulation following AVJA., Methods: Two hundred thirteen patients (110F:103M), 73 +/- 10 years old, were followed for a period of 6 +/- 3 years after AVJA. Forty-nine patients (23%) were known to have HF before AVJA. New HF was diagnosed if at least two of the following criteria were present: NYHA class >2, an LVEF <45%, and medication for HF. Aggravated HF was defined as an increase in the functional class and/or new prescription of medication for HF. All-cause death was a secondary endpoint., Results: During follow-up, 26% of the patients with known HF showed an aggravation of HF, while 13% developed new symptoms of HF. High age and low EF were independent predictors of new or aggravated HF and of new HF, while none of the tested variables predicted aggravation of known HF. The all-cause mortality was 16%, where high age and coronary artery disease were found to be independent predictors., Conclusion: AVJA followed by right ventricular pacing was associated with aggravated HF in 23% of patients with known HF, while development of new symptoms of HF occurred much less often during follow-up (13%). The majority of patients who underwent AVJA continued to do well during long-term follow-up.

Aim: To develop a new stress scale and use it for investigating impact of ethnicity on perception of stress., Subjects and Methods: One thousand one hundred and twenty-four students (grades 6-9) from 14 schools filled in a questionnaire at school with questions about age, sex, use of language at home (proxy for cultural background), stress and stressors. Factor analysis and analysis of variance were used to analyze the data., Results: Two-stress dimensions were identified, 'pressure'(7 items, Cronbach's alpha 0.862) and 'activation'(4 items, Cronbach's alpha 0.767). Scores on the two scales and a separate 'stress' item were higher in girls and increased with grade. Use of another language than Swedish at home showed a significant effect only for activation, with lower scores in girls. The interaction effect between sex and language was significant for all variables and was due mainly to lower stress in girls using another language than Swedish at home., Conclusion: This new stress scale has some promising qualities like a condensed format, basis in a specific stress concept and formulated to be as age and culture independent as possible. Immigrant girls seem to perceive less stress than Swedish born girls, which opens up for questions about protective mechanisms.

There has been a need to assess the "sickness degree" in patients with acute and chronic hepatic failure. The Model for End-Stage Liver Disease (MELD) score was developed as a tool for a more objective estimate of the "degree" of sickness in patients with chronic liver disease. In this study, the MELD score was retrospectively calculated and compared in adult patients accepted for orthotopic liver transplantation (OLT) in our institution in 1999 and 2004. We analyzed the gender, age, and MELD score associated with different indications for OLT during this period.

Background: Most studies regarding esophageal cancer are based on a selection of patients, influencing the prognosis as well as other variables measured. Sweden may be unique in that it has registries that cover the whole population, permitting population based studies regarding diseases such as esophageal cancer. This also makes it possible to study the true nature of a population of patients and to describe changes in that population over time., Method: Retrospective analysis of the files of all 1284 patients diagnosed with esophageal cancer in Stockholm County 1978-1995. The study period was divided into three six-year intervals (periods I, II and III)., Results: A total of 201 patients were diagnosed at autopsy. They were only analyzed regarding histopathological and demographic parameters. A statistically significant increased survival for the whole group of patients was found, but this improvement in survival was not found among resected patients. No survival benefit was noted for patients operated on at large centers compared to patients operated on at surgical clinics with few yearly resections performed. The well-known increase in the incidence of adenocarcinoma in the esophagus among men was documented. A tendency (non-significant) of an increase in the incidence of adenocarcinoma among women was also noted., Conclusions: Survival seems to have increased among esophageal cancer patients, but this survival benefit is not dependent on improved surgery. The number of yearly operations in a clinic did not correlate to long-term survival in this study.

This part of an on-going intervention trial analyses impacts of obesity on psychosocial factors and health. The study sample comprised 800 obese men (BMI > or = 34 kg/m2) and 943 women (BMI > or = 38 kg/m2) ranging in age from 37 to 57 years. All participants completed standardized health-related quality of life measures, a validated obesity-specific eating inventory and study-specific questionnaires on current and past health status, use of medical care and medications, socioeconomic status, dietary habits, physical activity habits, weight history and familial history of obesity. Chronic patients and population samples were used as reference. The obese reported distinctly poorer current health and less positive mood states than the reference subjects, women being worse than men. Anxiety and/or depression on a level indicating psychiatric morbidity were more often seen in the obese and again women reported more affliction than men. Furthermore, the average poor mental well-being was worst than in chronically ill or injured patients, such as rheumatoid, cancer survivors and spinal cord injured persons. Predictors of perceived health and psychosocial functioning could be discerned using a comprehensive system of statistical analyses (16-28% explained variance). A background of both somatic and psychiatric morbidity was decisive for the health and psychosocial functioning in the obese; joint symptoms and angina pectoris dominated among somatic variables. Physical inactivity was the most prominent of traditional risk factors. The number of dieting attempts and body image were important weight correlates. Our results provide further evidence to the effect that severe obesity is a crippling condition.

SOS (Swedish obese subjects) is an on-going intervention trial designed to determine whether the mortality and morbidity rates among obese individuals who lose weight by surgical means (gastric banding, vertical banded gastroplasty and gastric by-pass) differ from the rates associated with conventional treatment. For this purpose, the study is recruiting a sample of obese men and women who constitute a registry of potential subjects from which the participants are drawn. Eligibility criteria for participation in the registry were: age at application 37-57 years and BMI greater than or equal to 34 kg/m2 for men and greater than or equal to 38 kg/m2 for women. Before receiving a health examination, all patients complete extensive questionnaires on current and past health status, utilization of medical care and medications, socio-economic status, psychological profiles, dietary habits, physical activity, weight history, and familial disposition to obesity. Each surgical case is matched to its optimal control in the registry, to ensure that the two groups do not differ systematically with respect to any of 18 matching variables that may affect prognosis. The first 1006 subjects included in the registry have been studied with respect to morbidity and compared with on-going population studies of men and women in Göteborg, Sweden. The relative risks of prevalent disease and symptoms associated with obesity in 50-year-old males and females respectively were 4.3 and 4.7 (dyspnoea), 14.7 and 11.8 (angina), 6.3 (myocardial infarction, males only), 2.1 and 4.5 (hypertension), 5.2 and 6.6 (diabetes), 4.6 and 26.1 (claudication) and 1.7 and 1.8 (gall bladder disease). Correspondingly, obese males and females display elevations of systolic and diastolic blood pressure, fasting glucose, insulin, triglyceride, and uric acid levels. However, total cholesterol was not increased in obese males and was in fact significantly lower in obese compared with reference women. HDL-cholesterol was lower in obese than reference men (data were not available in reference women). The rate of taking sick pensions was over twice as high in SOS obese patients than in population controls. Finally, comparison of measurements with self-reported prevalence estimates revealed a considerable amount of previously undiagnosed hypertension and diabetes in the obese subjects. These data suggest that the excess health risks associated with obesity may not be fully appreciated.