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To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1552-6569.2007.00093.x Byline: Caterina Rosano (1), Howard J. Aizenstein (1), Minjie Wu (1), Anne B. Newman (1), James T. Becker (1), Oscar L. Lopez (1), Lewis H. Kuller (1) Keywords: White matter; hyperintensity; dementia; focal atrophy Abstract: ABSTRACT Background and Purpose. This study investigated the association of medial temporal lobe (MTL) atrophy and cerebrovascular disease (white matter hyperintensities [WMH], subclinical infarcts) with the risk of developing Alzheimer's disease (AD) among cognitively normal older adults. Methods. Risk of developing AD was examined for 155 cognitively normal older adults (77.4 years, 60% women, 81% white). The MTL volumes and the presence of WMH and of subclinical infarcts were determined from brain magnetic resonance imaging (MRI) at the beginning of the study. Follow-up cognitive evaluations (average 4.3 years) identified those who developed AD. Results. The presence of either MTL atrophy or subclinical infarcts was independently and significantly associated with a greater risk to develop AD (OR [95% CI]: 4.4 [1.5, 12.3] and 2.7 [1.0, 7.1], respectively). In addition, those participants with both MTL atrophy and at least one brain infarct had a 7-fold increase in the risk of developing AD (OR [95% CI]: 7.0 [1.5, 33.1]), compared to those who had neither of these conditions. Conclusions. In cognitively normal older adults, markers of neurodegeneration (as reflected by MTL atrophy) and of cerebrovascular disease (as reflected by infarcts on MRI) independently contribute to the risk to develop AD. Author Affiliation: (1)From the School of Public Health, Department of Epidemiology, University of Pittsburgh, Pennysylvania (CR, LHK); Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pennsylvania (HJA, MW); School of Public Health, Department of Epidemiology, and Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pennsylvania (ABN); Departments of Psychiatry, Neurology and Psychology, University of Pittsburgh, Pennsylvania (JTB); Department of Neurology, University of Pittsburgh, Pennsylvania (OLL, LHK). Article History: Received November 17, 2006, and in revised form November 17, 2006. Accepted for publication November 22, 2006. Article note: Address correspondence to Caterina Rosano, MD, MPH, 130 N Bellefield, room 519, Pittsburgh PA, 15213. E-mail: RosanoC@edc.pitt.edu.

Celiac disease is a malabsorption syndrome in which atrophy of the villi (minute projections) within the intestines occurs as a result of exposure to gluten, the primary protein component of wheat flour. It is now becoming clear that many cases of celiac disease exist without symptoms of malabsorption or resulting malnutrition. Furthermore, it is also becoming clear that celiac disease is a systemic disease (affecting many systems of the body), and involves pathological events outside the intestine and is apparently unrelated to malnutrition. The authors report the cases of five patients who developed dementia and who were subsequently found to have celiac disease. One patient was 58, the others were 39 years of age or younger at the time of presentation. Two of the patients were sisters. The patients were confirmed to have celiac disease on the basis of a biopsy of the small intestine, and were placed on a gluten-free diet. Unfortunately, the gluten-free diet resulted in an improvement in symptoms in only one patient. The remaining four patients continued to suffer a downward course towards dementia; computed tomography revealed atrophy of the cerebral cortex of the brain in the four deteriorating patients. In two patients, the serum level of vitamin B12 was found to be low, a condition which was likely to be the result of the condition of the small intestine. However, the use of vitamin B12 supplements in these patients did not result in an improvement in symptoms. It is not known how long the five patients suffered celiac disease prior to its diagnosis; none of the patients were malnourished or had obvious symptoms of the malabsorption syndrome. It is not known, therefore, whether earlier diagnosis and dietary restriction might have halted the downward slide of their mental faculties. The details of the cases, however, suggest that the mental deterioration which occurred was not simply a result of malnourishment stemming from the intestinal dysfunction. Rather, it would seem that dementia may be a direct complication of celiac disease in some patients. The cause of the dementia in these patients remains unknown. The authors caution that celiac disease must be considered as a possible cause of dementia, especially when seen in a young patient. (Consumer Summary produced by Reliance Medical Information, Inc.)

A 21-year-old man with a history of hemochromatosis and chronic heart failure presented with a 6-month history of weight loss (13.5 kg), fatigue, and generalized weakness. On physical examination, he [...]