Multimodal prediction of dementia with up to 10 years follow up: the Gothenburg MCI study.

BACKGROUND: Neuropsychological tests, CSF Aß42, T-tau, P-tau181, hippocampal volume, and white matter lesions have been shown to predict conversion to dementia in patients with mild cognitive impairment (MCI). OBJECTIVE: To examine the predictive value of combinations of these markers and to examine if the absence of pathological markers provides a lasting reduction of conversion rates. METHODS: The Gothenburg MCI study is a clinically based study. Seventy-three MCI patients were included in the present sub-study and followed for a maximum of ten years. Thirty-four patients converted to dementia (18 to AD) and 39 remained stable. At inclusion, patients were classified into positive or negative risk groups according to results from neuropsychological testing (Rey auditory verbal learning test, Boston naming test, Trail making test B), CSF biomarkers (amyloid ß42, T-tau, and P-tau181), and MRI scans (hippocampal volume, white matter lesions). RESULTS: Trail making test B (TMT-B) was the best single predictor for the prediction of dementia (AUC 0.89, HR 25), and T-tau was the best predictor of AD (AUC 0.97, HR 41). The combination of hippocampal volume and TMT-B was the best combination for the prediction of dementia (HR 25), and the combination of hippocampal volume and T-tau was the best combination for the prediction of AD (HR 37). CONCLUSION: Neuropsychological tests, CSF markers, and hippocampal volume predicted conversion from MCI to AD and general dementia. The absence of pathological markers provided a long-time protection from dementia.

Clinical outcomes of children with carbapenem-resistant Acinetobacter baumannii bacteremia.

BACKGROUND: A relentless increase in the rate of carbapenem-resistant among Acinetobacter baumannii has substantially reduced the access to effective antimicrobial regimens. Currently limited information is available regarding the prognosis or outcomes of children with blood stream infection caused by carbapenem resistant A. baumanii. OBJECTIVE: To determine the clinical outcomes and predictors for fatality among children with carbapenem-resistant A. baumannii (CRAB) bloodstream infection (BSI). MATERIAL AND METHOD: A retrospective descriptive study was conducted among children hospitalized at the Queen Sirikit National Institute of Child Health (Children's Hospital), Bangkok, Thailand. Those who had CRAB isolated from blood cultures during theperiod between October 2005 and September 2010 were included in the study. RESULTS: A total of 89 cases of BSI caused by CRAB were identified. The incidence was 1.2 cases per 1,000 hospitalized patients. The median age at onset of bacteremia was 62 days and 88% had at least one underlying comorbidity. The 2-week and 30-day case fatality rates were 39% and 42%, respectively. A large proportion of deaths (63%) occurred before blood culture results became available. Extended spectrum resistance, defined as resistance to all other first line antibiotics at the hospital, i.e., all cephalosporins, aminoglycoside, quinolone and carbapenems, was significantly associated with a higher 2-week case fatality rate (CFR) (48% compared with 23% among their counterpart, p = 0.028) and death at an earlier stage of the bacteremia (Kaplan-Meierp = 0.016). In univariate analysis, factors associated with 2-week case fatality include malignancy-associated febrile neutropenia, fever ≥2 days before the initiation of appropriate antibiotic, presence of septic shock, organ dysfunction, and being infected by extended spectrum resistant strains. Correspondingly, CFR of cases who received ≥1 appropriate empiric antibiotics within 24 hours of clinical suspicion appears to be lower albeit not reaching statistical significance, than their counterpart, i.e., the CFRs between the two groups were 10% vs. 23%, respectively (p = 0.675). Colistin susceptibility based on disc diffusion test remained high (100%) in this sample. Nevertheless, those who received colistin treatment had a 2-week CFR of 20%. On the other hand, none of the cases infected with sulbactam susceptible strain, who received sulbactam containing regimen (n = 15), died. No significant renal toxicity was observed among children receiving colistin treatment in our sample. CONCLUSION: Carbapenem resistant A. baumannii bacteremia exhibited a high fatality rate, which mainly occurred before the pathogen was known to the clinicians. Extended spectrum resistance was associated with high fatality rate. Early administration of effective empirical antibiotics such as colistin and sulbactam in this sample was associated with lower fatality rate among children affected by this condition.

White Matter Lesion Assessment in Patients with Cognitive Impairment and Healthy Controls: Reliability Comparisons between Visual Rating, a Manual, and an Automatic Volumetrical MRI Method-The Gothenburg MCI Study.

Age-related white matter lesions (WML) are a risk factor for stroke, cognitive decline, and dementia. Different requirements are imposed on methods for the assessment of WML in clinical settings and for research purposes, but reliability analysis is of major importance. In this study, WML assessment with three different methods was evaluated. In the Gothenburg mild cognitive impairment study, MRI scans from 152 participants were used to assess WML with the Fazekas visual rating scale on T2 images, a manual volumetric method on FLAIR images, and FreeSurfer volumetry on T1 images. Reliability was acceptable for all three methods. For low WML volumes (2/3 of the patients), reliability was overall lower and nonsignificant for the manual volumetric method. Unreliability in the assessment of patients with low WML with manual volumetry may mainly be due to intensity variation in the FLAIR sequence used; hence, intensity standardization and normalization methods must be used for more accurate assessments. The FreeSurfer segmentations resulted in smaller WML volumes than the volumes acquired with the manual method and showed deviations from visible hypointensities in the T1 images, which quite likely reduces validity.