EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, MAY 19, 2003
To contact Robert C. Green, M.D., M.P.H., call Gina DiGravio at 617/638-8491.

DEPRESSION MAY BE A RISK FACTOR FOR ALZHEIMER DISEASE

CHICAGO—Symptoms of depression are associated with the development of Alzheimer disease (AD), even in families where the depression symptoms first occurred more than 25 years earlier according to an article in the May issue of The Archives of Neurology, one of the JAMA/Archives journals.

Depression and depression symptoms are common in patients with AD, and may represent early symptoms of AD, according to information in the article.

Robert C. Green, M.D., M.P.H., of Boston University School of Medicine, Boston, and colleagues examined the association between depression symptoms and the risk of developing AD in 1,953 patients with AD and 2,093 of their unaffected relatives who were enrolled in the Multi-institutional Research in Alzheimer's Genetic Epidemiology Study (MIRAGE study).

The researchers found that patients with a history of depression symptoms were about twice as likely to have AD. For patients in whom depression symptoms occurred within one year before the onset of AD, the association with AD was almost five times stronger. For families in which depression symptoms occurred more than one year before the onset of AD, the association with AD was not as strong but still significant. In families in which depression symptoms first occurred more than 25 years before the onset of AD, the association with AD was about 70 percent greater.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, MAY 19, 2003
To contact Yves Agid, M.D., e-mail agid{at}ccr.jussieu.fr

SEVERAL FACTORS PREDICT SUCCESS FOR BRAIN SURGERY TO TREAT PARKINSON DISEASE

CHICAGO—Researchers have determined several predictors that influence the effectiveness of a brain surgery procedure used to treat advanced Parkinson disease (PD), according to an article in the May issue of The Archives of Neurology, one of the JAMA/Archives journals.

The surgery involves the placement of electrodes in part of the brain called the subthalmic nucleus (STN), which is overactive in patients with PD, according to information in the article. The hyperactivity of the STN can cause patients to experience tremors, involuntary jerking motions and stiffness. Electrodes placed in the STN stimulate this region, helping to reduce the motor disabilities characteristic of PD in some patients. However, the outcome of STN stimulation depends on proper placement of the electrodes within the brain, and certain clinical features of the patient.

Yves Agid, M.D., of Hopital de la Salpetriere, Paris, France, and colleagues studied 41 patients with PD treated by STN stimulation. The patients were all responsive to levodopa, a medication often given as the first treatment to patients with PD.

The researchers found that improvement in segmental akinesia (involuntary limb movement) and the observation of dyskinesias (tremors and movement) provoked by stimulation of the STN during the surgical procedure, but not rigidity, were predictive of an improvement of Parkinson-related motor disability after the operation. These factors also predicted a reduction in the amount of levodopa patients required after the surgery. Patients who responded to STN stimulation during surgery by exhibiting dyskinesias had better scores on Parkinsonian motor disability tests after the procedure than patients who did not exhibit dyskinesias during surgery.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, MAY 19, 2003
To contact Edwin F. Williams III, M.D., call Susan Sullivan at 518/786-7000.

PARENTS MORE EMOTIONALLY AND PSYCHOLOGICALLY AFFECTED BY DISFIGURING BIRTHMARKS ON THEIR CHILDREN

CHICAGO—The parents of children with hemangiomas (large, often red birthmarks usually found on the face that are caused by blood vessel abnormalities) are more likely to experience emotional and psychological distress over their child's condition than the children themselves, according to an article in the May/June issue of The Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.

Hemangiomas are the most common vascular lesions of infancy and childhood, affecting an estimated 1 percent to 3 percent of all newborns and 10 percent of infants by the age of one year, according to information in the article. Most hemangiomas occur on the head and neck (60 percent) and 20 percent of patients have more than one hemangioma. Because hemangiomas can be disfiguring, they can cause psychological distress for the child and parents, but most hemangiomas disappear by the time a child reaches school age. However, in cases where the hemangioma does not resolve, families may experience anxiety, and may even be accused of child abuse, according to the article. There are currently many treatments for hemangiomas, including laser treatment, steroid treatment and surgery.

Edwin F. Williams, III, M.D., of the Williams Center for Facial Plastic Surgery, Latham, N.Y., and colleagues surveyed the families of 39 children who were treated for hemangiomas about the parents' and child's emotional attitudes regarding the hemangiomas and their treatment. The hemangiomas were present between birth and 8 weeks old in the 39 children. The children were first taken to the Vascular Birthmarks Clinic in Latham, N.Y. between the ages of 2 weeks and 144 weeks by their parents for an initial consultation about possible treatments for the hemangiomas.

The researchers' survey found that there was a negative effect on the child's family, with considerable fear due to comments by others made in public. Parents responded that they believed their child was not deeply affected by his or her condition or by treatment (laser, corticosteroid injections, oral corticosteroids, surgery, or a combination). However, most parents said that their children were too young to appreciate his or her malady.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, MAY 19, 2003
To contact Paolo Carli, M.D., e-mail CARLI{at}unifi.it

SKIN SELF-EXAMINATION MAY BE HELPFUL FOR EARLY DIAGNOSIS OF MELANOMA

CHICAGO—Strategies for detecting melanomas as early as possible should include self-examination of the skin, as well as a total skin examination during dermatology visits, according to an article in the May issue of The Archives of Dermatology, one of the JAMA/Archives journals.

According to information in the article, the incidence of "thin" melanomas, or skin cancers with a more favorable prognosis, are increasing, in part, due to the improvement in early diagnosis of melanoma achieved in the past decades. However, the incidence rates of "thick" melanomas, associated with a poorer outcome, are not declining. An important objective in lowering the overall incidence of skin cancers in the future is early detection, and prevention, according to the article.

Paolo Carli, M.D., of the University of Florence, Florence, Italy, and colleagues investigated patterns of detection and variables associated with early diagnosis of melanoma in 816 patients in Italy diagnosed with melanoma and who were at a moderate risk for melanoma.

The researchers found that there was a significant association between early diagnosis and being female, having a higher educational level, residing in northern and central Italy (compared with southern Italy) and being in the habit of performing a skin self-examination. When the researchers adjusted for all these variables, they found that only detection by a dermatologist was associated with a better chance of early diagnosis.

The researchers write: "In conclusion, this study provides new insights into the fight against melanoma; it demonstrates that the pattern of detection in the Mediterranean population is similar to the patterns found in predominantly fair skinned people, and that detection by a dermatologist, maybe incidentally, is associated with better prognosis. Moreover, an SSE [skin self-examination] is an independent predictor of early diagnosis after allowance for other confounders, such as age, sex, anatomical site, and education level."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, MAY 19, 2003
To contact Kathleen A. Daly, Ph.D., call Brenda Hudson 612/624-5680.

EAR TUBE PLACEMENT CAUSES EAR PROBLEMS TO PEAK, THEN DECREASE OVER TIME

CHICAGO—Problems associated with chronic inflammation and fluid in the middle ear generally decrease after placement of ear tubes to relieve symptoms, according to an article in the May issue of The Archives of Otolaryngology — Head & Neck Surgery, one of the JAMA/Archives journals.

According to information in the article, ear drum and middle ear problems are associated with chronic otitis media with effusion (OME, inflammation of the middle ear), especially in young children who have the highest risk for developing ear problems. OME is often treated by the placement of tubes through the eardrum (tympanostomy tube placement) to help drain excess fluid, making it difficult to separate the effects of the disease from effects of treatment.

Kathleen A. Daly, Ph.D., of the University of Minnesota, Minneapolis, and colleagues investigated the incidence and prevalence of middle ear problems and eardrum problems in children with OME who had ear tubes placed.

The researchers studied 140 children for an average of 8 years after ear tube placement. The children ranged from 6 months old to 8 years old.

The researchers found that the annual incidence of ear problems was greater during three to five years of follow-up than six to eight years of follow up. The most ear problems occurred during the five year follow-up period.

The researchers write: "The annual incidence of sequelae [problems] decreased during follow-up. This finding parallels decreasing incidence of OME and tube placement as children mature and demonstrates that sequelae are more likely to develop during active acute and chronic OME. The cumulative effect of incidence resulted in few ears free of sequelae by 8 years of follow-up."