Armin F. Haerer

Prevalence of Parkinson's disease in the biracial population of Copiah County, Mississippi

A door-to-door survey of major neurologic disorders was conducted in the essentially biracial population of Copiah County, MS, using a pretested screening questionnaire. All those suspected of having Parkinsons disease were requested to have a neurologic examination by board-certified neurologists. The study also included those living in institutions. The prevalence of Parkinsons disease (age 40 +) was 347 per 100,000 inhabitants. No substantial differences in the age-adjusted prevalence ratios by race or by sex were found in the population studied. Age-specific prevalence ratios for Parkinsons disease increase with advancing age. Over 40% of identified cases were newly diagnosed during the study.

Prevalence and Clinical Features of Epilepsy in a Biracial United States Population

Summary: A need for prevalence information emphasizing racial differences prompted a door‐to‐door survey of all residents of Copiah County, Mississippi. The fieldwork involved a complete census and an extensive screening questionnaire inquiring about diagnoses, signs, and symptoms of neurologic disease. Residents who lived in institutions or had screening responses suggestive of epilepsy were requested to have an examination by neurologists who used defined diagnostic criteria. Prevalence day was 1 January 1978, and the survey yielded prevalence ratios of 1,043/100,000 inhabitants for epilepsy and 678/100,000 inhabitants for active epilepsy. Age‐adjusted prevalence ratios were somewhat higher for males and for blacks. Of the 246 identified cases of epilepsy, 37% were judged symptomatic. The leading (putative) cause was head trauma, especially among white males. About 57% of the 246 cases had been evaluated previously by a neurologist or neurosurgeon, while 7% had never been evaluated medically before the survey.

Amyotrophic lateral sclerosis and metallic toxins.

Twenty-four of a group of 31 patients with amyotrophic lateral sclerosis had been exposed to metallic toxins in their work, but no convincing evidence could be found of abnormal amounts of lead, mercury, or arsenic in the urine of 21 of the group or in necropsy tissues of two. Therapy with various chelating agents did not alter their clinical course.

Racial Differentials in the Prevalence of Major Neurological Disorders

A morbidity survey was designed to estimate the prevalence of major neurological disorders in a rural, biracial county in the south-central United States. Methods were standardized and tested, and a complete enumeration (or census) was employed for both the institutionalized and the noninstitutionalized population. People need not have entered the health care system for detection of their disorders. The survey generated age-, sex-, and race-specific prevalence ratios. This report provides information useful for interpreting the survey findings and for planning similar investigations.

Stroke rates in patients with lacunar and large vessel cerebral infarctions

A stroke registry was developed to determine the value of various clinical data in distinguishing lacunar from large vessel infarctions. Adequate localization was achieved in 98% of 246 patients with brain infarcts. These and 30 transient ischemic attack patients were followed for a median of 1082 days (range 2-1657). Follow-up data on TIA patients were invalidated by evidence of serious underreporting of TIAs in our general population. Among 212 male patients with cerebral infarcts not due to cardiogenic embolism, syphilis, migraine, vasculitis, or other unusual etiologies, 1-, 12-, and 36-month recurrence rates were 23%, 31% and 39% among patients with large vessel anterior circulation infarcts; 15%, 20% and 28% among patients with large vessel posterior circulation infarcts; and 8%, 16% and 21% among patients with lacunar anterior circulation infarcts, respectively. Six patients with posterior circulation lacunes did not experience recurrence. Comparative case fatality data were also compiled. Large vessel infarcts tended to be followed by further large vessel infarcts, usually in the same vascular distribution, whereas lacunar infarcts were not predictive of the type or location of subsequent events.

PREVALENCE SURVEYS OF NEUROLOGIC DISORDERS: METHODOLOGIC IMPLICATIONS OF THE COPIAH COUNTY STUDY

This article addresses three questions to be answered during the planning of prevalence surveys of chronic disorders in geographically defined populations: (a) Should personal interviews be used alone (i.e. without accompanying physical examinations) to find and confirm cases in a household population? (b) As an alternative means of identifying cases, is it adequate to review patient records from hospitals and clinics serving the population to be surveyed? (c) Should population members residing in institutions of long-term care be made ineligible for the anticipated survey? Data on major neurologic disorders, obtained from the Copiah County Study, are used to suggest caution in answering any of these questions in the affirmative, since in particular circumstances the consequences for the intended research may be serious or even disastrous. For example, with 42% of Parkinsons disease cases diagnosed for the first time during the study, a casefinding approach solely through medical-care providers would have been highly questionable for that disorder.

Visual Field Defects and the Prognosis of Stroke Patients

The prognosis of stroke patients is related to the presence or absence of homonymous hemianopia at time of admission to a stroke center. Two hundred thirty-four patients were followed for an average of 15 months. In patients with nonhemorrhagic strokes in the middle cerebral artery territory the presence of a dense homonymous hemianopia lasting for more than 24 hours, together with any degree of motor, sensory or speech defect, seemed to affect adversely the potential for rehabilitation and survival. Data were insufficient to draw similar conclusions with other types of cerebrovascular lesions. The pertinent literature is briefly reviewed.

Cerebrovascular Disease of Young Adults in a Mississippi Teaching Hospital

Two hundred and seven consecutive inpatients aged 15 to 50 with cerebrovascular disease at the University of Mississippi Medical Center were studied and followed up for an average of two and one-half years. Most of the patients arrived in the hospital in the acute stage of their disease. There was a rising trend for the onset of strokes with age in general, but this varied for different types of cerebrovascular disease. The diagnoses are detailed by age, race, and sex, and the prognosis is given for each subgroup. Patients with cerebral thrombosis or transient ischemic attacks had the best prognosis in this age group and thus are ideal candidates for rehabilitation and detailed study. The incidence of hypertension, concomitant major illnesses and laboratory abnormalities is given for each subgroup. The prognosis of patients in each subgroup is related to their initial motor deficit and level of consciousness.

Acute cerebral infarction. Evaluation and treatment.

Patients with recent strokes, suspected strokes, or transient ischemic attacks should be hospitalized to permit comprehensive evaluation and initiation of proper therapy. Immediate short-term measures to prevent further brain infarction may be advisable. In many cases definite heart or lung disease is present and requires primary treatment.