From clues to mechanisms: understanding ALS initiation and spread.

Baystate Medical Center/Tufts University School of Medicine, 759 Chestnut Street, S4648, Springfield, MA 01199 .
Neurology (Impact Factor: 8.25). 10/2008; 71(12):872-3. DOI: 10.1212/01.wnl.0000325992.50108.60
Source: PubMed
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    ABSTRACT: OBJECTIVES: To examine whether there is a continued increase in neurological deaths in the major developed countries over the period 1979-2010. STUDY DESIGN: Analyzes changing patterns of neurological deaths and Total Mortality of people aged 55-74 years by sex. METHODS: Baseline WHO 3-year average mortality for 1979-81 were compared with changes in 2008-10, for Total Mortality and the neurological categories Nervous Disease, and Alzheimer & other Dementias deaths in rates per million. To control for different diagnostic practice, the focus is upon Total Neurological Deaths in relation to Total Mortality and Odds ratios are calculated. UK Motor Neuron Disease, Parkinson's disease and variant CJD are explored as possible constituent categories of Nervous Disease for other countries. RESULTS: Total Mortality fell substantially in every country, conversely, Nervous Disease and Alzheimer's rose in seven and six countries respectively. Total Neurological Deaths for males and females increased significantly in Australia, Canada, England & Wales, Italy, the Netherlands and especially the USA. Unlike motor neurone disease, variant CJD' deaths in England and Wales did not contribute substantially to the overall neurological increases found. Odds ratios indicated that neurological deaths differentially increased significantly in every country compared to Total Mortality. CONCLUSIONS: These results pose a major public health problem, as the epigenetic contribution to these changes, rather than longevity, have serious implications indicating earlier onset of neurological morbidity pressurizing families, health and social care services, with resource implications especially for Australia, Canada, Italy, Netherlands, Spain, the UK and the USA.
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