Vocal Cord Dysfunction in Amyotrophic Lateral Sclerosis
Significant glottic narrowing due to vocal cord dysfunction in patients with amyotrophic lateral sclerosis is described by van der Graaff and colleagues (SEE ARTICLE). Both nuclear and supranuclear mechanisms may play a role. They point out that vocal cord dysfunction can occur at any stage of the disease, may account for sudden death in amyotrophic lateral sclerosis, and requires vigilant airway management.

Autoimmune Targets to Heart and Skeletal Muscles in Myasthenia Gravis
Suzuki et al (SEE ARTICLE) report that heart and skeletal muscles are autoimmune targets in patients with myasthenia gravis. This autoimmunity has a broad clinical spectrum with antistriational autoantibodies. The involvement of the heart in myasthenia gravis needs to be defined early and treated with aggressive immunotherapy, which has had a good clinical outcome. Editorial perspective is provided by Johan A. Aarli, MD. (SEE ARTICLE)

Muscle Strength and Rate of Cognitive Decline in Alzheimer Disease
Boyle and colleagues (SEE ARTICLE) show that an increase in muscle strength is associated with a significant decrease in the risk of Alzheimer disease, as found in community-based older persons without dementia at baseline. Further, muscle strength was associated with a decreased risk of mild cognitive impairment. These observations support the view that exercise has a beneficial effect of reducing the risk of developing significant cognitive loss and dementia.

Magnetic Resonance Imaging Predictors for Conversion to Multiple Sclerosis
Moraal et al (SEE ARTICLE) find that at least 9 T2 lesions and 3 periventricular lesions show strong prognostic value for conversion to clinically definite multiple sclerosis, though all patients in the study received interferon beta-1b for a least 1 year. These findings are important in providing an accurate assessment and grading of patient prognosis and response to therapy.

Clinical Features in Early Parkinson Disease Predict Survival
Lo and colleagues (SEE ARTICLE) describe specific motor and nonmotor features in early Parkinson disease that predict increased mortality risk, particularly postural instability gait difficulty, cognitive impairment, and hallucinations. Clearly, these predictors will be useful in clinical practice and when designing clinical trials.

Figure 1. Kaplan-Meier plot of time to death for clinical subtype. PIGD, postural instability gait difficulty.

Figure 2. Kaplan-Meier plot of time to death for cognitive impairment.

Survival Profiles in Frontotemporal Dementia and Motor Neuron Disease
Hu et al (SEE ARTICLE) provide clarity and focus in describing the distinct patterns of survival profiles in patients with frontotemporal dementia and motor neuron disease. Overall survival may depend on the relative timing of emergence of secondary symptoms.

Macular Volume by Optical Coherence Tomography and Neuronal Loss in Multiple Sclerosis
Burkholder and colleagues (SEE ARTICLE) show, using ocular coherence tomography, that reduced macular volumes were associated with peripapillary retinal nerve fiber layer thinning (axon loss). This diagnostic method offers a means to quantitate the degree of neuronal loss for grading disease activity and responsiveness to therapy.

Optical Coherence Tomography in Clinically Isolated Syndrome
Outteryck et al (SEE ARTICLE) indicate that optical coherence tomography does not show retinal axonal loss at the earliest clinical stage of multiple sclerosis and does not predict conversion to multiple sclerosis at 6 months.

Family History and Apolipoprotein E 4 Status and Cognitive Decline in the Absence of Alzheimer Disease: The Cache County Study
Hayden and colleagues (SEE ARTICLE) report that much of the association between family history of Alzheimer disease, apolipoprotein E 4, and cognitive decline is attributed to undetected incipient or latent disease.

Hippocampus and Memory Performance in an Aging Population
Reitz et al (SEE ARTICLE) find that in early Alzheimer disease, or in nondemented persons with impaired memory ability, functional and metabolic hippocampal hypofunction contribute to memory impairment.

Brain Volume, Hippocampal Volume, Cerebrovascular Risk Factors, and Apolipoprotein E 4 in Mild Cognitive Impairment Subtypes
He and colleagues (SEE ARTICLE) report that amnestic forms of mild cognitive impairment appear to have demographic, genetic, and magnetic resonance imaging findings suggestive of Alzheimer disease pathology, where as the nonamnestic forms have findings suggestive of vascular disease. These distinctions have considerable value in appreciating the neurobiology of disease for these different syndromes and potential therapies.

Lipid Profile and Risk of Ischemic Stroke: The Northern Manhattan Study
Willey et al (SEE ARTICLE) find that baseline lipid panel components were not associated with an increased stroke risk in the cohort. Treatment with cholesterol-lowering medications and changes in low-density lipoprotein cholesterol over time may have attenuated risks in this population, and lipid measurements at several points over time are a better marker of stroke risk.