WORLD HOSPITAL DIRECTORY
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Hon. H.E. Sir. Dr. Raphael Louis-PM Candidate (2015 - 2020)


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WORLD HOSPITAL DIRECTORY is the one and only largest database of hospitals around the world. There are over 65,000 plus records of hospitals across globe with geo data viz Longitude, Latitude, UTM, GPS, Lombard projection, map, etc, thereby enabling the browsers to know to distance between the searched Hospital and the browsers.

WORLD HOSPITAL DIRECTORY has the World's largest online database of general, multispeciality, eye, dental, children, maternity, cardiac care, orthopedic, nephrology, neurology, diabetic, psychiatric, cancer, ENT, hospice, Rehabilitation, alternate medicine, veterinary hospitals across globe. Discover the complete list of hospitals available in North America, South America, Europe, Asia, Australia, New Zealand, rest of the world and online.

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1CEMIC
CEMIC
Category: General Hospitals
Argentina
South America, America
2Croydon Hospital (Tablelands HSD)
Croydon Hospital (Tablelands HSD)
Category: Mulispeciality Hospitals
Australia
Australia and New Zealand, Oceanic
3Regionaal Hospital Sint-Maria
Regionaal Hospital Sint-Maria
Category: Mulispeciality Hospitals
Belgium
Western Europe, Europe
4Bairro Passo D'areia Farmaconte Dist. Produtos Hospitalares Ltda.
Bairro Passo D'areia Farmaconte Dist. Produtos Hospitalares Ltda.
Category: Mulispeciality Hospitals
Brazil
South America, America
5BCIT - Technology Centre, Health Technology Research Group
BCIT - Technology Centre, Health Technology Research Group
Category: General Hospitals
Canada
North America, America

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Stopping Hospital Infections
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Protect Yourself Against the Flu Vaccine!
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Increasing Patient Care and Reducing Liability in Seven Simple Steps
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CT and MRI Scans in Neurological Practice
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Alcohol Rehabilitation Centers - Take An Informed Decision
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Arthritis Pain Relief : FAQ
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Teaching NeuroImages: Superficial siderosis due to a dural cervical arteriovenous fistula
<p>A 58-year-old man presented to our hospital with cerebellar ataxia, pyramidal signs, dysarthria, bilateral deafness, and cognitive impairment. These symptoms were consistent with superficial siderosis (SS) of the CNS, confirmed by MRI (figure A).<sup>1</sup> Cerebral angiography showed a dural arteriovenous fistula perispinal and pontic with venous drainage in the left foramen C1-C2, fed by meningeal branches of the vertebral artery (figure, B). The fistulous point was clipped. SS of CNS is a&nbsp;rare&nbsp;disease resulting from hemosiderin deposition on the surface of the CNS and cranial nerves.<sup>2</sup>&nbsp;At diagnosis, the etiology may not be known. Finding etiology is necessary (trauma, vascular malformation).<sup>2</sup></p>


Teaching NeuroImages: Multiple clinical manifestations of a ganglionic sympathetic defect
<p>A 39-year-old woman with longstanding asymmetric facial flushing noticed episodic deformation of her left pupil (figure 1), which 2 months later became miotic. Despite no ptosis, a left Horner syndrome was pharmacologically confirmed (figure 2). She also had left cheek pain, present only at mealtime. Radiologic investigations were normal.</p>


Spotlight on the February 21 issue


Epilepsy and unintended pregnancies
<p>Women with epilepsy (WWE) have increased risk of adverse pregnancy outcomes for both the mother and child.<sup>1,2</sup> Some of these risks can be reduced by planning prior to pregnancy. Risks of major congenital malformations and adverse cognitive/behavioral outcomes are higher for certain antiepileptic drugs (AEDs). For example, guidelines recommend avoiding the use of valproate during pregnancy.<sup>1</sup> However, waiting until a woman knows she is pregnant and contacts her physician creates a risk of fetal exposure during early pregnancy. Further, changing AED during pregnancy risks precipitating seizures. Waiting until a woman is planning pregnancy does not work as many pregnancies are unplanned. Even in the general population, unintended pregnancies may increase the risk of unfavorable outcomes and of abortions (42% in 2011 excluding miscarriages).<sup>3,4</sup> Thus, understanding the rates of unintended pregnancy in WWE is important. No prior large-scale studies have examined the rate and predictors of unintended pregnancies in WWE, despite the fact that some AEDs with enzyme-inducing properties can lower hormonal contraceptive levels.</p>


How can neurologists avoid burnout?
<p>Over the last decade, surveys of American physicians have shown an alarming decrease in professional satisfaction and well-being accompanied by an increase in the symptoms of burnout.<sup>1</sup> Physician burnout is a dysfunctional syndrome comprising emotional exhaustion, cynicism, depersonalization, and loss of empathy, accompanied by career dissatisfaction, from a feeling of meaninglessness of work and a sense of low personal esteem and accomplishment.<sup>2</sup> Burnout represents a growing problem because it leads to serious harm to both physicians and patients. It produces physician impairment with poor judgment, treating patients as objects, medical errors, and poorer patient outcomes. Burned-out physicians exhibit work&ndash;life imbalance and conflicts, abandon the profession, elect premature retirement, and experience higher rates of depression, substance abuse, and suicide.<sup>3</sup></p>


Predictors of unintended pregnancy in women with epilepsy
<sec><st>Objective:</st> <p>To determine whether rates of unintended pregnancy in women with epilepsy (WWE) vary by contraceptive category and when stratified by antiepileptic drug (AED) category.</p> </sec> <sec><st>Methods:</st> <p>These retrospective data come from the Epilepsy Birth Control Registry (EBCR) web-based survey of 1,144 WWE in the community, 18&ndash;47 years of age, who provided demographic, epilepsy, AED, contraceptive, and pregnancy data. Participants indicated whether pregnancies were intended or unintended, as well as the type of contraceptive and AED used at conception. We report failure rates relative to the frequency of use of each contraceptive category in the EBCR.</p> </sec> <sec><st>Results:</st> <p>Most WWE (78.9%) reported having at least one unintended pregnancy; 65.0% of their pregnancies were unintended. Unintended pregnancy was more common among younger, racial minority, and Hispanic WWE. Among reversible contraceptive categories, the intrauterine device had the lowest failure rate. Failure rates varied greatly on systemic hormonal contraception (HC), depending on whether oral or nonoral forms were used and especially in relation to the category of AED with which HC was combined. Oral forms had greater failure rate than nonoral forms. HC combined with enzyme-inducing AEDs had a substantially greater failure rate than HC combined with no AED or any other AED category and in comparison to barrier plus any AED category. Other AED&ndash;HC combinations, in contrast, carried lower risks than barrier.</p> </sec> <sec><st>Conclusions:</st> <p>Unintended pregnancy is common among WWE and may vary by contraceptive category and AED stratification. In view of the important consequences of unintended pregnancy on pregnancy outcomes, these retrospective findings warrant further prospective investigation.</p> </sec>


Multimodal MRI profiling of focal cortical dysplasia type II
<sec><st>Objective:</st> <p>To characterize in vivo MRI signatures of focal cortical dysplasia (FCD) type IIA and type IIB through combined analysis of morphology, intensity, microstructure, and function.</p> </sec> <sec><st>Methods:</st> <p>We carried out a multimodal 3T MRI profiling of 33 histologically proven FCD type IIA (9) and IIB (24) lesions. A multisurface approach operating on manual consensus labels systematically sampled intracortical and subcortical lesional features. Geodesic distance mapping quantified the same features in the lesion perimeter. Logistic regression assessed the relationship between MRI and histology, while supervised pattern learning was used for individualized subtype prediction.</p> </sec> <sec><st>Results:</st> <p>FCD type IIB was characterized by abnormal morphology, intensity, diffusivity, and function across all surfaces, while type IIA lesions presented only with increased fluid-attenuated inversion recovery signal and reduced diffusion anisotropy close to the gray&ndash;white matter interface. Similar to lesional patterns, perilesional anomalies were more marked in type IIB extending up to 16 mm. Structural MRI markers correlated with categorical histologic characteristics. A profile-based classifier predicted FCD subtypes with equal sensitivity of 85%, while maintaining a high specificity of 94% against healthy and disease controls.</p> </sec> <sec><st>Conclusions:</st> <p>Image processing applied to widely available MRI contrasts has the ability to dissociate FCD subtypes at a mesoscopic level. Integrating in vivo staging of pathologic traits with automated lesion detection is likely to provide an objective definition of lesional boundary and assist emerging approaches, such as minimally invasive thermal ablation, which do not supply tissue specimen.</p> </sec>


Dysarthria and broader motor speech deficits in Dravet syndrome
<sec><st>Objective:</st> <p>To analyze the oral motor, speech, and language phenotype in 20 children and adults with Dravet syndrome (DS) associated with mutations in <I>SCN1A</I>.</p> </sec> <sec><st>Methods:</st> <p>Fifteen verbal and 5 minimally verbal DS patients with <I>SCN1A</I> mutations (aged 15 months-28 years) underwent a tailored assessment battery.</p> </sec> <sec><st>Results:</st> <p>Speech was characterized by imprecise articulation, abnormal nasal resonance, voice, and pitch, and prosody errors. Half of verbal patients had moderate to severely impaired conversational speech intelligibility. Oral motor impairment, motor planning/programming difficulties, and poor postural control were typical. Nonverbal individuals had intentional communication. Cognitive skills varied markedly, with intellectual functioning ranging from the low average range to severe intellectual disability. Language impairment was congruent with cognition.</p> </sec> <sec><st>Conclusions:</st> <p>We describe a distinctive speech, language, and oral motor phenotype in children and adults with DS associated with mutations in <I>SCN1A.</I> Recognizing this phenotype will guide therapeutic intervention in patients with DS.</p> </sec>


Prevalence of epilepsy/seizures as a comorbidity of neurologic disorders in nursing homes
<sec><st>Objective:</st> <p>To determine the prevalence of epilepsy/seizure (epi/sz) comorbid with other neurologic disorders in elderly nursing home residents and to examine demographic and regional variability and associations with clinical characteristics.</p> </sec> <sec><st>Methods:</st> <p>We studied 5 cross-sectional cohorts of all residents in any Medicare/Medicaid&ndash;certified nursing home in the United States on July 15 of each year from 2003 to 2007. Epi/sz was identified by ICD-9 codes (345.xx or 780.39) or check box (Minimum Data Set). Epi/sz prevalence was stable across all years, so only 2007 data were examined further. Logistic regression with generalized estimating equations was used to model cross-sectional prevalence of epi/sz as a function of demographics and neurologic comorbidities of interest, with adjustment for clinical characteristics, including cognitive status, comorbidity burden, medication burden, and activities of daily living.</p> </sec> <sec><st>Results:</st> <p>Point prevalence of epi/sz in 2007 was 7.7% (n = 91,372 of N = 1,186,579) differing by geographical region, race/ethnicity, age group, and sex. Neurologic conditions having the highest association with epi/sz were brain tumor (epi/sz prevalence 23.4%&ndash;35.2%), head injury (17.9%), hemiplegia (17.7%), and stroke (13.7%). Epi/sz comorbid with stroke or dementia had a strong decreasing association with age (65&ndash;74 years had 3.8-times higher odds of epi/sz than 85+ years). Activities of daily living, comorbidity burden, and cognition scores were worse in persons with than without epi/sz.</p> </sec> <sec><st>Conclusions:</st> <p>The prevalence of epi/sz in the elderly nursing home population is &gt;7-fold higher compared to community-dwelling elderly and is 7 to 30 times higher among those with certain comorbid neurologic conditions. Demographics and clinical characteristics had weaker associations with epi/sz prevalence.</p> </sec>


Frontotemporal dementia with the V337M MAPT mutation: Tau-PET and pathology correlations
<sec><st>Objective:</st> <p>To assess the efficacy of [<sup>18</sup>F]AV1451 PET in visualizing tau pathology in vivo in a patient with frontotemporal dementia (FTD) associated with the V337M microtubule-associated protein tau (<I>MAPT)</I> mutation.</p> </sec> <sec><st>Methods:</st> <p><I>MAPT</I> mutations are associated with the deposition of hyperphosphorylated tau protein in neurons and glia. The PET tracer [<sup>18</sup>F]AV1451 binds with high affinity to paired helical filaments tau that comprises neurofibrillary tangles in Alzheimer disease (AD), while postmortem studies suggest lower or absent binding to the tau filaments of the majority of non-AD tauopathies. We describe clinical, structural MRI, and [<sup>18</sup>F]AV1451 PET findings in a V337M <I>MAPT</I> mutation carrier affected by FTD and pathologic findings in his affected mother and in an unrelated V337M <I>MAPT</I> carrier also affected with FTD. The biochemical similarity between paired helical filament tau in AD and <I>MAPT</I> V337M predicts that the tau pathology associated with this mutation constitutes a compelling target for [<sup>18</sup>F]AV1451 imaging.</p> </sec> <sec><st>Results:</st> <p>We found a strong association between topography and degree of [<sup>18</sup>F]AV1451 tracer retention in the proband and distribution of tau pathology in the brain of the proband's mother and the unrelated V337M mutation carrier. We also found a significant correlation between the degree of regional MRI brain atrophy and the extent of [<sup>18</sup>F]AV1451 binding in the proband and a strong association between the proband's clinical presentation and the extent of regional brain atrophy and tau accumulation as assessed by structural brain MRI and [<sup>18</sup>F]AV1451PET.</p> </sec> <sec><st>Conclusion:</st> <p>Our study supports the usefulness of [<sup>18</sup>F]AV1451 to characterize tau pathology in at least a subset of pathogenic <I>MAPT</I> mutations.</p> </sec>


Natural course of mild cognitive impairment in Parkinson disease: A 5-year population-based study
<sec><st>Objective:</st> <p>To examine the incidence, progression, and reversion of mild cognitive impairment in patients with Parkinson disease (PD-MCI) over 5 years.</p> </sec> <sec><st>Methods:</st> <p>A population-based cohort of patients with incident PD underwent repeated neuropsychological testing of attention, executive function, memory, and visuospatial abilities at baseline (n = 178), 1 year (n = 175), 3 years (n = 163), and 5 years (n = 150). Patients were classified as PD-MCI and diagnosed with dementia according to published criteria.</p> </sec> <sec><st>Results:</st> <p>Thirty-six patients (20.2%) fulfilled criteria for PD-MCI at baseline. Among those with normal cognition at baseline (n = 142), the cumulative incidence of PD-MCI was 9.9% after 1 year, 23.2% after 3 years, and 28.9% after 5 years of follow-up. Overall, 39.1% of patients with baseline or incident PD-MCI progressed to dementia during the 5-year study period. The conversion rate to dementia was 59.1% in patients with persistent PD-MCI at 1 year vs 7.2% in those with normal cognition during the first year (adjusted odds ratio 16.6, 95% confidence interval 5.1&ndash;54.7, <I>p</I> &lt; 0.001). A total of 27.8% of patients with baseline PD-MCI and 24.2% of those with incident PD-MCI had reverted to normal cognition at study end, but the reversion rate decreased to 9.4% in those with persistent PD-MCI at 2 consecutive visits. Compared with cognitively normal patients, PD-MCI reverters within the first 3 years of follow-up were at increased risk of subsequently developing dementia (adjusted odds ratio 10.7, 95% confidence interval 1.5&ndash;78.5, <I>p</I> = 0.019).</p> </sec> <sec><st>Conclusions:</st> <p>Early PD-MCI, regardless of persistence or reversion to normal cognition, has prognostic value for predicting dementia in patients with PD.</p> </sec>


Decreased intestinal acetylcholinesterase in early Parkinson disease: An 11C-donepezil PET study
<sec><st>Objective:</st> <p>To investigate systemic levels of acetylcholinesterase in early Parkinson disease (PD) with <sup>11</sup>C-donepezil PET, a potential marker of parasympathetic innervation.</p> </sec> <sec><st>Methods:</st> <p>This was a cross-sectional study with 19 patients with early-stage PD (disease duration 1.5 &plusmn; 0.6 years) and 16 age-matched controls who had clinical assessments, olfaction tests, and <sup>11</sup>C-donepezil PET to measure acetylcholinesterase density in peripheral organs.</p> </sec> <sec><st>Results:</st> <p>The patients with PD showed significantly reduced <sup>11</sup>C-donepezil uptake in the small intestine (&ndash;14%, <I>p</I> = 0.018), colon (&ndash;22%, <I>p</I> &lt; 0.001), and kidneys (&ndash;14%, <I>p</I> = 0.028). No difference in myocardial or pancreatic acetylcholinesterase levels was seen.</p> </sec> <sec><st>Conclusion:</st> <p>We found significantly decreased <sup>11</sup>C-donepezil signal in the intestine and kidneys of patients with early PD, suggesting that parasympathetic denervation is present early in the disease course.</p> </sec>


Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage
<sec><st>Objective:</st> <p>To evaluate the associations among diffusion-weighted imaging (DWI) lesions, blood pressure (BP) dysregulation, MRI markers of small vessel disease, and poor outcome in a large, prospective study of primary intracerebral hemorrhage (ICH).</p> </sec> <sec><st>Methods:</st> <p>The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a multicenter, observational study of ICH among white, black, and Hispanic patients.</p> </sec> <sec><st>Results:</st> <p>Of 600 patients, mean (&plusmn;SD) age was 60.8 &plusmn; 13.6 years, median (interquartile range) ICH volume was 9.1 mL (3.5&ndash;20.8), and 79.6% had hypertension. Overall, 26.5% of cases had DWI lesions, and this frequency differed by race/ethnicity (black 33.8%, Hispanic 24.9%, white 20.2%, overall <I>p</I> = 0.006). A logistic regression model of variables associated with DWI lesions included lower age (odds ratio [OR] 0.721, <I>p</I> = 0.002), higher first recorded systolic BP (10-unit OR 1.12, <I>p</I> = 0.002), greater change in mean arterial pressure (MAP) prior to the MRI (10-unit OR 1.10, <I>p</I> = 0.037), microbleeds (OR 1.99, <I>p</I> = 0.008), and higher white matter hyperintensity (WMH) score (1-unit OR 1.16, <I>p</I> = 0.002) after controlling for race/ethnicity, leukocyte count, and acute in-hospital antihypertensive treatment. A second model of variables associated with poor 90-day functional outcome (modified Rankin Scale scores 4&ndash;6) included DWI lesion count (OR 1.085, <I>p</I> = 0.034) as well as age, ICH volume, intraventricular hemorrhage, Glasgow Coma Scale score, WMH score, race/ethnicity, acute in-hospital antihypertensive treatment, and ICH location.</p> </sec> <sec><st>Conclusions:</st> <p>These results support the hypotheses that acute BP dysregulation is associated with the development of DWI lesions in primary ICH and that DWI lesions are, in turn, associated with poor outcomes.</p> </sec>


Evolution of cerebral microbleeds after cranial irradiation in medulloblastoma patients
<sec><st>Objective:</st> <p>To characterize the temporal and spatial pattern of cerebral microbleeds (CMBs) after cranial irradiation in patients with medulloblastoma.</p> </sec> <sec><st>Methods:</st> <p>We retrospectively identified patients with medulloblastoma treated with craniospinal irradiation at the Massachusetts General Hospital between 1999 and 2015. Longitudinal MRI including T2*-weighted gradient-recalled echo (GRE) sequences were reviewed, and the prevalence, spatial pattern, and risk factors associated with CMBs were characterized.</p> </sec> <sec><st>Results:</st> <p>We identified a total of 27 patients; 5 patients were children (median age 6.3 years) and 22 patients were adults (median age 28.8 years). CMBs were found in 67% (18/27) of patients, who were followed for a median of 4.1 years. Patients with CMBs had longer GRE follow-up time compared to those without CMBs (4.9 vs 1.7 years, <I>p</I> = 0.035). The median latency of the appearance of CMBs was 2.79 years (interquartile range 1.76&ndash;4.26). The prevalence of CMBs increased with each year from time of radiation therapy, and the cumulative prevalence was highest in patients age &lt;20 years (100% cumulative prevalence, vs 59% in adult patients treated at age &ge;20 years). CMBs were mostly found in lobar distribution and predominately in bilateral occipital lobes. Patients using antithrombotic medications developed CMBs at a significantly higher rate (<I>p</I> = 0.041).</p> </sec> <sec><st>Conclusions:</st> <p>Our data demonstrate a high prevalence of CMBs following cranial irradiation, progressively increasing with each year from time of radiation therapy.</p> </sec>


Burnout, career satisfaction, and well-being among US neurologists in 2016
<sec><st>Objective:</st> <p>To study prevalence of and factors that contribute to burnout, career satisfaction, and well-being in US neurologists.</p> </sec> <sec><st>Methods:</st> <p>A total of 4,127 US American Academy of Neurology member neurologists who had finished training were surveyed using validated measures of burnout, career satisfaction, and well-being from January 19 to March 21, 2016.</p> </sec> <sec><st>Results:</st> <p>Response rate was 40.5% (1,671 of 4,127). Average age of participants was 51 years, with 65.3% male and nearly equal representation across US geographic regions. Approximately 60% of respondents had at least one symptom of burnout. Hours worked/week, nights on call/week, number of outpatients seen/week, and amount of clerical work were associated with greater burnout risk. Effective support staff, job autonomy, meaningful work, age, and subspecializing in epilepsy were associated with lower risk. Academic practice (AP) neurologists had a lower burnout rate and higher rates of career satisfaction and quality of life than clinical practice (CP) neurologists. Some factors contributing to burnout were shared between AP and CP, but some risks were unique to practice setting. Factors independently associated with profession satisfaction included meaningfulness of work, job autonomy, effectiveness of support staff, age, practicing sleep medicine (inverse relationship), and percent time in clinical practice (inverse relationship). Burnout was strongly associated with decreased career satisfaction.</p> </sec> <sec><st>Conclusions:</st> <p>Burnout is common in all neurology practice settings and subspecialties. The largest driver of career satisfaction is the meaning neurologists find in their work. The results from this survey will inform approaches needed to reduce burnout and promote career satisfaction and well-being in US neurologists.</p> </sec>


Transient smartphone blindness: Relevance to misdiagnosis in neurologic practice
<p>Transient smartphone blindness (TSB) was recently described in 2 women who experienced recurrent episodes of monocular vision impairment immediately after viewing a smartphone.<sup>1</sup> This physiologic phenomenon is caused by temporarily discrepant light adaptation levels between the 2 retinae. We confirm the phenomenon of TSB and its relevance to neurologic practice, including the potential for misdiagnosis as cerebrovascular disease or multiple sclerosis (MS).</p>


MRI findings in Collet-Sicard syndrome
<p>A 44-year-old woman presented with 4 weeks of increasing neck pain and newly arising dysphagia and hoarseness. Examination was remarkable for left tongue atrophy and fibrillations, tongue deviation to the left, left vocal cord paralysis, and trapezius and sternocleidomastoid muscle wasting (figure) (Collet-Sicard syndrome, CN IX-CNXII paralysis<sup>1,2</sup>). Workup revealed a partially calcified left cervical glomus jugulare tumor extending from the jugular foramen into the parapharyngeal space (figure, A). The tumor encased the left internal carotid artery, CNXI, and CNXII. The inoperable lesion was treated with external beam radiation therapy (45 Gy, 25 fractions). Her neurologic syndrome remains stable with improved pain.</p>


Editors' Note
<p>Editors' Note: In WriteClick this week, referencing "Calcium supplementation and risk of dementia in women with cerebrovascular disease," Dr. Rosenberg questions whether "the steep increase in calcium levels" after supplementation should be cited as a possible mechanism for the increased risk of dementia seen in the study, given that the absolute increase is relatively small and occurs over several hours.</p>


Letter re: Calcium supplementation and risk of dementia in women with cerebrovascular disease
<p>Kern et al.<sup>1</sup> reported that calcium supplementation may increase the risk of dementia in elderly women with cerebrovascular disease. Among the possible mechanisms that could explain this association, the authors mentioned "the steep increase in serum calcium levels caused by the supplements."<sup>1</sup> This statement was referenced to a previous publication,<sup>2</sup> which described the supplement-induced increase in serum calcium as "modest" based on the results of an earlier study in young healthy participants.<sup>3</sup> A more recent study in overweight, but otherwise healthy, postmenopausal women administered a single dose of 500 mg elemental calcium supplement after pretreatment with 10 &mu;g 25(OH)D3 and found that the maximal increase in serum level of ionized calcium postdosing was in the vicinity of 0.3 mg/dL (i.e., approximately only 5% of the upper limit of this ion's normal serum concentration); this change peaked 3&ndash;5 hours after the supplement's ingestion.<sup>4</sup> Such a small increase over several hours can hardly be termed "steep." The mechanism, if any, linking the increased dementia risk with calcium supplementation should be looked for outside the realm of calcium's pharmacokinetics.</p>


Letter re: Calcium supplementation and risk of dementia in women with cerebrovascular disease
<p>Kern et al.<sup><cross-ref type="bib" refid="R1">1</cross-ref></sup> conducted a small, observational, retrospective, longitudinal, population-based cohort study of calcium supplementation and increased dementia risk in elderly women. Women who took calcium supplementation had higher odds of dementia. However, the number of individuals taking calcium supplements without vitamin D was low and compromised the reliability of the results. The sample size (n = 98) in the calcium supplements group included women taking calcium supplements with 85.7% (84 of 98) also taking vitamin D.<sup>1</sup> The authors, recognizing vitamin D as a confounding variable, included it in regression models and stated that vitamin D did not affect the "main results."<sup>1</sup> However, controlling for vitamin D would not improve statistical power. Women taking calcium supplements with vitamin D should have been excluded at baseline because the dependent variable in the hypothesis was calcium supplementation alone.<sup>1</sup> The calcium supplement group was described as "women treated with calcium supplements,"<sup>1</sup> but they were actually women treated with calcium supplements, most of whom took vitamin D. Thus, the study hypothesis of calcium supplementation association with an increased risk of dementia was tested with a small sample size of 98 where only 14 individuals were relevant to the research question.</p>


Author response: Calcium supplementation and risk of dementia in women with cerebrovascular disease
<p>We thank Drs. Rosenberg and Beale for the interesting comments on our article.<sup>1</sup></p>