Current Status and Perspectives in the Kanagawa Birth Defects Monitoring Program (KAMP)*

ABSTRACT The Kanagawa Birth Defects Monitoring Program has been in operation since October 1981 as the first population-based monitoring system in Japan. By the end of 1983, baseline rates of 48 marker malformations were calculated from 100,000 births. Several biological factors increase the incidence of malformations. They include stillbirth, low birth weight, small for gestational age, consanguinity and multiple birth. In the case of obvious deviations from the baseline rates, artificial factors should be ruled out prior to the decision of true deviations. The accuracy of KAMP seems to be high by the monitor of Down syndrome as an indicator. In order to establish the population-based program, covering all or nearly all births in a whole country, the following conditions should be satisfied: 1) the adoption of common marker malformations with clear definitions, 2) the standardization of the systems, 3) the standardized data analysis and the follow up procedures of “alarms,” 4) a better classification system of birth defects, 5) the official government sanction and financial support.     

Adverse effects of anticholinergic activity on cognitive functions in Alzheimer's disease

Background:  Elderly patients with Alzheimer's disease (AD) take more medicines, other than those for anti-dementia agents, than healthy people and are sensitive to anticholinergic medications. There are only a few reports, however, on the relationship between cognitive function and anticholinergic activity in AD patients, which is caused by taking prescribed medication.
Methods:  We measured serum anticholinergic activity (SAA) in 76 AD patients referred to a Psychogeriatric Unit and separated them into SAA positive group ( n = 26, SAA (+) group) and SAA negative group ( n = 50, SAA (−) group). The difference in demographic data and cognitive functions were compared between the two groups.
Results and Conclusions:  The total scores of the Mini-Mental State Examination (MMSE), the score of MMSE domain of registration and recall were significantly lower ( P < 0.05) and the Functional Assessment Staging (FAST) score, the number of different kinds of prescribed psychotropic medications (the number of prescribed psychotropic medications) were significantly higher ( P < 0.05) in the SAA (+) group than in the SAA (−). These results suggest that a higher number of psychotropic medications prescribed leads to a tendency for SAA to be positive and that anticholinergic activity accelerates Alzheimer's pathology and decreases cognitive function, especially memory in AD patients. We should more prudently prescribe psychotropic medications to AD patients, because the prescribed psychotropic medications are one of the important causes of decline in cognitive function of AD patients by way of anticholinergic activity.     

STIMULATION OF CYCLIC AMP PRODUCTION IN FRTL-5 THYROID CELLS BY CRUDE IMMUNOGLOBULIN FRACTIONS OF SERUM FROM PREGNANT WOMEN

In an assay for thyroid-stimulating antibodies, in which FRTL-5 thyroid cells were incubated with crude immunoglobulin (Ig) fractions precipitated from serum with 15% polyethylene glycol, significant increase in cAMP production was elicited by the samples from 25 (35.7%) out of 70 pregnant women. The highest value was 529.5%. There was a close correlation between thyroid stimulating activities and serum hCG concentrations (r = 0.708, P less than 0.001). When 125I-hCG was added to serum from pregnant women, about 20% of the radioactivity was incorporated into the Ig fractions. hCG preparations within a range of concentrations of 30-300 IU/m elicited 2.3-16.5 times increase in cAMP in a dose-dependent manner. Nine pregnant women with serum TSH concentrations less than the lower limit of the normal range (less than 0.25 mU/l) displayed significantly higher values for both thyroid stimulating activities and serum hCG concentrations (P less than 0.001, respectively) compared with those who had normal TSH levels in serum. These data suggest that hCG or its variant may stimulate the thyroid sufficiently to suppress secretion of TSH from the pituitary in some pregnant women.