Family studies in common variable immunodeficiency

The occurrence of cancer, immunodeficiency, and diseases with possible autoimmune aetiology were studied in 355 blood relatives of 12 patients with common variable immunodeficiency (CVID). The family members were identified through the patients and interviewed after completing a questionnaire, their diseases were medically confirmed by local general practitioners. In two families consanguineous marriages were identified with the coefficients of inbreeding of 0.03125 and 0.01563, respectively: one patient, a dizygotic twin of an unaffected sister, was a granddaughter of first cousins, the second patient was the third daughter of second cousins. These cases of CVID strongly support the autosomal recessivity of the underlying genes. One male patient with CVID was shown to be related to a patient with X-linked hypogammaglobulinaemia, both sharing a common carrier. The different clinical courses of their diseases suggest two genetically determined immunodeficiencies and genetic heterogeneity. No family had an unusual clustering of cancer. The occurrence of tumours in the blood relatives of CVID patients was not significantly higher than in the relatives of spouse controls. Immunological examination of 30 first degree relatives of the CVID patients revealed three children (2 males and 1 female) with selective IgA deficiency, in one boy combined with elevated serum IgE level. Four relatives with rheumatoid heart disease, 12 cases of gastric or duodenal ulcer, and 14 relatives with thyroid disease represented the most often encountered diagnoses with a possible autoimmune component in their aetiology.     

Anti-DNA antibody idiotypes in primary biliary cirrhosis

A significant increase in 16/6 Id--a major cross-reactive idiotype of anti-DNA antibodies (Ab) derived from a patient with systemic lupus erythematosus (SLE) and hitherto identified in SLE patients and their relatives, was found in 16/17 patients with primary biliary cirrhosis (PBC). The increased serum level of Ab with the 16/6 idiotype (16/6 Id) in PBC patients (median 50 ng/ml) was not found in 6/7 of the patients' spouses nor among 27/28 healthy controls or most patients with other types of cirrhosis. The quantity of 16/6 Id was not correlated to either the stage of disease or the presence of antimitochondrial, antinuclear, or anti-dsDNA antibodies. However, 16/6 Id could be shown to be associated with anti-ssDNA antibodies. The high frequency of the lupus-derived 16/6 Id in PBC may accompany the polyclonal B-cell activation seen in that disease. Of 14 healthy first-degree relatives of the PBC patients, 4 (29%) also had elevated serum 16/6 Id (20-25 ng/ml) and the cluster of 3 of them in a single family may indicate a genetic predisposition to develop PBC.     

Recurrent pyoderma in a family with a defect in leucocyte locomotion.

Granulocyte functions including leucocyte locomotion and chemoluminescence were studied in three generations of a family in which all male members had presented with recurrent pyoderma. While parameters of humoral immunity including serum concentrations of IgG, IgA, IgM, and IgE and of complement components C3 and C4 as well as the response of mononuclear leucocytes to mitogens proved to be within the normal range, leucocyte locomotion was found to be severely impaired in all affected subjects. Moreover, granulocyte dysfunction in male members was associated with the occurrence of a single haplotype (HLA-A2, B13, DR7). These findings suggest that the defect in leucocyte locomotion and the pyoderma might not only have been inherited in an X linked manner but might also have been linked to a gene within the inherited HLA haplotype.     

Immune functions and the prognosis of patients with solid tumours

Summary The immune competence of 169 patients with solid malignant tumours was assessed before initiation of radiotherapy or chemotherapy and followed during the course of the disease. The data of years 1974–1984 were collected and subjected to an analysis in order to evaluate their prognostic significance. The number of leucocytes and lymphocytes in the peripheral blood, the percentage or absolute number of E-rosette forming cells or EAC-rosette forming cells or serum immunoglobulin levels did not show any association with the prognosis. Lymphocyte proliferative responses to PHA, Con A and PPD as studied before initiation of the treatment did not correlate with recurrence or final prognosis of the disease, except that the responses to PPD were slightly lower in patients with recurrence of gynaecological cancer, melanoma or gastrointestinal cancer than in their respective control patients. In the values observed after the first treatment course a low response to PPD was associated with poor prognosis in patients with melanoma or gastrointestinal cancer. At the time of recurrent disease the PPD response showed an association with a poor final outcome in patients with gastrointestinal malignancy. Of the responses assessed less than 3 months before death due to cancer, only in patients with breast cancer were low Con A responses seen; in all patient groups the PHA responses decreased in the terminal patients. The results do not support the idea that the methods currently available should be routinely used in the follow-up of cancer patients; rather, they indicate the need to seek new methods for this purpose.     

Role of adenylate kinase, AMP deaminase and 5'-nucleotidase in the metabolism of adenylic nucleotides

The activities of adenylate kinase, AMP-deaminase and 5'-nucleotidase in various tissues of the rat were studied. The activity of the forward adenylate kinase reaction (ATP + AMP----2 ADP) against the back one (2 ADP----ATP + AMP) was predominant. The liver was shown to contain two, while the blood serum--three adenylate kinase isoenzymes. In the skeletal muscles, the catabolism of adenylic acid involving AMP-deaminase and 5'-nucleotidase predominantly occurred via deamination, in the liver--via dephosphorylation, while in the leucocytes, erythrocytes and blood serum the activity of these processes was essentially the same. In vitro, ATP enhanced the activity of AMP-deaminase in the liver, leucocytes and erythrocytes and decreased it in the blood serum. Under effects of ATP, the activity of 5'-nucleotidase in the leucocytes and blood serum was markedly elevated, that in the liver and erythrocytes was unaffected.     

Phagocytosis and leucocyte enzymes in protein–calorie malnutrition

1. Enzymes pertinent to bactericidal activities of leucocytes were assayed in children suffering from protein-calorie malnutrition. 2. Leucocytes obtained from malnourished and control children contained similar activities for glucose 6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase. Granule-bound NADPH oxidase activity was low in leucocytes isolated from malnourished patients and failed to show the phagocytic stimulation which is normally seen in control leucocytes. Further, leucocytes obtained from malnourished patients did not release the acid phosphatase from lysosomes during phagocytosis, unlike those from controls. 3. Treatment of the malnourishment with a diet high in calories and protein resulted in significant increase in the activities of glucose 6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase and NADPH oxidase and in releasing the acid phosphatase from the lysosomes into the supernatant fraction during phagocytosis. 4. The significance of these enzyme changes are discussed in relation to the increased susceptibility of these patients to infection.     

Interferon production by human leukaemic leucocytes.

The Sendai virus-induced interferon (IF) production by partially purified human leucocyte suspensions of normal donors and of leukaemic patients have been investigated in vitro. (i) An increased production was observed with leucocytes taken from patients suffering from chronic myelogenous leukaemia (CML) during exacerbation, but the production was approximately normal with cells taken during remission. (ii) IF production was not influenced by large doses of cytostatics (DBM, 5-FU, FUDR, 5-HU, 6-MP, cyclophosphamide) irrespective of whether normal or CML leucocytes were used. (iii) In contrast, production was inhibited in both systems by inhibitors of RNA or protein synthesis (actinomycin D, puromycin, cycloheximide). (iv) CML leucocytes produced IF for a prolonged period of time as compared to normal leucocytes. (v) Leucocytes from children with acute blastic leukaemia and those from adults with chronic lymphoid or acute paramyeloblastic leukaemia produce, in contrast to normal leukocytes, approximately as much IF in the absence as in the presence of serum. It is concluded that the Sendai virus-induced IF synthesis in CML leucocytes requires de novo protein synthesis.     

Regulation of 3-hydroxy-3-methylglutaryl coenzyme-A reductase activity in type II hyperlipoproteinaemia.

The regulation of 3-hydroxy-3-methylglutaryl coenzyme-A reductase activity in leucocytes was studied in a family with familial type II hyperlipoproteinaemia (WHO classification). The propositus was heterozygous and 16 other members of the family were studied. Leucocytes were isolated by a relatively quick and simple procedure and used for enzyme estimations. The results suggest that measurement of the regulation of this enzyme in leucocytes may be helpful in the diagnosis and management of the condition.     

Anti-pituitary antibodies in patients with hypopituitarism and their families: longitudinal observation.

In an attempt to investigate the clinical significance of anti-pituitary antibodies in patients with hypopituitarism, anti-pituitary antibody in plasma was examined in 10 such patients (7 cases of isolated ACTH deficiency, 1 of partial hypopituitarism, and 2 of Sheehan's syndrome), on two or three occasions with an interval of more than 6 months (longitudinal study). In a total of 16 relatives of these 4 patients (2 cases of Sheehan's syndrome, one in each of partial hypopituitarism and isolated ACTH deficiency) and one patient not involved in the longitudinal study, anti-pituitary antibodies were also examined (family study). Anti-pituitary antibodies reacting with rat pituitary cytoplasmic antigens (pituitary cell antibodies: PCA) and pituitary cell surface antibodies (PCSA) reacting with GH3 cells and/or AtT-20 cells were measured with indirect immunofluorescence. The longitudinal study revealed the disappearance of antibodies in 3 patients, 2 PCA positive and one both PCA and PCSA positive. In 3 patients, altered antibody titers or a newly appearing antibody were found during the follow-up period. In 4 patients, the pituitary antibodies were negative during the follow-up periods. Of 16 family members studied, positive PCA was found in 3 members (2 in the families of patients with PCA positive Sheehan's syndrome, and 1 in the family of the patients with PCA positive partial hypopituitarism). Positive PCSA was found in 4 members (one in each of families of patients with partial hypopituitarism and isolated ACTH deficiency and of two cases of Sheehan's syndrome), and weakly positive PCSA was found in one family member of a patients with PCA positive Sheehan's syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)     

Change in the activity of specific and nonspecific immunity mechanisms in vitamin B1 deficiency]

The effect of thiamin deficiency on the immune response and activity of some mechanisms of natural immunity was studied in experimental mature rats. Thiamin deficiency was simulated by a single injection of hydroxythiamin (thiamin antagonists). Hydroxythiamin markedly decreased the complement activity, phagocytic activity of peripheral blood leucocytes, serum bactericidal activity as well as antibody production in response to sheep red blood cells. On the contrary, lysozyme activity increased. Vitamin B1 deficiency reduced 14C-leucine incorporation activity in the liver proteins.     

Screening and genetic counselling for relatives of patients with colorectal cancer in a family cancer clinic.

OBJECTIVE--To introduce and monitor a screening programme for first degree relatives of patients with colorectal cancer based on their calculated lifetime risk. DESIGN--Lifetime risks were calculated for first degree relatives of patients with colorectal cancer and used to offer screening based on estimated risk. SETTING--A family cancer clinic was set up as part of the North East Thames Regional Genetic Service for relatives of patients who had developed colorectal cancer before the age of 45 and members of families in which multiple cancer had occurred. PATIENTS--Self referrals as well as patients referred by general and hospital practitioners. INTERVENTION--Relatives with a lifetime risk of 1 in 10 or greater (high risk group) were offered screening five yearly by colonoscopy, and those whose risk was between 1 in 10 and 1 in 17 were offered yearly screening for faecal occult blood. Women with family histories compatible with Lynch type II cancer family syndrome were offered screening for breast and pelvic tumours. RESULTS--In four years 715 patients were seen. Acceptance of screening was 90% (644 patients). Of 151 patients screened for faecal occult blood, two were found to have polyps. This screening test was unsatisfactory for the high risk group, having a negative predictive value of 78% in 59 patients tested. Regular screening by colonoscopy was offered to 382 high risk patients; 62 patients with polyps and five with colonic cancer were found. One hundred and ten pedigrees were identified with the Lynch type II cancer family syndrome, and four of 35 women screened were found to have breast cancer. Of 14 relatives aged over 65 with a 1 in 2 risk of site specific colonic cancer or Lynch type II cancer family syndrome, seven were found to have polyps, one of whom had carcinoma in situ. CONCLUSIONS--Family history can be used to identify those at risk of colonic cancer and to target appropriate screening. Colonoscopy detected a high number of premalignant colonic polyps, but faecal occult blood testing was unsatisfactory for those at high risk of colorectal cancer.     

The Association between Intelligence Scores and Family History of Psychiatric Disorder in Schizophrenia Patients,Their Siblings and Healthy Controls

Background

The degree of intellectual impairment in schizophrenia patients and their relatives has been suggested to be associated with the degree of familial loading for schizophrenia. Since other psychiatric disorders are also more present in relatives of schizophrenia patients, the definition of family history should be broadened. The association between family history for psychiatric disorder and intelligence scores was investigated in patients with non-affective psychosis, their unaffected siblings and controls.

Methods

A sample of 712 schizophrenia proband families (696 patients and 766 siblings) and 427 healthy control families (517 subjects) participated in this study. Family history of psychiatric disorder was determined while excluding the data of the participating schizophrenia patient. A dichotomous division was made between families with no first- or second degree relative with psychiatric disorder and families with one or more affected relatives. Total intelligence scores were estimated by admission of the short form of the Wechsler Adult Intelligence Scale III.

Results

A significant interaction was found between family history of psychiatric disorder and clinical status (F(2,1086.87)= 4.17; p=.016). Patients with a positive family history of psychiatric disorder obtained higher intelligence scores compared to patients with no family history (mean IQ scores are 95.52 and 92.72) with an opposite effect in controls (mean IQ scores are 108.71 and 111.19). No significant difference was found between siblings of schizophrenia patients with or without a positive family history (mean IQ scores are 102.98 and 103.24).

Conclusion

In patients with schizophrenia, a negative family history of psychiatric disorder was associated with relatively low IQ suggesting that the etiology in these patients may involve environmental or genetic factors which are unique to the patient and are not observed in other relatives. Possible factors include severe environmental stressors containing premature birth or brain injury and genetic factors (e.g de novo Copy Number Variants).     

A PEDIGREE OF ONE FAMILY WITH DELAYED SLEEP PHASE SYNDROME

The prevalence of delayed sleep phase syndrome (DSPS) has been estimated to be quite low. Although no genetic inheritance pattern has been described, it has been reported that close to 50% of DSPS patients have biological relatives with similar symptoms. A pedigree of one extended family with symptoms suggestive of DSPS has been identified. Morningnesseveningness questionnaires were administered to all first- and second-degree relatives of a proband identified with DSPS. A total of 51 (86%) questionnaires were returned, and 6 adult biological relatives of 27 (22%) showed a preference for eveningness, which is much higher than reported in the general population. Both the paternal and maternal branches contained affected individuals, suggesting the possibility of a bilineal mode of inheritance. While the trait did not obey simple Mendelian inheritance, the vertical patterns of transmission were consistent with either an autosomal dominant mode of inheritance with incomplete penetrance or a multifactorial mode of inheritance. These data provide some preliminary support to the notion that eveningness, and thus DSPS, may have a genetic component. The prevalence of symptoms suggestive of DSPS is higher in this family than reported in the general population. Case reports such as this support the utility of larger, more systematic studies. It is unclear whether this degree of familiarity is representative of that in the general population. (Chronobiology International, 18(5), 831-840, 2001)     

A PEDIGREE OF ONE FAMILY WITH DELAYED SLEEP PHASE SYNDROME

The prevalence of delayed sleep phase syndrome (DSPS) has been estimated to be quite low. Although no genetic inheritance pattern has been described, it has been reported that close to 50% of DSPS patients have biological relatives with similar symptoms. A pedigree of one extended family with symptoms suggestive of DSPS has been identified. Morningnesseveningness questionnaires were administered to all first- and second-degree relatives of a proband identified with DSPS. A total of 51 (86%) questionnaires were returned, and 6 adult biological relatives of 27 (22%) showed a preference for eveningness, which is much higher than reported in the general population. Both the paternal and maternal branches contained affected individuals, suggesting the possibility of a bilineal mode of inheritance. While the trait did not obey simple Mendelian inheritance, the vertical patterns of transmission were consistent with either an autosomal dominant mode of inheritance with incomplete penetrance or a multifactorial mode of inheritance. These data provide some preliminary support to the notion that eveningness, and thus DSPS, may have a genetic component. The prevalence of symptoms suggestive of DSPS is higher in this family than reported in the general population. Case reports such as this support the utility of larger, more systematic studies. It is unclear whether this degree of familiarity is representative of that in the general population. (Chronobiology International, 18(5), 831–840, 2001)     

Cytokine levels (IL-6 and IFN-gamma), acute phase response and nutritional status as prognostic factors in lung cancer

Raised serum levels of interleukin 6 (IL-6) have been described in cancer patients. This cytokine mediates the acute phase response and has been also involved in the pathogenesis of cancer cachexia. The objectives of the present study were: (1) to determine the relationships of IL-6 and other cytokines with neoplasia extension, acute phase response and nutritional status, in lung cancer patients; and (2) to establish the prognostic value of serum cytokine levels. A prospective study in which IL-1, IL-2, IL-6, tumour necrosis factor alpha (TNF-alpha) and interferon gamma (IFN-gamma) have been determined in 66 newly diagnosed lung cancer patients. Nutritional status was assessed objectively. Serum levels of growth hormone (GH), insulin growth factor 1 (IGF-1) and acute phase reactants as C Reactive Protein, alpha1 antitrypsin and ferritine, were determined. Increased IL-6 levels were related to extensive disease, impaired performance status, enhanced acute phase response and malnutrition. Raised serum IL-6 levels, extensive disease, low Karnofsky index, malnutrition, acute phase response and low IFN-gamma were all related to a shorter survival. When assessed by a multivariate analysis, IL-6 kept its independent prognostic value together with age, disease extension, and decreased IFN-gamma serum levels.IL-6 is increased in lung cancer patients, enhances the acute phase response in them, and is correlated with poor nutritional status, impaired performance status and shorter survival.     

Vergleichende Enzymuntersuchungen im Serum,in Erythrocyten und in Leukocyten von schwachsinnigen Anstaltspatienten

Zusammenfassung Bei 39 Patienten mit Down-Syndrom (1), 53 Patienten mit idiopathischem (2) und 71 Patienten mit exogenem Schwachsinn (3) wurden die Aktivitäten von Aph, SPh, LDH, GOT und ALD im Serum, in Erythrocyten und Leukocyten spektrophotometrisch bestimmt und untereinander und mit einer Kontrollgruppe 60 gesunder Personen verglichen.Eine signifikante Aktivitätssteigerung zeigten im Serum der Gruppen 1–3 APh, SPh, GOT und LDH (nur Erwachsene), in Leukocyten APh (Kinder, Gruppe 1;2), SPh, LDH (Kinder, Gruppe 1–3) und GOT (Erwachsene, Gruppe 1; Kinder, Gruppe 1 und 2) und in Erythrocyten der Gruppe 1–3 die GOT.Die Patienten der Gruppe 1 ließen im Vergleich mit den Patienten der Gruppen 2 und 3 einen Trend zu Erhöhungen der APh, SPh, GOT und LDH im Serum, in Erythrocyten und Leukocyten erkennen.Die Untersuchung des Blutbildes bei den Patienten der Gruppen 1–3 und den Personen der Kontrollgruppe ergab unauffällige Befunde. Im Differentialblutbild ließ sich bei den Patienten der Gruppen 1–3 eine geringgardige Lymphocytose beobachten.Bei 12 Patienten aus den Gruppen 2 und 3 wurden Leberfunktionsproben durchgeführt; 5 dieser Patienten zeigten pathologische Werte und lieferten Hinweise für das Vorliegen einer diskreten Leberparenchymschädigung.Die Befunde wurden diskutiert.

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Comparative studies of enzymes in serum, erythrocytes and leucocytes in hospitalized patients with mental deficiency

Summary The activities of a number of enzymes (alkaline (APh) and acid phosphatase SPh), lactic acid dehydrogenase (LDH), glutamic oxalacetate transaminase (GOT), aldolase (ALD), glucose-6-phosphat-dehydrogenase (G-6-PD) in serum, erythrocytes and leucocytes of 39 patients with Down's syndrome (1), 53 patients with hereditary mental deficiency (2), and 71 patients with exogene mental deficiency (3) were determined spectrophotometrically. On the one hand the results were compared mutually and on the other hand with samples of 60 healthy persons.Statistically significant differences between oligophrenic patients and healthy persons were observed in serum APh, SPh, GOT and LDH, in the groups 1–3 (only adults), in leucocytes APh (children, groups 1–2), leucocytes SPh and LDH (children, groups 1–3), leucocytes GOT (adults, group 1; children, group 1–2) and in erythrocytes GOT in all groups; all these enzymes showed a distinct increase.Compared with patients of the group 2 and 3, the APh, SPh, GOT, and LDH in serum, erythrocytes and leucocytes of patients of the group 1 (Down's syndrome) indicated a trend to increase.The peripheral blood counts and determinations of hemoglobin in patients of the groups 1–3 and in persons of the control group were normal. A low grade lymphocytosis in the differential blood state was observed.12 patients from the group 2 and 3 were examined in regard to their hepatic functions. 5 of these had pathological hepatic functions and showed symptomes of a slight alteration of the liver parenchyma.The results were discussed.

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(Direktor: Prof. Dr. med. H. Schade)     

Immunostimulatory effect of azadirachtin in Oreochromis mossambicus (Peters)

The effect of azadirachtin, a triterpenoid derived from Azadirachta indica on the immune response was studied in the freshwater teleost, O. mossambicus. Bovine serum albumin (BSA) and sheep erythrocytes (SRBC) were used as antigens to evoke immune response. The immune responses in fish were measured by quantifying antibodies produced and counting the peripheral blood leucocytes in control and experimental fish. In general, azadirachtin significantly enhanced the antibody response and leucocyte count in a dose dependent manner. An inverse relationship was observed between the dose of azadirachtin and the degree of immunostimulation. Timing of azadirachtin administration in relation to immunization revealed that the maximum enhancement of antibody response was observed when the stimulant was given two days prior to immunization. The observed immunostimulatory property of azadirachtin has an implication in the maintenance of finfish health in freshwater intensive aquaculture practices.     

Familiality of metabolic abnormalities is dependent on age at onset and phenotype of the type 2 diabetic proband

To determine the impact of a family history of the common form of type 2 diabetes and the phenotype of the proband on anthropometric and metabolic variables in normoglycemic first-degree relatives, we studied 2,100 first-degree relatives of patients with the common form of type 2 diabetes (FH+) and 388 subjects without a family history of diabetes (FH-). All subjects participated in an oral glucose tolerance test to allow measurement of insulin secretion [30-min incremental insulin/glucose (I/G 30)] and insulin sensitivity [homeostasis model assessment (HOMA) of insulin resistance (IR)]. A subset participated in a euglycemic clamp (n = 75) and an intravenous glucose tolerance test (n = 300). To study the effect of a particular phenotype of the proband, insulin secretion and sensitivity were also compared between first-degree relatives of diabetic probands with high and low waist-to-hip ratio (WHR) and probands with early and late onset of diabetes. FH+ subjects were more insulin resistant, as seen from a higher HOMA-IR index (P = 0.006) and a lower rate of insulin-stimulated glucose uptake (P = 0.001) and had more features of the metabolic syndrome (P = 0.02, P = 0.0002) compared with FH- subjects. Insulin secretion adjusted for insulin resistance (disposition index, DI) was also lower in the FH+ vs. FH- subjects (P = 0.04). Relatives of diabetic probands with a high WHR had reduced insulin-mediated glucose uptake compared with relatives of probands with a low WHR (P = 0.04). Relatives of diabetic patients with age at onset <44 yr had higher HOMA IR (P < 0.005) and lower DI (P < 0.005) than relatives of patients with age at onset >65 yr (highest quartile). We conclude that early age at onset of type 2 diabetes and abdominal obesity have a significant influence on the metabolic phenotype in the nondiabetic first-degree relative.     

Clinical importance of enteric communication with abdominal abscesses.

The dynamics of leucocytes in abdominal abscesses were studied using indium-111 autologous leucocyte scanning in 30 patients. Thirteen patients showing enteric drainage of leucocytes on delayed scans were characterised by a lack of abdominal localising signs and a low detection rate by ultrasound (25%). By contrast, 16 of 17 patients without enteric drainage had abdominal signs, and in these patients ultrasound was associated with a higher detection rate (58%). Despite the presence of an enteric route of drainage for the abscess 10 of the 13 patients needed surgical intervention. These results help explain the wide variation in clinical presentation of abdominal abscesses; suggest that 111In leucocyte scanning should be the initial investigation in those patients without focal signs; and show that formal surgical drainage is needed in patients recognised as having enteric communication with abscesses.     

Evidence for familial factors that protect against dementia and outweigh the effect of increasing age.

A positive family history is associated with increased risk for dementia. It is not known whether a negative family history with long-lived relatives predicts a reduced risk for dementia. We studied the survival rate and the occurrence of dementia in 232 parents and siblings of 43 optimally healthy individuals > or = 84 years of age and compared them with 233 parents and siblings of 51 random controls and 499 parents and siblings of 88 Alzheimer disease (AD) patients. Prevalence of dementia after age 60 years was .031 for the relatives of healthy elderly, .066 for the relatives of random controls, and .217 for the relatives of AD patients. The cumulative incidence of dementia by age 85 years was estimated as .041 (+/- .019) for the relatives of healthy elderly individuals, .102 (+/- .038) for the relatives of random controls, and .360 (+/- .037) for the relatives of AD patients. Hazard-ratio estimates suggest that the risk of dementia for the relatives of healthy elderly is 3 times lower than the risk for the relatives of random controls (P < .03) and is 11 times lower than the risk for the relatives of AD patients (P < .00005). An analysis of age at death indicated that the relatives of healthy elderly and the relatives of AD patients had a longer life span than did the relatives of random controls.(ABSTRACT TRUNCATED AT 250 WORDS)