Can we predict cognitive decline after initial diagnosis of multiple sclerosis? Results from the German National early MS cohort (KKNMS)

BACKGROUND: Cognitive impairment (CI) affects approximately one-third of the patients with early multiple sclerosis (MS) and clinically isolated syndrome (CIS). Little is known about factors predicting CI and progression after initial diagnosis. METHODS: Neuropsychological screening data from baseline and 1-year follow-up of a prospective multicenter cohort study (NationMS) involving 1123 patients with newly diagnosed MS or CIS were analyzed. Employing linear multilevel models, we investigated whether demographic, clinical and conventional MRI markers at baseline were predictive for CI and longitudinal cognitive changes. RESULTS: At baseline, 22% of patients had CI (impairment in ≥2 cognitive domains) with highest frequencies and severity in processing speed and executive functions. Demographics (fewer years of academic education, higher age, male sex), clinical (EDSS, depressive symptoms) but no conventional MRI characteristics were linked to baseline CI. At follow-up, only 14% of patients showed CI suggesting effects of retesting. Neither baseline characteristics nor initiation of treatment between baseline and follow-up was able to predict cognitive changes within the follow-up period of 1 year. CONCLUSIONS: Identification of risk factors for short-term cognitive change in newly diagnosed MS or CIS is insufficient using only demographic, clinical and conventional MRI data. Change-sensitive, re-test reliable cognitive tests and more sophisticated predictors need to be employed in future clinical trials and cohort studies of early-stage MS to improve prediction

STATE LEGISLATORS AND ECONOMIC DEVELOPMENT: UNIVERSITY-INDUSTRY RELATIONSHIPS AND THE ROLE OF GOVERNMENT IN BIOTECHNOLOGY

This article presents a detailed examination of some key political dimen- sions underlying cooperative research in agricultural biotechnology among state land-grant universities, state legislatures, and biotechnology corpora- tions. Factor analysis and path analysis methods are employed to assess differences in the perceptions of university administrators, biotechnology corporation researchers, and state legislators, using national and state survey data. Two attitudinal dimensions, one regarding cooperation among university and corporate researchers, and the other regarding barriers to joint research, are extracted. Generally similar attitudes are shared by university and legislative respondents, who are concerned over the prospects of market-oriented university research. In contrast, corporate respondents are more concerned with reducing barriers to cooperative research and the need for more open communication between academia and industry, and with issues of patent rights. Extensions of this work to other states and to other high-technology industries are considered. Copyright 1990 by The Policy Studies Organization.

PLANNED INCAPACITY TO SUCCEED? POLICY-MAKING STRUCTURE AND POLICY FAILURE

Policies may fail in two analytically distinct ways: they may fail to achieve their goals, or they may fail to retain political support and be terminated. By failing to distinguish between ineffectiveness and political failure, the three most common interpretations of the War on Poverty and the Comprehensive Employment and Training Act (failure owing to central government incompetence, failure owing to pluralism, and "hidden" success) cannot adequately account for the gap between their ambiguous performance and their clear political failure. To understand these differences, one must understand the effect of America's fragmented political structure on the design and implementation of poverty and unemployment remedies. Under resource constraints and given a large degree of policy discretion, American states in the aggregate have retained their historic resistance to social policies that would increase short-term expenditures and reduce the attractiveness of their business climate. These jurisdictions and their Congressional representatives opposed new fully nationalized initiatives, insisting on policy designs that promised fiscal relief while protecting state and local policy control. National policymakers found that grant-in-aid programs offered the path of least resistance in these circumstances. Although social policy grant programs could win initial approval in Congress, these designs proved to be increasingly unwieldy, expensive, and difficult to control in practice. The programs yielded ambiguous overall results but provided unambiguous examples of waste, fraud and abuse, fueling the perception of failure and contributing to the backlash against these programs and their political failure. Copyright 1988 by The Policy Studies Organization.