Primary Sjögren's Syndrome White Matter Changes and Cognitive Dysfunction.

This case report describes a 52-year-old, female applicant for long term-care insurance with a history of an autoimmune connective tissue disease initially diagnosed as systemic lupus erythematosus (SLE). Over several years, the signs and symptoms evolved into a clear diagnosis of primary Sjögren's syndrome (PSS). The specific criteria for this diagnosis are reviewed including the symptoms, antinuclear antibodies (ANA), extractable nuclear antigen antibodies (ENA), abnormal salivary scintigraphy and positive Schirmer test.

"MODY2" (maturity onset diabetes of the young type 2).

A 25-year-old male with "MODY2" (maturity onset diabetes of the young type 2) applied for life and disability insurance. MODY2 is also identified by the glucokinase gene that is mutated in this disorder. The etiology, clinical characteristics, and long-term risks of this disorder are reviewed.

Brief case report: dopa-responsive dystonia.

A 42-year-old female applied for life insurance. She was diagnosed with dopa-responsive dystonia as a child. Just prior to applying for insurance, she attempted to go off her carbidopa-levodopa resulting in increased symptoms of stiffness with some imbalance.

Hereditary neuropathy.

A 58-year-old male presented with a history of slowly progressive bilateral hand weakness manifested by decreased grip strength and pinch strength associated with some pain in the first metacarpal-carpal joints with atrophy of the muscles of the web space. An evaluation based on history, physical exam, and judicious diagnostic testing yielded a finding of motor and sensory peripheral polyneuropathy and a working diagnosis of hereditary nerve pressure palsy syndrome (HNPP) or hereditary neuropathy with liability to pressure palsies. The clinical findings and diagnostic tests for sensory and motor peripheral neuropathy are discussed.

"TIA" or migraine in a woman with no risk factors for cerebral vascular disease.

A 48-year-old female presented to an emergency room with symptoms of episodic hemianopsia, dysphasia, and facial numbness. She had no obvious risk factors for cerebral vascular disease but was admitted into the hospital with a diagnosis of transient ischemic attack (TIA). A neurologist reviewed her history and discovered the additional history of bilateral head pressure accompanying her symptoms.

Stratifying long-term care risk by cardiovascular risk factors--an analysis of claims experience with atrial fibrillation.

Objective: The objective of this study is to stratify all-cause disability experience by stroke risk factors in a large cohort of individuals who have been underwritten and successfully enrolled in a long- term care insurance (LTCI) program.

Method: A large database of over 120,000 underwritten insured lives for LTCI between 1994 and 2002 allowed classification of claims risk for atrial fibrillation, hypertension, diabetes, and combinations of these cardiovascular risks. The mean duration of policy was over 5.

Assessment for congenital long QT syndrome.

A 29-year-old male presented for an evaluation of his risk for having congenital long QT syndrome. Despite being asymptomatic and having a normal QTc interval on the resting ECG, a suggestive family history was an indication for a thorough cardiac evaluation. A geneticist reviewed this workup and recommended against genetic testing.