The levels of dopamine-β-hydroxylase (DBH), the enzyme responsible for conversion of dopamine to noradrenaline, vary widely in the normal population, but are maintained relatively constant in each individual. We investigated the serum DBH activity in 52 patients in a geriatric hospital and 14 nursing home residents. Average age of these subjects is 79.8 years (male 76.6, female 80.8). 66 subjects (17 males, 49 females) were divided into four groups (A, B, C, D) by two criteria, namely, dementia and bedridden state: A group (dementia, bedridden), B group (dementia, non-bedridden), C group (non-dementia, bedridden), and D group (non-dementia, non-bedridden). Blood sampling was done after fasting overnight while the subjects were still in bed early in the morning. The sera were stored in a deep freezer at -20°C and assayed by the photometric method of Nagatsu and Udenfriend. On the other hand, activities of daily living (ADL) of these 66 subjects were evaluated according to the ADL Scale of Yokufukai Geriatric Hospital. This Scale consists of 12 items including“food intake”, “standing”, “ambulation”, “clothing”, “vision”, “hearing”, “communication”. Each item has five stages, and the better the stage of ADL is, the higher the score is (maximum score 65, minimum score 13). The correlation coefficient between serum DBH activity and ADL score in D group was 0.57 (p<0.02), the highest of all groups. However, the correlation coefficients in other groups were low and not statistically significant. This would mean that serum DBH activity and physical activity are considerably parallel in the non-demented, old people who can take care of themselves. It has been shown that acute changes of sympathetic activity in man may be reflected by changes in DBH activity. So we investigated changes in serum DBH activity by physical exercise in 11 additional subjects (5 males, 6 females) with comparatively high ADL score. The work load was 200 meter rapid walking in the aisle of the ward in the afternoon. Blood samples were collected at sitting position just before, immediately after, and 30 minutes after rapid walking, respectively. In this work load test, the heart rate and blood pressure did not change significantly in all subjects. The levels of serum DBH activity elevated in all men, producing a mean increase of 32.7%, while in women, only two of 6 subjects showed the rise and remaining four the decline, producing a mean decrease of 18.8%. This paradoxical reduction in serum DBH activity of women might result from insufficient work load. Although it has been suggested that serum DBH activity could be a useful indicator of sympathetic nervous system activity, normal range of this enzyme is very wide (1-100 International Unit). Transient changes in serum DBH activity by physical exercise would reflect alterations in sympathetic nervous activity. Therefore, it will be reasonable to determine not only the basal value, but also the changes in serum DBH activity by physical stress in detecting a subtle reflection of underlying sympathetic nervous activity.
The oxidative phosphorylation of liver mitochondria in old-aged rats or human is supposed to be injured since the mitochondria were found to be fewer in number and larger in volume than those in younger rats or human. However, recent study showed that the efficiency of oxidative phosphorylation of liver mitochondria in old-aged rats is the same as that of liver mitochondria in younger rats. There is still some possibility that the mitochondria in old group is injured much more easily than that in younger group under certain conditions. In this report, we demonstrated that ADP/O and RCR of liver mitochondria in old-aged rats were decreased much more than those of liver mitochondria in younger rats when the mitochondria were left at room temperature for 30 minutes or were prepared from rats in which tolbutamide, one of uncouplers, had been given orally. Further more, due to addition of 0.2mM Ca++ in vitro the decrease in ADP/O and RCR of the mitochondria in old-aged rats was decreased much more than those of the mitochondria in younger rats when mitochondria were prepared from rats with tolbutamide loading. These results suggest that the liver mitochondria in old-aged rats become very sensitive to various stresses.
Myasthenia gravis (MG) of onset after the age of 50 was compared clinically with that of onset below 50. There were 48 patients of MG (14 males, 34 females) who visited the neurologic clinic, University of Gunma Hospital for the last seven years, and 6 another patients of MG (3 patients of onset after 50 years old) admitted to the geriatric ward, University of Tokyo Hospital. Of 48 patients of the former group those with onset after the age of 50 was 7 (50%) in males and 4 (12%) in females with the incidence according to age at onset being highest in the sixth decade in males and in the second to fourth decades in females. The distribution resembled to those in USA and European patients (Schwab et al., Osserman et al.) rather than to those in Japanese series in which onset was most common in younger adults in both sexes, and it suggested a scrutiny in the elderly group might bring forth the discovery of more male patients of MG. Symptoms at onset, severity of MG according to Osserman's classification at our initial examination, and severity at the follow-up study more than one year after the initial examination were all similar in both older and younger onset groups, indicating the onset at older age implied no poor outcome. Antiacetylcholine receptor antibody titers were determined in serum in 9 patients of older onset and 24 of younger onset, revealing the relatively low levels below 10nMol/l significantly more frequent in the former group. Thymus was examined by means of computed tomography (CT) of the anterior mediastinum, pneumomediastinography, and histological investigations after thymectomy or autopsy, though CT was useful only in the detection of thymic tumors. Hyperplastic or remaining thymus was disclosed in 2 (25%) of 8 patients with older onset and 15 (65%) of 23 with younger onset, with significantly lower frequency in the former group, thus indicating that thymus might play no important role in the pathogenesis of MG in the older age group except in the case of thymoma. Three illustrating cases of onset at older age were presented. Case 1, a 78-year-old male developed ptosis and diplopia, followed by bulbar and neck muscle weakness. Because of poor response to anticholinesterase medications prednisolone was prescribed with dose of 25mg on alternate days, causing subsequent transient respiratory and cardiac arrest. Dysphagia persisted after the improvement of other muscles and debility progressed terminating in death due to paralytic ileus. By autopsy no thymic tissue was discovered both macro-and microscopically. Case 2, a male developed MG of Osserman IIA at the age of 52 and had a fluctuating course including four crises even after thymectomy for thymoma, dying of laryngeal cancer 9 years after the onset of MG. No remnant of thymus was found by autopsy. Case 3, a male with onset of MG of Osserman IIA at the age of 60 showed a hyperplastic or remaining thymus with pneumomediastinography, though thymectomy was not indicated because of good control with anticholinesterase drugs.
Serum lipidperoxide (LPO) values and erythrocyte superoxide dismutase (SOD) activities of one hundred and eighteen healthy persons ranging from sixty to eightynine years of age were measured and compared with those of thirty healthy young adults in their twenties. At the same time, α-tocopherol (α-Toc), serum total-cholesterol (Total-CH), serum triglyceride (TG), serum high density lipoprotein cholesterol (HDL-CH), serum β-lipoprotein (β-Lipo) and blood pressure of the former group were measured and discussed as to the relationship with LPO and SOD. The results obtained were as follows. 1) The mean and standard deviation (SD) of serum LPO values (MDA values) in the aged group were 4.86±1.04nmol/ml and 95% rejection limits were 2.79-6.93nmol/ml. Serum MDA values in the aged group were significantly higher than those in the young group. 2) TG levels increased and HDL-CH levels decreased according as MDA values increased. 3) The SOD activities in the aged group were 11.23±1.49units/mgHb, 8.27∼14.19units/mgHb, and were significantly lower than those in the young group. 4) SOD activities increased according as MDA values decreased or as α-Toc levels increased. 5) The higher MDA values were related to the higher systolic and diastolic pressures but there were no significant relations between blood pressure and SOD activity.
As a part of the research both on the prophylaxis and on the treatment of hyperlipidemia and atherosclerosis, we tried to clarify the relationship between nutrition and serum lipids; The contents of food were investigated in 121 healthy adults for three days, and the relations were analysed to the obesity, blood pressure and serum lipids measured simultaneously. Total energy, carbohydrate, protein, fat, salt, iron and calcium were estimated as nutrients. Foods were classified into eight groups; that is cereals and potatoes, fruits, meat and fish, dairy products, oil, vegetables, sugar and cake, and beverage. These results were analysed by using the technique of multivariate analysis to make clear the correlation between nutrition and serum lipids, totally. Firstly, each single coefficients of correlation were calculated between each item of investigation. Significant correlation was observed between diastolic blood pressure and either of triglyceride, phospholipid, total cholesterol and atherogenic index, while there was no correlation between systolic blood pressure and serum lipids. There was significant positive correlation between obesity and triglyceride and/or atherogenic index, and negative correlation between obestiy and high density lipoprotein cholesterol. Each single coefficients of correlation between each of nutrients and serum lipids were determined. However, the results were not as we would expect, for example, total energy and fat intake did not correlated with any of serum lipids. And it was difficult to find any tendencies from the correlation matrix between foods and sereum lipids. Secondly, canonical correlation analysis between serum lipids and nutrition was studied. By this analysis, canonical correlation coefficient between serum lipids and nutrition was 0.438, which was significant (p<0.05). Canonical correlation coefficient between serum lipids and foods was 0.406, which was not significant at less than 5%, while the probability was less than 10%. After the addition of obesity and bood pressure to nutrition and/or foods, canonical correlation coefficients were 0.574 and 0.578 respectively, both of which were significant (p<0.01). Thirdly, multiple regression analysis was performed between nutrition and each components of serum lipids. Total cholesterol, triglyceride, phospholipid, high density lipoprotein cholesterol and atherogenic index showed significant correlation only after addition of obesity and blood pressure to nutrition, while phospholipid showed significant correlation with nutrition without any addition of other factors. Finally, we tried to find out the index of the deviation of food intake. For this purpose, factor analysis was performed for the contents of food. Althouth foods were able to be divided into four groups by the factors obtained, there did not exist any clear relations between these factors and serum lipids. Moreover as an index of deviation of food intake, all foods were divided into vegetable foods and animal foods. Weight of vegetable foods showed significant negative correlation with phospholipid and/or high density lipoprotein cholesterol, and showed tendency of negative correlation with total cholesterol.
302 cases of advanced gastric cancer in the last 5 years and 92 cases of early gastric cancer in the last 7 years and 10 months have been diagnosed in our department. Among them, the gastric cancer of the aged, over 60 years old, occupied 172 cases (57.0%) and 32 cases (34.8%) respectively. The sexual ratio of the gastric cancer in the aged was 1.9:1 in the advanced cancer, and 3.0:1 in the early cancer, and the proportion of the male was more than female. The frequency of the cases with no complaints of the advanced and early cancer was higher in the aged than in the middle-aged and young. Borrmann 1 type was found only in the aged patients over 70 years old in the macroscopic classification of the advanced gastric cancer with the frequency of 8 cases. The Borr. 2 typed cancer increased with the age, but the Borr. 3 and 4 typed decreased. In the aged type I and IIa+IIc of the early gastric cancer were frequent, on the contrary type IIc and IIc+III were few. The cancer in the aged were located: the advanced often in A and C regions and less in M region, comparing to the early. When we consider only the size of lesion of Borr. 1, 2, 3 and 5 type, they are larger in the aged than in the middle-aged and young. 82.1% of early gastric cancer in the aged showed smaller than 3cm in maximal diameter. According to the histological classification of the gastric cancer, aged patients tend to show more papillary adenocarcinoma and well differentiated tubular adenocarcinoma, but less poorly differentiated adenocarcinoma and signet-ring cell carcinoma comparing to in the middleaged and young patients.
Hand dexterity may be reduced in the elderly. This study has investigated some relationship between motor skills and aging by administering the Purdue Pegboard test to 90 subjects who had no clinical evidence of neurological disorders and hand disability. The Purdue Pegboard is a test of dexterity originally designed to aid in the selection of employees for industrial jobs. It measures complex activity involving gross movements of hands, fingers and arms in addition to fingertip dexterity. The sample has included university workers, medical doctors, nurses, attending patients and their family members. Their age range is 22 to 85 years. Average age is 52.2 years in 43 male subjects and 61.1 years in females. Correlation coefficients between age and each score of five tasks including right hand, left hand, both hands, right plus left plus both hands and assembly are -0.83, -0.79, -0.80, -0.85 and -0.86, respectively. All these figures show highly significant correlation between age and hand performance (p<0.001). There is no significant difference among both sexes. Left hand score is higher than right hand score in 17.8% of normal subjects, which offers one possible incidence of left handedness and right hemisphere dominancy for language. It has been administered to 32 patients with post-stroke hemiplegia and 9 patients with Parkinson's disease in clinical application. Performance of unaffected hand of hemiplegic patients is a little lower than that of normal subjects. Especially right hand of left hemiplegic patients is inferior to that of normal control. In Parkinson's disease hand performance is reduced nearly depending on Yahr's stage of disability. These results suggest that hand dexterity is inversely proportional to age in adults and pegboard score may be a useful index of aging. This test is also anticipated to be of value in assessing disability and improvement in hand function gained by theraeputic procedures such as physical therapy, occupational therapy and medication.
The purpose of the present study is to clarify the clinical significance of brain atrophy by computed tomography (CT) on Alzheimer type dementia (AD). The relationships of CT findings, intellectual impairment by psychological assessment and severity of dementia by clinical evaluation were studied on 109 patients with clinical diagnosis of AD and 43 controls. Mean age of patients with AD was 71.8±8.9 years and that of the controls was 69.1±5.3 years. The subjects suspected of cerebrovascular diseases and normal pressure hydrocephalus on CT films were excluded. CT examinations were carried out on three tomographic sections, that is, a section through anterior and posterior horns of lateral ventricles, a section through cellae mediae of lateral ventricles and a section through cortex with intracranial space of 60-80cm2. In the three tomographic sections, CSF space percent (CSF%) and half width full max (HWFM) in the histogram corresponding to brain tissue were employed as indexes of brain atrophy by CT. CSF% is the ratio of CSF space for intracranial space. It was obtained by the computerised planimetric method to avoid visual difinition of ventricular borders. HWFM was, also, calculated from the histogram of pixel number according to the distribution of CT number corresponding to CSF and brain tissue in the intracranium. Psychological evaluation of dementia was made by using Hasegawa's dementia scale (HDS). In HDS, 0 Point represents complete failure and full score is 32.5. Clinical dementia Rating (CDR) was employed for clinical staging of dementia. According to CDR, severity of dementia was divided into five groups, that is, normal, questionable, mild, moderate and severe dementia. The present study revealed the following findings. Though CSF% in the sections through lateral ventricles significantly correlated with age, it was more significantly correlated with HDS and CDR scores, respectively. This finding seems to mean that the effect of dementia is so great as to override the effect of dementia. In the cortex slice, the correlations between CSF% and HDS and CDR scores were very low, though they were significant. HWFM in the same slice, showed the moderate and significant correlations with HDS and CDR scores, respectively, comparing with no relationship between HWFM and age. Concerning mean CSF% and HWFM of each group according to CDR staging, they increased with advancement of dementia. The significant differences between the groups by CDR, however, were not always obtained. According to CT indexes as independent variable, the normal subjects were discriminated from the demented subjects in 82.6% of the total by discriminant analysis. The results by discriminant analysis and multiple regression analysis strongly suggested that HWFM in the cortex slice was most likely related with severity of dementia. Conclusively, it was indicated that CSF% in the sections through lateral ventricles and HWFM in the cortex slice were valuable indexes for the evaluation and screening of dementia by CT.