We have reported that age related brain atrophy progress more slowly in brainstem and cerebellum than in cerebrum using CT measurement method. Age related cerebellar atrophy, and correlation between cerebellar atrophy and arteriosclerosis were studied in 142 autopsy brains (60-102 years) of neurologically and pathologically normal patients. The sectioned areas of cerebellar vermis and hemispheres were calculated using a digitizer connected to a personal computer. In addition, the number of Purkinje cells were calculated in the sagittal section of cerebellar hemisphere. Weight of whole brain and cerebellum measured before section. The degree of arteriosclerosis in the vertebral basilar artery was scored from none to severe range. The significant inverse correlation was observed between age and indices of cerebellar atrophy such as brain weight (=-0.32), cerebellar weight (r=-0.26) and areas of cerebellar vermis (r=-0.30) and cerebellar hemisphere (r=-0.37). The atrophy of the cerebellum became prominent after 80 years. The number of Purkinje cells declined with the advancement of old age. Cerebellar atrophy and decrease of Purkinje cells paralleled arteriosclerosis of the vertebral basilar artery. 1) Cerebellar atrophy occurs with advancing age as well as cerebrum, however it is relatively mild before 80 years. 2) Arteriosclerotic change of vertebro-basilar artery enhances age related cerebellar atrophy.
This study was done at the Yokufukai Geriatric Hospital to examine the relationship between diabetes mellitus and large cerebral infarction (confirmed by autopsy in all cases) in 590 cases aged 60 years and over. The cases were grouped into the diabetes mellitus group (DM) and the non-diabetes mellitus group (N-DM). The background factors, possibly related to the development of cerebral infarction were also compared in these two groups. 1. No significant difference was noted in the incidence of large cerebral infarction between the DM and N-DM. As for DM therapy, large cerebral infarction occurred in 22.5% of the sulfonylurea groups (SU) and the incidence was roughly 6.8 times (p<0.01) as high as that of the dietary alone groups (F) and 2.6 times of the N-DM group. In cases with hypertension of the SU group, the incidence was 7.2 times (p<0.01) as high as that of the F group and 2.5 times (p<0.02) that of the N-DM group. 2. No significant difference was recognized between the SU group and the F group in the background factors, such as the age at death, complcation of hypertension and atrial fibrillation. The age at initial examinations (the age at the onset) and fasting glucose levels exceeding 140mg/dl at initial examinations were significantly higher in the SU group than in the F group (p<0.01) and the incidence of severe cerebral arteriosclerosis tended to be higher in the SU group than in the F group (p<0.1). 3. When the background factors were compared by the presence or absence of large infarction in the SU group, the incidence of hypoglycemia was significantly higher in the patients with large infarction (p<0.05) and that of the fasting glucose levels higher than 140mg/dl at initial examinations tended to be higher (p<0.1) in cases with large infarction. From the above results, special care should be paid in the administration of SU for the elderly diabetic patients with possible severe cerebral arteriosclerosis, to prevent large cerebral infarction which might be related to hypoglycemia.
It has been known that diagonal ear lobe crease (ELC) is a typical sign which appeared in a state of coronaly heart disease and vascular disease. Many studies of the diagonal ear lobe crease have been carried out in the patients with coronary heart disease, AMI and cerebral vascular disease. But as regards healthy subjects, there were few except the report which published by Moncoda et al, 1979. In this time we have investigated whether this ELC would be evaluated as one of the usefull signs of atherosclerosis in 768 subjects (30-87 years, male: 228, female: 539) on Hachijo Island. The relationship between the risk factors of atherosclerosis; obesty, hypertension, ECG abnormalities and abnormal lipid metabolism also apolipoproteins, were studied respectively. The results obtained were as follows: 1) The frequencies of ELC were significantly higher in male than in female (p<0.01). 2) The frequencies of ELC increased accordingly with aging on both sex. 3) As regards the frequencies of obesity and normal weight subjects in ELC presence group, there were no significant. 4) The frequencies of hypertension involved in ELC presence group were significantly higher than in ELC absence group (p<0.01). 5) The frequencies of abnormal ECG involved in ELC presence group were significantly higher than in ELC absence group (p<0.01). 6) The levels of TC and β-Lp were significantly higher in ELC presence group than in ELC absence group, however, TRG and HDLC had no significance (p<0.05). 7) Atherogenic Index (TC-HDLC/HDLC) in ELC presence group were significantly higher than ELC absence group (p<0.02). 8) The levels of Apo AI, AII and Apo AI/B ratio in ELC presence group were significantly lower than in ELC absence group, however, the levels of Apo B, CII, CIII and E and had no significant (p<0.1, p<0.05, p<0.1). The freruencies of abnormal lipids metabolism and hypertension in ELC presence group were significantly higher than in ELC absence group, age and sex matched, however obesity and ECG abnormalities were no significant (p<0.01). 10) The frequencies of the combination risk factors for atherosclerosis (abnomal lipids metabolism, ECG abnormalities and hypertension) in ELC presence group were significantly higher than in ELC absence group p<0.01). 11) The frequencies of the combination risk factors for atherosclerosis (abnomal lipids metabolism and hypertension) in ELC presence group were significantly higher than in ELC absence group (p<0.05). These observations suggested that there is a positive association between the diagnonal ear lobe crease and atherosclerosis, furthermore the inspection of ELC would be one of the useful clinical procedure for diagnosis of atherosclerosis.
The aim of our study was to define the reliability of pre-breakfast and post-breakfast blood glucose as an index of glucose control in elderly diabetics. We have, therefore, examined the correlation between plasma glucose levels and HbA1 values in diabetics who showed relatively stable in glucose control. The rsults were as follows: 1) Both the pre-breakfast plasma glucose (FPG) and 2-3h post-breakfast plasma glucose (PPG) values showed a strong positive correlatin with HbA1 and HbA1C values determined at 4, 8 and 12 weeks after testing in both diet-treated and drug-treated groups. As a whole, the best correlations were found 4 weeks after testing. 2) The correlation coefficient between HbA1 and PPG 4 weeks after testing in both diet-treated and drug-treated elderly (60 years and over) groups was significantly lower than its correlations with FPG and PPG in the adult (59 years and under) groups and FPG in the elderly groups. 3) In both diet-treated and drug-treated groups, the mean FPG concentrations and the stndard deviations for each of the HbA1 categories were not significantly different between the adult and elderly groups. On the other hand, the mean PPG concentrations and standard deviations in elderly subjects were significantly higher than those for adult subjects at HbA1 levels less than 8% in the diet-treated group and less than 9% in the drug-treated group. 4) In patients with HbA1 levels less than 9% and within-subject variability of HbA1 levels less than 0.2%, the mean coefficient of variation of three serial PPG measurements was not significantly different between adult subjects and elderly subjects. In the elderly diabetics, the interindividual variability of PPG for a given HbA1 was larger than those of FPG in the eldrely and larger than FPG and PPG in the adult diabetics.
In order to investigate the effects of aging on thyroid function, total serum thyroxine (T4), triiodothyronine (T3), reverse T3 (rT3), free T4 (FT4) and thyrotropin (TSH) were measured in 109 normal controls, 153 cancer patients and 70 noncancerous inpatients. Mean T4, T3, T3/T4 and rT3 were stable throughout life in healthy adults. Values for TBG and FT4 in controls over age 70 were significantly lower than in younger controls. In cancer patients, mean serum T3 declined with increasing age, whereas throughout all decades, mean T4, rT3 and FT4 were stable. Concerning the age-related effect of undernutrition on thyroid frunction, cancer patients under age 60 had no significant correlation between serum values of T3, T3/T4, or rT3 and the magnitude of weight loss. However, reductions in serum T3 and T3/T4 and an elevation in serum rT3 values were noticed in lean cancer patients over age 60. In the effect of dementia on thyroid function, predementia and dementia group had significantly lower mean T3 and T3/T4 values than in sunormal or normal group, whereas mean T4, TBG and TSH values were stable. In noncancerous elderly inpatients, the group of grade 3 or 4 in performance state had a significant decrease in T3 and T3/T4. These findings suggest that age-related changes in extrathyroidal concersion from T4 to T3 reflect the multifactor including cancer itself, undernutrition, dementia and performance status.
Relationship between bone mineral contents and calcium intake and physical activity was investigated. Subjects were 85 healthy residents (39 men and 46 women) living in a geriatric home. The average age was 77.8 years. As indicator of bone mineral contents, bone density and cortical width of the metacarpal bone on an X-ray film were measured with a microdensitometer. Average daily calcium intake was calculated after weighing residual volume of meals. Amount of physical activity was investigated by an interview. The rsults were: 1) Calcium intake and bone density were correlated in men and women after controling age and cortical width was correlated in men. 2) Bone density was correlated with the intake of cow milk and was highest in those who drank milk every day. 3) Bone density was higher in those who maintained physical activities. These findings are important in care and guidance to the elderly.
Electrocardiograms of 479 subjects, who consisted of 226 males and 253 females, were recorded in the mass examination, . With aging heart rate decreased, RR interval was prolonged on ECG. PQ or QT intervals were also prolonged with aging. The QRS electrical axis tended to decrease after 20 years old. PQ intervals increased until 30 years old in males or until 20 years old in females, and then further increased gradually with aging. The same tendency of PQ interval was found, when heart rate was in the range of 55 to 75 beats per minute. There were significant positive correlations (r=0.582, r=0.638, r=0.632, respectively) found between aging and PQ, RR, or QT intervals in males, while significant positive ones (r=0.539, r=0.471, r=0.564, respectively) between them in females. Systolic or diastolic blood pressure levels were elevated with aging until 70 years old in both sexes. Sv1+RV5 increased in the voltage values until 9 years old in both sexes, then to decrease until 20 to 30 years old and again to increase until 79 years old. The left ventricular hypertrophy by the voltage criteria tended to increase with aging. The frequency of the horizontal depression of ST segment or the inversion of T wave tended to increase with aging.
Mahley et al had proposed that HDL-with apo E would play important roles in protective or anti-atherosclerotic functions of HDL, that is, in reverse cholesterol transporting to liver from peripheral tissues and in competing with LDL for binding to LDL-receptors. And Bittolo Bon et al. in 1984 reported for the first time that apo E concentration in HDL in survivors of myocardial infarction was significantly lower than that in controls. But apo E in HDL (HDL-E) in patients with old cerebral infarction (OCI) as the atherosclerotic subjects was not yet determined. So, in order to estimate whether HDL-E could be clinically expected to be one of the anti-atherogenic index, HDL-E in OCI was determined in this study by Ikeda's method using quantitative immunofixation electrophoresis, by which HDL-E was detected for the first time at near the α2-globulin region behind α lipoprotein (that is, HDL-without apo E). Samples were sera acquired in fasting from normolipidemic, aged 50-70 years old, 10 male and 10 female OCI without hepatobiliary disorders and age-matched healthy controls, and were examined as to triglycedies, cholesterol, apo A-I, apo B and apo E, in addition to determination of HDL-E. Cholesterol in HDL (HDL-C) and apo A-I were lower, and apo B, apo B/apo A-I ratio (B/A-I) and atherogenic index (A.I.) [(cholesterol-HDL-C)/HDL-C] were significantly higher in OCI than in controls. No significant difference in serum levels of apo E between two groups was observed, but HDL-E concentrations (0.6±0.2vs 1.4±0.3mg/dl, p<0.001), HDL-E ratios (HDL-E×100/serum apo E, %) (16.8±7.2 vs 42.1±6.4%, p<0.001), ratios of HDL-E/apo A-I (0.5±0.2 vs 1.1± 0.2%, p<0.001) and ratios of HDL-E/HDL-C (1.9±0.7 vs 2.8±0.6%, p<0.001) were significantly lower in OCI than in controls. Therefore, this result would reveal the disturbance of distribution of apo E to HDL in atherosclerotic subjects as OCI. In other words, it would be suggested from this result that anti-atherosclerotic functions of HDL in which apo E abnormally decreased would be weakened, as well as Bittolo Bon's speculation. And, as new information the significant reverse correlation between HDL-E ratios and levels of apo B which was main apolipoprotein of LDL was recognized in this study, so the information would clear the suspicion that HDL-with apo E might induce to be atherogenic hyper-low-density lipoproteinemia because of competing with LDL for natural binding to receptors. And more, HDL-E ratios significantly correlated with negative-atherogenic parameters of HDL-C and apo A-I, and inversely correlated with atherogenic parameters of B/A-I and A.I.. The results in this paper suggest that HDL-E ratio would be able to be evaluated as a negative-atherogenic index.
Renal function of erderly persons was evaluated by the radionuclide renal function test based on the renal uptake rate and the renal volume determined by Tc-99m-DMSA transectional tomographic images using single photon emission computed tomography (SPECT). Forty-three erderly cases (13 healthy persons and 30 patients with various types of renal disorders) aged between 60 and 87 on an average of 70 were studied and compared with results obtained from 20 healthy adults (18-45 years old). Renal volume was calculated from the summation of voxels in the region districted by equi-count threshold level (percentage to maximum count) on each section of the SPECT image. Attenuation correction was made by GE-STAR protocol utilizing Sorrenson's precorrection method. The renal uptake rate was expressed as a percentage of the total radioactivity detected within the renal volume, against an amount of dose injected. In the 26 kidneys of 13 healthy elderly persons, Tc-99m-DMSA renal uptake was 23±5%, which was signifficantly lower (p<0.01) than that of healthy adults being 27±2%. A correlation coefficient between renal volume and uptake of 79 kideys of 43 elderly persons was 0.5081 (p<0.01). Creatinine clearance (Ccr) was better correlated with the total renal uptake (r=0.6471, p<0.01) than with the total renal volume (r=0.3592, p<0.01). This method is considered to be useful for clinical purpose as a test of renal function for elderly persons since it requires neither blood nor urine samples.
Brain atrophy in 47 subjects without neurologic disturbances, ranging in age from 46 to 82 years, was studied using magnetic resonance imaging (MRI). Moreover, the association of the periventricular hyperintensity area (PVH) recognized with MRI, was also investigated. The volume percentages of the brain, the ventricles and sulci to cranial cavity were calculated as indicators of brain atrophy. The brain volume index decreased and the indeces of the ventricles and sulci linearly increased with age, significantly. The volume ratio of the ventricles to sulci significantly increased with increasing age (p<0.01) and the correlation coefficient was 0.38. This ratio showed negative correlation to the brain volume index. The volume percentage of PVH to the cranial cavity started to increase in the sixties and negatively correlated with the brain volume index. There was positive correlation between the ratio of the ventricles to sulci and the index of PVH.
A 70-year-old woman was admitted to our hospital, in March 1981, for the evaluation of markedly elevated erythrocyte sedimentation rate (ESR) and hypergammaglobulinemia. Physical examinations revealed no abnormalities except for bilateral cervical and axillary lymphadenopathy. There was no hepatosplenomegaly. The laboratory data were: ESR 149mm/hr, Hb 11.5g/dl, WBC 5, 400/μl, platelet 133, 000/μl, and total serum protein 9.8g/dl with albumin 38.8%, α1-globulin 3.0%, α2-globulin 7.8%, β-globulin 8.0%, and γ-globulin 43.2%. The serum levels of IgG, IgA, IgM were 6, 240mg/dl, 172 mg/dl, and 96mg/dl, respectively. Plasma cells were morphologically mature and normal, while slightly increased in the bone marrow (8.6%). Histological examination of a lymph node biopsied from the left axillary area demonstrated normal structure showing marked proliferation of plasma cells around follicles. As there were no other findings suggesting liver, infectious, connective tissue, or neoplastic diseases, she was diagnosed as having idiopathic plasmacytic lymphadenopathy with polyclonal hypergammaglubilinemia (IPL). She had received no therapy until June 1985 when the serum IgG concentration tended to increase gradually. A short course of oral prednisolone therapy (25mg/day) resulted in a transient decrease in the level of serum IgG. Thereafter, she has received no special therapy because neither symptoms nor changes in the laboratory find-engs were noted. The surface marker analysis on the lymph node cells obtained from the biopsied lymph node showed that they were E-rosette positive (+) 52.8%, surface membrane (Sm)γ+39.2%, Smμ+2.9%, Smκ+ 13.5%, and Smλ+11.0%, suggesting polyclonal proliferation of IgG-producing cells. These results coresponded to the finding that Smγ, Smκ, and Smλ positive cells were demonstrated histologically on the sections of the biopsied lymph node by using the PAP stains. When peripheral mononuclear cells of this patient were cultured in vitro for 7 days with or without pokeweed mitogen, the IgG production was markedly higher than that of the normal control. The in vitro interleukin-2 production by peripheral mononuclear cells also increased. The results of peripheral lymphocyte subpopulations measured by using the flow-cytometric immunofluorescence method coupled with monoclonal antibodies were as follows. The number of OKT8+, Leu2a+/Leu15+ (suppressor), and Leu4+/HLA-DR+ (activeted T) decreased. In contrast, OKT9+, OKT10+, OKIa1+, HLA-DR+, and Leu7-/Leu11c+ (natural killer) cells increased. Surprisingly, the SmIgG+ cells did not increase in the blood. It was not explainable from this study why SmIgG+ cells decreased in the blood in spite of increased in vitro IgG production by peripheral mononuclear cells. The response to phytohemagglutinin, concanavalin-A, and pokeweed mitogen were preserved normal. Since most of the IPL cases reported previously were young adults less than 40-year-old and had usually hepatosplenomegaly, the case reported here may be clinically somewhat different from them. As the pathophysiology of IPL is not elucidated sufficiently, further clinical, histological, and immunological studies will be required.