Mirror-writing is script that runs in the direction opposite to normal, with the individual letters also reversed. Although mirror-writing is well recognized as occurring in the presence of central nervous system damage, and is especially seen in association with hemiplegia, its mechanism has not yet been elucidated. The purpose of the present study is to document a high incidence of mirro-writing among patients aged 65 years or more, and to investigate the relationship of mirror-writing with brain damage and the degree of cognitive dysfunction. The subjects analyzed in this study were 112 patients (44 males and 68 females) and their average age was 73.8 years. Hasegawa's Dementia Scale (HDS) was used to evaluate their cognitive function. We could find no cases of mirror-writing with the right hand. A high incidence of mirror-writing was found in patients who could use their left hand. Mirror-writing was seen in 67% of patients with cerebral lesions on CT scan. However, we could not observe any relationship between the incidence of mirrow-writing and damage to a given circumscribed area of the brain. More than 90% of demented patients, whose HDS scores were less than 20, showed mirror-writing with their left hand. The mean score on the HDS for those with a high incidence of mirror-writing was significantly lower than the score for those without mirror-writing. These results indicate that a high incidence of mirror-writing among aged patients is related to cerebral damage and cognitive dysfunction.
A comparative study between patients aged over 65 (elderly group) and those under 65 (non-elderly group) was performed to determine the therapeutic efficacy of combination chemotherapy with vincristine, cyclophosphamide, Adriamycin and prednisolon (VCAP) for untreated multiple myeloma as both induction and maintenance therapy. The subjects selected were 38 patients with untreated myeloma who presented over the 7.5 years from 1982 to 1989 (June), consisting of 14 aged over 65 and 24 aged under 65. According to the classification of Durine and Salmon, 3 and 11 patients of the elderly group were stage II and III cases, respectively, while the numbers were 8 and 16 in the non-elderly group. The results defined by Imamura's criteria showed a 61.3% (9/14) partial remission rate in the elderly group and a 66.7% (17/24) rate in the non-elderly group. The 50% survival was 43 months in the elderly group and 65.5 months in the non-elderly group, with no significant difference between the groups. Thus, VCAP therapy for the induction of remission and maintenance for multiple myeloma therapy resulted in satisfactory prolongation of life in both groups, with a low incidence of the adverse reactions.
We analyzed the blood cell counts and serum levels of total protein (TP), total cholesterol (TC) and triglyceride (TG) of 2, 231 healthy subjects (1, 295 men and 936 women) between age 20 and 99 years in order to clarify the following two subjects. (1) In the approximately 10 years since the report of Shirakura et al in 1978, eating habits have improved and the average life expectancy has extended in Japan. Is there any effect of such betterment on blood cell counts of the aged? (2) It has been pointed out that quality of everyday life, such as staying at home but not in an old-age home, working, traveling, and so forth, had an influence on the blood cell counts of aged. Is there any difference between the blood cell counts of people under 60 years and those of people older than 60 years who have a good quality of life as mentioned above? The hemoglobin concentration, red blood cell count, and hematocrit value began to decrease in men in their sixth decade and in women in their seventh decade and the change was more prominent with advancing age, especially in men. The white blood cell count and platelet count tended to decrease with advancing age. The serum levels of TP, TC, and TG also declined with age in those over 60 years of age. These results confirmed that the hemoglobin concentration, red blood cell count, and hematocrit value decrease in the elderly subjects as they grow older and it may be considered that reduced ingestion of protein is one of the causes of the phemomenon.
To examine satisfaction with quality of life among elderly people with active diseases, in-patients aged 65 and over in Tokyo Metropolitan Geriatric Hospital were interviewed. Multivariate analysis was performed using Hayashi's quantification theory (the 2nd family). The dependent variable was the question “are there any satisfactory aspects of your becoming old?” and 18 explanatory variable items including age, gender, activity of daily living (ADL) and physical and mental status. Among 68 patients examined, 49 cases fulfilled all the items. The correlation ratio was 0.353, and rate of correct discrimination was 77.6% (78.9% and 76.7% of positive and negative responses, respectively). The range and correlation coefficient of ADL and age were greater than those of other items. Affirmative answers increased with advancing age and loss of independency in ADL responded negatively. Poor prognosis also affected satisfaction with life. These results suggest that age and progression of disability are important factors which determine life satisfaction in elderly in-patients.
Among several glycated compounds (GC) which are based on Maillard reaction, glycated hemoglobin (HbA1c) and fructosamine (FRA) have been utilized widely as a markers of diabetes. Recently, glycated albumin (GA) has been pointed out as a new indicator. For the determination of GA, spectrophotometry combined with an affinity column method has been mainly used, however the procedure is complicated. Recently a two-column HPLC method (ion-exchange column and affinity column) has been developed by Shima. We have evaluated a GA analyzer GAA-2000 based on Shima's method. After a series of fundamental and performance evaluation studies, the GAA-2000 was found to be appropriate for our study. Reference values obtained from this equipment were 10.56-16.87%. Correlation coefficients based on GA using diabetic and diabetic nephropathy patient specimens (n=87) were: FRA (r=0.944)>HbA1c (r=0.842)>Glucose (r=0.510) Superoxide dismutase (SOD) and lipid peroxidase (LPO) with are produced in relation to active oxygen did not show a good correlation. Although we tried classify the patients according to juvenile (20∼39), middle (40-64) and senile (>65) the method of Asada et al., we could not find any distinct tendencies.
Recently, plasma fructosamine concentration has been used as an indication of mean plasma glucose level preceding at last 1 to 2 weeks. In the present study, to chracterize the clinical significance and problems of plasma fructosamine concentration in aged subjects (≥65yrs), we determined plasma fructosamine concentration as well as serum albumin, total protein, HbA1, AbA1c and fasting plasma glucose concentrations in 81 (<65yrs) non-diabetic subjects (group A), 161 aged (≥65 yrs) non-diabetic subjects and 26 aged diabetics (group D). Aged non-diabetic subjects were further classified into 75 subjects with good ADL (group B) and 86 with poor ADL (group C). The normal limit of plasma fructosamine concentration (mean±2SD) in group A was 24% higher (3.1mmol/l) than that in group B (2.5mmol/l) but the plasma fructosamine/serum albumin ratio (F/ALB) was similar in these two groups. Plasma fructosamine correlated negatively (p<0.01) with age. This aging effect was explained by the reduced serum albumin in aged subjects. However, in group C, reduced plasma albumin was not associated with reduced plasma fructosamine. Plasma fructosamine corrected by albumin (F/ALB) is a useful parameter of blood glucose control in aged subjects. In aged subjects with poor ADL, HbA1, HbA1c and plasma glucose should be determined with fructosamine.
The present study was designed to clarify the characteristics of metabolic acidosis in aged patients with chronic renal failure. The subjects consisted of ambulatory cooperative patients (19 males and 18 females). Their values of creatinine clearance (Ccr) varied from 6.8 to 107.5ml/min/1.73m2. The relationship of Ccr to acid-base and electrolyte disturbances was investigated. The estimations of normal values in acid-base and electrolyte composition were based on the method of Hoffmann. The results are summarized as follows: 1. A high incidence of metabolic acidosis was demonstrated in patients whose Ccr values were below 20ml/min/1.73m2. 2. A significant positive correlation of Ccr values and plasma levels of bicarbonate (p<0.001) and a significant inverse correlation of Ccr values and serum levels of chloride (p<0.01) were observed. 3. The values of the anion gap did not change, irrespective of Ccr values. 4. Serum concentrations of potassium were inversely correlated with plasma levels of bicarbonate (p<0.01). Hyperchloremic normal anion gap acidosis with hyperpotassemia was the characteristic feature of metabolic acidosis in aged patients with chronic renal failure. The normal anion gap could be explained by normophosphatemia or mild hyperphosphatemia, even in the patients with advanced renal failure.
The authors examined the relationship between cerebral white matter changes and mental function, blood pressure in 39 neurologically normal aged (21 males, 18 females, mean age 75.0 years) who had no latent lesions on MRI images. The severity of cerebral white matter changes was estimated by T1 value images on MRI and was measured in the bilateral frontal lobe on an axial slice at the level of the basal ganglia and in the bilateral anterior, middle, and posterior portions on axial slices at the level of the body of the lateral ventricle (Figure 1). Mental function was measured by the Hasegawa's dementia rating scale (HDS) and Kohs' block design test (Kohs' test). The severity of cerebral frontal white matter changes increased significantly with age (p<0.05) (Figure 2). However there was no significant correlation between the severity of cerebral white matter changes and HDS, Kohs' test (Figure 3). The severity of frontal white matter changes correlated with the mean arterial blood pressure (p<0.02) (Figure 4). These results suggest that the severity of cerebral white matter changes is not related with mental function in the normal elderly, and that the severity of frontal white matter lesions is related with mean arterial blood pressure.
During last year, 931 men aged 51.0±9.5 years participated in our hospital's 3-day health screening. Their axillary temperature were taken 3 times per day (twice each, at 6:00a.m., 2:00p.m. and 6:00p.m.) during their 3-day stay and the mean axillary temperature was determained for each subject. In 72 among all subjects, the mean axillary temperature was below 36°C. These 72 subjects were classified as low-temperature individuals with normal temperature below 36°C. This study was designed to compare low-temperature subjects with mean axillary temperature, on various factors, such as age, degree of obesity, liver function, renal function, lipids, electrolytes, and biochemical data (blood glucose, serum amylase, and CPK). This study also included seasonal changes in these low-temperature subjects. The following results were obtained. 1) Age was most closely related to low-axillary temperature, and the degree of obesity (modified Broca-Katsura method) had second significant relation. The low-axillary temperature was in common in subjects over 60 years and was also common in obese subjects, regardless of their age. 2) No seasonal effect was observed with low-temperature subjects. 3) Only the age and the degree of obesity (modified Broca-Katsura method) showed negative correlation independently with the mean axillary temperature. (For age, the correlation coefficient was Y=-0.006539X+36.491, while for obesity it was Y=-0.004536X+36.203.) Therefore the older and the more obese the subjects, the lower the mean axillary temperature. 4) The following linear multipule regression equation was found to hold true: A=36.526-0.006365B-0.004190C in which, A denote the mean axillary temperature (°C), B the age (years), and C the degree of obesity (%) determined by the modified Broca-Katsura method. This study also revealed the fact that mean axillary temparature was most significantly related with age, and with obesity secondary.