The purpose of this study was to clarify the prognosis of senile dementia based on a 5-year follow-up study in institutions for the elderly. The subjects consisted of 747 cases over 60 years of age. Of these 316 cases showed clinical dementia but 431 cases had no intellectual disturbance in July, 1987. The mortality rate (56.3%) of the demented group was significantly higher than that (31.8%) of the non-demented group. The mortality rate of patients increased with aging. However, the mortality rate of the demented group did not correlate with the severity of dementia. An autopsy study revealed that the direct causes of death in 51.1% of demented patients were pneumonia and cardiovascular diseases. Among the demented patients followed up for 5 years, 22.5% showed severe worsening of dementia, 25.8% showed slight or moderate degree of worsening and 51.70 showed no change. Factors causing exacerbation of dementia included cerebrovascular disease and bone fracture.
The chronic effects of cigarette smoking upon regional cerebral blood flow (rCBF) are unclear. The present study investigated the effects of smoking on rCBF assessed by intravenous 133Xe injection in 40 asymptomatic individuals. Analysis was performed using linear regression analysis and multiple regression analysis, creating a model of the rCBF as a function of cerebrovascular risk factor. The risk factors included smoking status, smoking index, age, gender, mean arterial blood pressure, total cholesterol, fasting blood glucose, hematocrit and STT change and left ventricular hypertrophy in electrocardiogram. The male-to-female ratio was higher in the smoking group (18/2) than that in the non-smoking group (2/18). Among the smokers, mean hematocrit was significantly higher than in the non-smokers (p<0.01). There was no significant difference in rCBF and other variables between the two groups. Linear regression analysis revealed significantly negative correrations between smoking index and CBF in the whole brain (r=-0.33; p<0.05), right hemisphere (r=-0.34; p<0.05), right parietal cortex (r=-0.36; p<0.05), right occiptal cortex (r=-0.34; p<0.05) and left parietal cortex (r=-0.33; p<0.05). In other variables, age, male sex, hematocrit, left ventricular hypertrophy and STT change showed significantly negative correlations with rCBF. To reduce the effect of confounding variables in our assessment of the dose-related response, a multivariate regression analysis was carried out treating rCBF as a dependent variable and risk factors as independent variables. In the final model, age, hematocrit, male sex and presence of BCG changes remained as independent negative predictors for rCBF. The results show a fairly complex relationship of various risk factors and their interrelationships. Advancing age, increased hematocrit, male sex, and ECG changes may contribute to rCBF decrease in asymptomatic individuals. Chronic smoking does not act alone in reducing CBF; it may influence rCBF in relation to other risk factors such as hematocrit, gender and ECG changes.
The study is to evaluate the relationship between extracranial carotid atherosclerosis and ischemic cerebrovascular disease using noninvasive B-mode ultrasonograpny and X-ray computed tomography. The sensitivity of bruits for diagnosing severe carotid stenosis was also evaluated. A total of 229 consecutive Japanese patients were recruited for this study, of which 97 had chronic-stage ischemic cerebrovascular disease and remaining 132 patients had at least one risk factor for atherosclerosis. Carotid atherosclerosis was evaluated by B-mode ultrasonography. Ischemic cerebrovascular disease was assessed by history taking, neurological findings and X-ray CT examination. The severity of carotid atherosclerosis was assessed by using two indices; plaque score and maximum percentage diameter stenosis. We also evaluated whether it was ulcerated plaque or not. Plaque score was computed by summing up all carotid plaque thicknesses (mm) on both sides. According to the CT findings, cerebral infarction was divided into two types; deep subcortical infarction and cortical infarction. The incidence of cerebral infarction increased in relation to plaque score and maximum percentage stenosis. Although the incidence of cerebral infarction in patients without carotid atherosclerosis was only 33% (38/116), it in patients with moderate carotid atherosclerosis (plaque score >5) was 59% (26/44) (p<0.05, chi-square test). The incidence of ipsilateral infarction was revealed to be higher in patients with severe (50% or more) carotid stenosis (61%) than in cases of mild stenosis (280) (p<0.05). Thirteen patients had ulcerated plaques and they suffered more frequently cerebral infarction than patients without ulcerated lesions. Cortical infarction was more frequent in patients with severe carotid stenosis than in patients without carotid atherosclerosis. The sensitivity of bruits for diagnosing severe lesions was only 58%. In conclusion, carotid atherosclerosis was a potent indicator of ischemic cerebrovascular disease also in Japanese, especially when the plaque score was 5 or more.
A total of 257 autopsy cases of pancreatic carcinoma, including 160 male and 97 female cases with an average age of 68.2 years, were divided into an aged group (70 years or older, 136 cases) and a control group (younger than 70 years, 121 cases), and their respective clinicopathological features were compared. The male to female ratio was 1.2:1 in the aged group and 2.6:1 in the control group. In both groups, abdominal pain was noted in about one-third of the cases as the primary symptom, followed by appetite loss and icterus. Concerning the primary symptoms, the two groups did not differ from each other. The rate of surgical resection was higher in the control group (24.0%) than the aged group (10.3%). Mean survival times were similar in both groups (5.71 months for the aged group and 6.01 for the control group). Intrapancreatic location of the tumor showed similar tendencies in both groups. However, cancer of the head of the pancreas was 2.3 times more common than body/tail cancer in cases aged 80 or more. Approximately 90% of the cases were diagnosed as ductal carcinoma by histological examination. The degree of differentiation was similar in both groups, but the well differentiated type was somewhat predominant in cases 80 years or older. Metastasis or direct invasion was noted to the liver, peritoneum and lung in this order in both groups. Liver and lymph node metastasis were less frequent in cases 80 years or older. Multiple primary cancers were noted in 8.8% of the aged group and 9.1% of the control. If defined as 70 years or older, the biological nature of pancreatic carcinoma from the aged group did not differ from that of younger. Cancers in patients aged 80 years or older seemed to have somewhat low malignant potential.
In order to evaluate the quality of life (QOL) in hypertensive outpatients, we selected 78 patients with hypertension of various degrees of severity (WHO Classification I: 29 cases, II: 15, III: 34), 59 not ill healthy persons (N1) and 22 normotensive outpatients (N2) aged at 50 years and over, using the self-completed questionnaire (QUIK) which we developed. QUIK covers four domains including physical functioning (20 questions), emotional adjustment (10), interpersonal relationships (10) and attitudes toward life (10) totaling 50 questions. In this study the internal consistency of QUIK was α=0.95 by the Kuder-Richardson formula 20 and it's repeatability was r=0.89 by the Spearman-Brown formula. The QOL in hypertensive outpatients was definitely worse in terms of total score (N1 5.1±4.4 vs WHO II 9.3±7.2 and III 12.1±5.6, p<0.05), for physical functioning (N1 2.5±2.1 vs WHO I 3.7±2.8, II 4.7±3.8, III 5.4±2.8 p<0.05), for emotional adjustment (N1 1.2±1.4 vs WHO III 2.3±1.7, p<0.01), for interpersonal relationships (N1 0.8±1.3 vs WHO III 1.6±1.5, p<0.01) and for attitudes toward life (N1 0.7±1.2 vs WHO III 2.7±2.0 p<0.01). The total QUIK score increased according to the severity of symptoms (WHO I 5.8±4.4, WHO II 9.3±7.2 and WHO III 12.1±5.6), respectively. The total score of WHO I was significantly lower compared with that of WHO III (p<0.01). After three months a second measurement under management by pharmacotherapy showed that the QOL in the WHO I group significantly improved in terms of total score (6.6±5.1 vs 4.3±2.8, p<0.05) and emotional adjustment (2.2±2.6 vs 1.1±1.2, p<0.05), but not in the WHO II or III groups. Our results indicated that the QOL in hypertensive outpatients was obviously poor and diminished as the severity of organic damage developed.
Seven hundred and thirty seven patients over 65 years of age (mean 76 years) undergoing gastrectomies from 1979 to 1991 were reviewed to evaluate the cause of stomal stenosis in the early postoperative period. Fifty seven (7.7%) patients, 24 males (5.6%) and 33 females (10.6%), had overt stomal stenosis or obstruction documented by radiological and endoscopic findings. The incidence of stenosis in females was significantly higher than in males (p<0.05). Complications developed in 19 (20.0%) of 95 patients after gastroduodenostomy (Billroth-I), 29 (6.2%) of 465 after gastrojejunostomy (Billroth-II and others) and 8 (5.0%) of 159 after esophagojejunostomy (total gastrectomy). The incidence of complications in the first was significantly higher than in the other two (p<0.01). The cause of stomal stenosis was classified into three groups; (1) transient stenosis due to stomal edema in 21 patients, (2) intestinal obstruction immediately adjacent to the stoma (kinking, invagination and volvulus) in 22, (3) organic stenosis of pathological origin (stomal ulcer, anastomotic leakage and strangulation by the proliferated mesocolon) in 14. The period of recovery from postgastrectomy retention was different in each group. It was 20.7 (mean)±7.7 (SD) days in group (1), 29.7±12.6 days in group (2) and 62.1±30.0 days in group (3). These mean periods were significantly different from each other (p<0.01). Group (1) and most of group (2) responded well to conservative management consisting of decompression by nasogastric suction and parenteral feeding but a reoperation was necessary for only two patients in group (2). Half of group (3) was treated by endoscopic dilatation and one third by reoperation. This three-group classification is recommended as a basis for the clinical management of stenotic stoma.
We surveyed complaints of dysuria in male elderly outpatients by questionnaire survey. Seven hundred and twenty outpatients (39 aged 30-39, 63 aged 40-49, 170 aged 50-59, 229 aged 60-69, and 219 aged 70 or more) visiting our outpatient internal medicine clinics were asked by a questionnaire about the subjective symptoms of dysuria, including frequencies of nocturia, prolongation of the start of urination, straining at urination, and residual urine, graded as asymptomatic, mild, moderate and severe. The subjects were divided into three groups as to the dysuria; normal group without symptoms or one mild symptom, borderline group with two or more mild symptoms, and dysuria group with one moderate or severe symptom or more. The rates of the patients in the dysuria group were increased with age, being 15%, 16%, 21%, 31% and 53%, respectively, in the above-mentioned age groups. This finding emphasized the importance of questions about dysuria in elderly patients also in internal medicine outpatient clinics, and of differential diagnosis for the causal factor(s) for dysuria in elderly patients including benign prostate hypertrophy.
Twenty three patients with hip fractures, over 70 years old of age, who had surgical treatment and medical rehabilitation in the Yokufukai Geriatric Hospital were studied to evaluate changes of EEG findings at the time of hip fracture. In all cases, the pre-fracture ambulation status were independent. EEG findings were graded as normal, abnormal (minor degree, moderate-to-severe degree) and states of ambulation after hip fracture were graded good or poor. Good ambulation was defined as total independence and poor ambulation was defined as dependent on assistance or bedridden. In 11 cases of good ambulation, nine had an EEG which was normal or abnormal to a minor degree during pre- and post-fracture periods. In 12 cases of poor ambulation, seven had an EEG which was normal or abnormal to a minor degree in the pre-fracture period, but in the post-fracture period, only two of them were in the same grade and five showed moderate-to-severe abnormal EEG findings. Five out of 12 cases of poor ambulation demonstrated moderate-to-severe EEG abnormality in pre- and post-fracture periods. The present study suggests that the response to hip fractures in the elderly are divided into two types based on their brain functions. One group can maintain good brain function immediately after hip fractures, while the other can not maintain sufficient brain function and lose their ambulatory ability.
Ambulatory blood pressure (BP) was non-invasively monitored in 124 normotensive elderly, living in an old people's home at the annual health examination. Cases were divided into 41 cases<75 years (group A, mean age 70.6) and 83 cases≥75 years (group B, 82.7) for analysis of the office BP and 24-hour BP. Whole-day systolic BP in group B was significantly higher than those in the group A (p<0.02) although no significant differences were observed in diastolic BP and pulse rate. Separated analysis of whole-day BP into daytime and nighttime revealed that the nighttime systolic BP in the group B was significantly higher than those in group A (132.2±17.4% vs. 123.8±18.6mmHg, p<0.02) whereas no significant difference was observed in day-time systolic BP between two groups (136.6±14.9 vs. 132.1±14.4mmHg, n.s.). The day-night difference in systolic BP ended to be less in group B than in group A (4.5±11.6 vs. 8.2±12.2mmHg, p<0.10). The prevalence of nondippers, who had a higher nighttime systolic BP than daytime systolic BP were 24.4% of the group A and 30.1% of the group B. It was concluded that systolic BP during the nighttime increased with the ageing process after age 60, although that during daytime did not change.
To evaluate the clinical significance of serum α1-Antichymotrypsin (ACT) as an early diagnostic marker of senile dementia of Alzheimer type (SDAT), we measured 333 healthy and not demented elderly subjects, 27 cases SDAT and 25 cases of vascular dementia (VD). For the measurement, a new high-sensitivity method, double antibody radioimmunoassay method was developed. In healthy elderly subjects, the mean value of serum ACT was 0.229mg/ml. A tendency towards increase of ACT with aging was noted but was not significant. The serum level of ACT in the SDAT patients was significantly higher (0.309mg/ml) compared with the healthy elderly subjects and the VD patients (0.226mg/ml) (p<0.01). We concluded that in the patients with SDAT, there was an overproduction of ACT and the serum value of ACT was markedly elevated. The measurement of serum ACT is very useful (sensitivity=88.9%, specificity=68.70; cut-off value=0.250mg/ml) for the early differential diagnosis of senile dementia.
Among 16 male (mean age of 66.6 years) and 51 female (mean age of 65.3 years) inhabitants of a rural area, the concentration of serum lipid peroxide measured as malondialdehyde (MDA) by Yagi's method was analyzed by physicochemical and food intake items. The MDA level in serum showed a peak of 6.2nmol/ml at fifties years old in females and showed constant values of 4.6 and 6.1nmol/ml for females and males, respectively, in those aged 60 more. The MDA level significantly correlated positively to total- or LDL-cholesterol level and urinary K/Cr, thus MDA level seemed to be a risk factor of arteriosclerosis. Fruit intake significantly positively correlated to MDA level in male. The MDA level showed a significantly higher level in the group with both higher total-cholesterol and urinary K/Cr levels, than in the other groups. It is suggested that a high intake of potassium increases the MDA level in the group with higher total-cholesterol level.
A 68-year-old man was admitted to our hospital because of postural hypotension in July 1991. He was also suffering from anhydrosis, urinary disturbances, constipation and impotence. He had not developed signs of Parkinsonism, cerebellar or peripheral neuropathy four years from the onset. Various autonomic function tests showed sympathetic and parasympathetic dysfunctions of mainly postganglionic origins. Thus we diagnosed this patient as “pure” progressive autonomic failure (“pure” PAF). “Pure” PAF is a new entity described by Bannister and Oppenheimer in 1982. It shows symptoms of autonomic failure without other neurological disturbances which manifest as Shy-Drager syndrome. Treatment with L-DOPS increased his blood pressure level and attenuated his symptoms due to orthostatic hypotension.