Monoclonal antibodies (TB1 & TB2), which were obtained by immunization of 24 amino acids in BALB/c mice, bound specifically to the amyloid senile plaque and amyloid-angiopathic lesions of brain tissues of patients with Alzheimer's disease (AD) or with senile dementia of Alzheimer type (SDAT), and strongly reacted with the 1st part (Asp-Ala-Glu-Phe-Arg-His-Asp) of β-protein. Western blotting and two-dimensioned immunoelectrophoresis of cerebrospinal fluid (CSF) and serum revealed bands of 125 and 20 kilodaltons. The positive frequency of 125 and 20KD bands detected by two-dimensioned immunoelectrophoresis was higher in the serum of AD and SDAT patients (12 cases) than in that of normal control patients. ELISA employing various anti-amyloid precursor protein (APP) antibodies was performed using the extract of the human neuroblastoma cell line (NB39) which produces APP. In the near future, we hope to measure APP in CSF and sera from patients with Alzheimer's disease.

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We investigated the correlation between aging and sensitivity of blood pressure to salt. 88 non-treated essential hypertensives were devided into four groups: less than 40 years old (n=20), 40-49 years old (n=20), 50-59 years old (n=39), and greater than 60 years old (n=11). Changes of blood pressure, plasma renin activity (PRA), plasma aldosterone concentration (PAC), plasma norepinephrine (PNE), and plasma epinephrine (PE) due to salt load were compared among four groups. Salt sensitivity of blood pressure was increased with aging, and there was a positive correlation between them (r=0.30, p<0.01). Decrement of PRA due to salt load was decreased with aging, and there was a negative correlation between them (r=-0.35, p<0.05). PCA and PNE were suppressed by salt load, and the decrement degrees did not change with age. PE did not change by salt load. We conclude that salt sensitivity is increased with age in essential hypertensives, and renin-angiotensin system might be involved in it.

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The prevalence, rate of correct clinical diagnosis and mortality of cancer were analyzed in 4, 894 consecutive autopsies at the Tokyo Metropolitan Geriatric Hospital from 1972 to 1990. average age and standard deviation of patients was 78.1±9.1 years. Cancer was found in 45.5% of patients of 60 years and over, and in 49.1% in men and 41.9% in women (p<0.001). Cancer prevalence decreased with advance in age; 50.0% in the sixties, 47.9% in the seventies, 43.2% in the eighties and 39.3% in the nineties and over. Multiple cancer was found in approximately 12% of patients of 70 years and over. The top three cancer incidences were gastric cancer, 15.0%, lung cancer, 10.7% and colon cancer, 5.9% in both genders. In men, prostate cancer was next common, followed in orderly hepatic cancer, esophageal cancer, gall bladder-bile duct cancer, pancreas cancer, renal cancer and urinary bladder cancer. In women, the following order of frequency was gall bladder-bile duct cancer, uterus cancer, pancreas cancer, hepatic cancer, breast cancer, thyroid cancer, esophageal cancer, renal cancer and urinary bladder cancer. The prevalence of gastric cancer, lung cancer, hepatic cancer and esophageal cancer was significantly higher in men, while that of gall bladder-bile duct cancer was higher in women. The age-related tendencies varied among cancers of different organs. Gastric cancer increased up to the sixties in men and up to the seventies in women and leveled off after those ages. Lung cancer revealed peak prevalence in the sixties and seventies and decreased after the age of eighty. The peak prevalence was 15.9% in men and 8.4% in women. In males, prostate cancer increased with advance in age, while hepatic and esophageal cancers decreased with advancing age. Despite the recent development of imaging techniques and increasing safety of biopsy examination, the rate of correct clinical diagnosis of stomach and colon cancers was 73%, and that of lung, pancreas and esophagus cancers was between 80 and 85%. However, correct diagnosis was made in over 90% of cases, when these cancers were the causes of death. Cancers with low diagnostic rate included thyroid cancer (56%), prostate cancer (46%), and renal cancer (39%), in which latent cancer was frequently found at autopsy. Cancers with a high mortality rate included gall bladder-bile duct cancer (85%), pancreas cancer (76%) and lung cancer (69%). Patients with hepatic and esophageal cancer died of cancer in 61%, and patients with cancers of the colon, kidney and stomach died of cancer in 44-50% of cases. Cancer patients of the urinary bladder, prostate, uterus, breast and thyroid died of cancer in only 20% to 27% of cases. As a whole, 55% of cancer patients died of cancer. Cancer in the elderly patients should be treated based on consideration of the nature and the progression of the cancer, age-dependent characteristics and other complicating diseases.

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The authors investigated gastric emptying in 18 elderly patients with cerebral vascular diseases using the acetaminophen method. Subjects were divided into 2 groups according to their levels of daily activity. One group consisted of 10 comatose patients (71-92 years old), the other consisted of 8 patients (74-95 years old) who could walk by themselves. We also investigated gastric emptying in 6 comatose patients (38-83 years old) because of other diseases such as amyotrophic lateral sclerosis and in 11 elder controls (75-95 years old). In elderly controls, the acetaminophen concentration at 45 minutes was 9.08±1.71μg/ml. In comatose patients due to cerebral vascular diseases, the concentration was 3.89±±1.60μg/ml, which showed significantly delayed gastric emptying (p<0.05). In patients with cerebral vascular diseases who could walk, the concentration was 6.51±0.99μg/ml. In comatose patients by another diseases, the concentration was 5.82 ±1.13μg/ml. We suspected that delayed gastric emptying is related to the comatose state. Trimebutine significantly (p<0.01) improved gastric emptying in comatose patients with cerebral vascular diseases.

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The authers investigated the concentrations of multiple neurochemicals (6 kinds of catecholaminergic and 5 kinds of indolaminergic substances) in the lumbar cerebrospinal fluid (CSF) of patients with and without senile dementia (13 Alzheimer type (AD), 7 vascular type (VD), 11 Parkinson's disease (PD) and 9 non-demented controls (C)) by means of a neurochemical analyzing system (Neurochem, ESA). By means of the enzyme-linked immunosorbent assay (ELISA), we also determined the concentration of α₁-antichymotrypsin (ACT) in the CSF, which may be a possible diagnostic biochemical marker of the senile dementia of Alzheimer type. ACT in CSF was significantly higher in the AD group. It correlated negatively with Hasegawa's dementia scale (HDS) significantly. It also correlated negatively with the concentration of HVA significantly and showed tendency to correlate with the concentrations of dopamine and the ratio of kynurenine and tryptophan (KYN/TRP). Each dementia group showed characteristic concentration patterns of neurochemicals (DA, HVA, MHPG/NE, KYN/TRP, and 5-HIAA/5-HT). Our approach may provide a new quantitative method to diagnose geriatric neuropsychological diseases as well as senile dementia.

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We evaluated the accuracy of two types of finger blood pressure (BP) measurement devices for home-use (EW276 H, NATIONAL Ltd. and HEM 804F, OMRON Ltd.) by comparing BP values with upper-arm BP measured with a standard mercury column sphygmomanometer in 28 elderly subjects (13 Hypertensives and 15 normotensives). The correlation coefficient of systolic BP value and that obtained by each method was R²=0.5 for EW 276H and R²=0.6 for HEM 804F. The higher the systolic BP, the greater was the difference between the upper-arm and finger BP values. The magnitude of the difference between finger and upper-arm values for systolic BP did not correlate with pulse wave velocity. An underestimation of the finger BP device in systolic BP was 23.8mmHg in hypertensives and 7.6mmHg in normotensives for the EW 276H, and 15.3 and 3.5mmHg, respectively for the HEM 804F. This study demonstrated a large difference between the finger BP value measured with the home-use devices and upperarm BP value measured with a standard mercury sphygmonanometer in elderly hypertensive patients. The difference may be due not only to atherosclerotic change, but also to methodological factors related to finger BP measurement.

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Thirty patients with atopic asthma in whose asthma IgE-mediated allergic reaction participates, were selected for this study. They were divided into three age groups: elderly patients aged 60 and over, middle-aged patients between the ages of 40 and 59, and young patients between 20 and 39, to clarify the effects of aging on the mechanism of onset of asthma. In the cellular composition of bronchoalveolar lavage (BAL) fluid, the proportion of BAL lymphocytes was increased in elderly patients, and the proportion of BAL eosinophils was increased in young patients, although there was no statistically significant difference between the proportions of these cells in the three age groups. The proportion of BAL basophilic cells (basophils and mast cells) was significantly lower in elderly patients than in young patients (p<0.05). The release of histamine from BAL cells was significantly lower in elderly patients than in middle-aged patients (p<0.05) and young patients (p<0.02). There was, however, no significant difference between the release of leukotrienes C₄ (LTC₄) and B₄ (LTB₄) in the three age groups. The release of histamine, LTC₄ and LTB₄ from peripheral leucocytes was not significantly different between the three age groups. Finally, Bronchial reactivity to methcholine showed a tendency to decrease with aging.

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A 78-year-old man was admitted to our hospital with anemia and jaundice. Hematological studies revealed hyperchromic macrocytic anemia, and biochemical studies revealed findings of hemolysis. The folic acid level was low and megaloblasts were observed in the bone marrow. From these findings, the patient was diagnosed as having megaloblastic anemia due to folic acid deficiency. This patient had been a heavy alcohol drinker in the habit of drinking alcohol without meals. He began to eat regular meals in the hospital, and the anemia and jaundice improved gradually. Since liver cirrhosis was suspected, amino acid analysis of the urine was performed, and abnormal excretion of β-aminoisobutyric acid (BAIB) was found. According to the amount of BAIB excreted, the Japanese population can be divided into low and high BAIB excretors comprising 65% and 36%, respectively. BAIB is also considered to reflect dissimilation of thymine. The present patient was included in the high excretion group because of the abnormally high urine level of BAIB, which was considered to be caused by ineffective hematopoesis in the bone marrow as a result of his megaloblastic anemia. For this reason, dissimilation of thymine was considered to have been active in this patient.

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The authors report that bifemerane hydrochloride treatment improved emotional incontinence in patient with cerebral infarction. Before and after bifemerane hydrochloride treatment, ^99mTc-HM PAO single photon emission CT (SPECT) was performed. After treatment, regional cerebral blood flows (CBF) in frontal lobe area increased selectively. These findings suggest that emotional incontinence and decreased CBF of the frontal lobe area were closely associated in this case.

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