It is considered that the atherogenic index (AI), calculated from cholesterol fraction levels, is biochemically acceptable but cannot completely express the degree of physiological development of individual arteriosclerotic changes in extremely elderly persons. The purpose of this study is to search for another form of the atherosclerotic index which is more reliable in terms of phyiological aspects, and to clarify the relationship between aortic pulse wave velocity (PWV) and AI in centenarians. We have measured the PWV in 40 healthy centenarians (7 males and 33 females; age 100 to 105, average age 101.1) and 92 ordinary eldely people (45 males and 47 females; age 70 to 89, average age 75.8) in Okinawa, Japan. The conventional AI was calculated by the Fridewald Method. A statistically significant difference in the AI value was observed between centenarians (1.91), and controls (2.59, p<0.0001). Higher levels of PWV in centenarians (10.15m/sec), were recognized than in the controls (8.45m/sec, p<0.0001). However, no significant correlations were noticed between PWV and AI in centenarians (r=0.0049) and in controls (r=0.094). These results suggested that pathological findings in centenarians are produced mainly by physiological fibrotic changes of the arterial wall instead of pathological atherosclerotic changes.
The authors report the clinical findings and the results of molecular genetic analysis of 8 patients with sporadic Alzheimer's disease. Differential diagnosis was carried out on the basis of familial history, laboratory data, brain imaging analysis using CT, MRI and SPECT. According to the clinical stage criteria made by Cummings and Benson, 6 cases were in stage 1 and the remaining 2 in stage 2. Recently, it was reported that affected members from 6 Japanese kindreds with familial Alzheimer's disease (FAD) had missense mutation in exon 17 of the gene for β/A4 amyloid precursor protein (APP). Amino acid substitution (Val-Ile) at codon 717 by this mutation was considered to be responsible for FAD in these kindreds. We used genomic DNA from 8 sporadic cases to determine whether the disease in these families is associated with an APP 717 mutation and the mutated codons, 102, 117, 129, 178, and 200, on the gene for proteinase-resistant prion protein (Prp) which causes transmissible dementia, Creuzfelt-Jacob disease (CJD) and Gerstmann-Sträussler syndrome (GSS). The results showed that there were no mutations on these genes in 8 patients. It would be necessary to analyze DNA from patient with sporadic Alzheimer's disease to examine the mutations found in the APP gene and Prp gene of heredity Alzheimer's disease patients.
It has been generally agreed that the elderly had a greater susceptibility, morbidity, and mortality in regard to a variety of bacterial infections. To clarify the host defence mechanism in the elderly, we studied the effect of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on neutrophil functions, the production of G-CSF by peripheral blood monocytes in response to lipopolysaccharide (LPS) and the serum levels of G-CSF in patients with bacterial pneumonia. There was no significant difference in the phagocytic activity of neutrophils between the elderly and control young adults. rhG-CSF enhanced phagocytosis by neutrophils, and a similar degree of enhancement was obtained in both group. Killing activity of neutrophils assessed by the new nitroblue tetrazolium reduction test in the elderly was significantly lower than that in young adults (p<0.001), however, pretreatment with rhG-CSF resulted in an increase of killing activity in the elderly, rasing their response to a level compatible to that of young adults pretreated with rhG-CSF. The amount of G-CSF in the culture supernatants from LPS-stimulated peripheral blood monocytes of the elderly was significantly lower than that of young adults (p<0.05). The serum levels of G-CSF in the acute phase of bacterial pneumonia in the elderly were significantly lower than those of young adults (p<0.01). These results indicated that impaired monocyte function may contribute, at least in part, to susceptibility to bacterial infection in the elderly.
This study was performed to evaluate the role of the nutritional and immune status on the prognosis of urinary tract infections (UTI) in the elderly. 192 patients among the 790 inpatients were diagnosed as UTI. Agerelated increase in the prevalence of UTI was accompanied with poor prognosis in the patients with hypoalbuminemia (<2.6g/dl) and lymphocytopenia (<700/mm3). To study the immunologic basis for susceptibility to UTI in the aged further, we compared the T-cell functions between outpatients without serious disease and inpatients with chronic UTI. The absolute numbers of lymphocyte, OKT3 (pan T-cell marker), OKT4 (Helper/Inducer marker) and Interleukin (IL)-2 as well as serum albumin concentration were decreased in the patients with UTI. A prospective study was done to confirm that these nutritional and immunological changes become risk factors in the prognosis of UTI with long-term and low-dose chemotherapy. In the patients continued with bacteriuria (Non-responders, n=6), serum albumin concentration and IL-2 production were significantly lower than the patients who became free from bacteriuria (Responders, n=7). These results suggest that poor nutrition-related immune dysfunction contributes to the vulnerbility of elderly patients to UTI and becomes risks for he prognosis of UTI.
As the number of the elderly in society increase, cases of abnormal bowel habit in the aged have also increased. This report describes 3 cases of acquired megacolon in the elderly. Case 1, a 71-year-old female, complained of constipation and developed megacolon after an attack of cerebral infarction. Case 2, a 82-year-old male, developed megacolon while receiving psychoactive medication. Case 3, a 69-year-old male who complained of constipation for a long time and rapidly developed megacolon was diagnosed as idiopathic megacolon.
Cataract is one of the typical ocular manifestations of Werner's syndrome. In contrast to cataract in normal elderly persons, cataract in patients with Werner's syndrome is known to be associated with degenerative corneal changes after cataract surgery. Among the corneal changes bullous keratopathy occurs in almost 100% of patients with Werner's syndrome after cataract surgery. Although penetrating keratoplasty appears to be the best treatment for bullous keratopathy, there have been few reports on bullous keratopathy in patients with Werner's syndrome. Here we report two patients with Werner's syndrome who underwent penetrating keratoplasty for the treatment of bullous keratopathy. In both cases, visual acuity was improved, suggesting that penetrating keratoplasty is a recommendable treatment for bullous keratopathy in patients with Werner's syndrome.
A 85-year-old female was admitted with general fatigue and chest discomfort in July 1991. Her chest X-ray film showed several pulmonary nodules in the bilateral lung fields without hilar lymphadenopathy. Metastatic lung cancer was suspected, but primary cancer was not detected in spite of cancer screening. Hemoglobin was 8.7g/dl. The patient also had various immunological abnormalities including increased serum cold agglutinin titer, decreased serum complement, positive anti-nuclear antigen and IgM-κ monoclonal gammopathy detected by immunoelectrophoresis. She was diagnosed as having autoimmune hemolytic anemia with cold agglutinin disease and M-protein. With the administration of corticosteroids, hemolytic anemia improved temporarily, but the patient died of hemorrhagic gastritis. At autopsy, a lung tumor was detected in the left upper lobe, mainly without hilar lymphadenopathy. The autopsy specimens showed Non-Hodgkin's lymphoma (diffuse medium-sized cell type), differentiated from macroglobulinemia by immunohistochemical studies. In elderly patients, with various immunological abnormalities, B-cell lymphoproliferative disorders such as malignant lymphoma should be suspected.