Aspiration pneumonia in patients who received enteral feeding via a nasogastric tube may result from retrograde colonization from the stomach, and this may be more likely when the gastroesophageal reflux is severe and the gastric pH is relative high. We investigated 11 elderly patients fed via nasogastric tube with suspected recurrent aspiration pneumonia by means of esophageal scintigraphy, 24-h pH monitoring, gastric pH and concentrations of gram-negative bacilli in gastric aspirates. The grade of respiratory tract infection (RTI) was evaluated by the frequency of episodes of fever with respiratory symptoms. The correlation between the grade of RTI and reflux index by scintigraphy was statistically significant (p<0.05), but the correlation between the grade of RTI and reflex rate by 24-h pH monitoring was not statistically significant. Although the correlation between gastric pH and log (base 10) concentration of gram-negative bacilli/ml of gastric aspirates was statistically significant (p<0.001), the correlation between the grade of RTI and gastric pH was not statistically significant. Scintigraphy was superior for evaluation of gastroesophageal reflux resulting in aspiration pneumonia in the tube-fed elderly patients.
To clarify the pathogenesis and endoscopic features of ischemic lesions of the colon, experimental ischemia was induced in dogs by arterial ligaiton, gelfoam injection, and clipping. In addition, clinical and endoscopic features of ischemic lesions in ischemic colitis cases in human were studied. In the experimental model, arterial ligation including marginal arteries frequently induced erosions in the large intestine, whereas ligation of the colic artery alone did not induce apparent mucosal lesions of the large intestine. Gelfoam injection to produce thrombi into caudal mesenteric artery or middle colic artery induced ulcers with a high rate of incidence and frequently accompanied by intestinal perforation. Temporal impairment of blood supply by arterial clipping produced erosion, but not ulcers. A high incidence of erosion was obtained in a group that underwent clipping for a prolonged period and a group of recieving Alosenn. Mucosal blood flow measured by the hydrogen gas clearance method was significantly decreased at 1hr and 4hr after gelfoam injection compared with those after arterial ligation. In human cases of ischemia following arterial surgery, endoscopic features were similar to those lesions of the experimental ischemia induced by gelfoam injection. These results suggest that thrombi in peripheral small arteries may play a major role in the pathogenesis of ischemic lesions of the large intestine.
The effects of the bathing on short-term and ciracadian blood pressure (BP) in bedridden elderly patients were investigated in 10 bedridden patients (4 male: 6 female) living in a community home. The mean age of the subjects was 78.7 years old and causes of bedridden status were cerebrovascular disease in 9 and spinal damage in one. To study the short-term hemodynamic effect of bathing, BP and pulse rate were measured every 2 minutes from 10 minutes before bathing to 14 minutes after. Blood samples were collected before and after bathing for measurements of plasma catecholamine and plasma renin activity. To study the effect of warm bathing on circadian, BP, ambulatory BP was noninvasively monitored every 15 minutes for 24 hours on days with and without bathing. In the short-time phase, BP temporally elevated when washing the body outside the bathtub accompanied with a decline soaking in warm water (38°C). Plasma catecholamine did not change after warm bathing. In the study of circadian change of BP, systolic BP on days of warm bathing remained at a lower level for 12 hours after bathing compared to days without bathing. In conclusion, hypotensive effects after bathing were prolonged in the bedridden elderly patients.
Although monocyte influx has been suggested as the primary source of pulmonary alveolar macrophages (AM), increasing evidence from recent studies has indicated that AM may be sustained through a self-renewal mechanism. We evaluated the age-related changes of the clonal growth (colony formation) of AM in mice (C57BL/6N mice and senescence accelerated mice). The colony forming unit (CFU) of AM of 24 month old C57BL/6N mice was lower than that of AM of 4-month-old mice (p<0.05). In SAMP6 (senescence accelerated mice), CFU of AM was decreased with aging (p<0.05). In SAMR1 (controls for SAMP6), CFU of AM was decreased with aging (p<0.001). In SAMR1, CFU of bone marrow (BM) adherent cells of 12-month-old mice was similar to that of 4-month-old mice. In SAMP6, CFU of BM adherent cells of 12-month-old mice was larger than that of 4-month-old mice (P<0.005). It was concluded that the CFU of AM declined with aging, but the CFU of the BM adherent cells did not. The decline of the AM CFU may be partly responsible for the defect of the immune response of the alveolar space in the elderly.
To investigate the relationship between troublesome behavior and cognitive status in Alzheimer type dementia (DAT), and to know whether the addition of cerebrovascular ischemia modifies that relationship, we studied behavioral and cognitive data from a clinical series of 57 DAT patients (mean age: 83.4 yrs) and 31 patients with mixed Alzheimer and vascular dementia (MIX) (mean age: 83.4 yrs). All subjects were ambulatory and were recruited from among patients having been admitted to our affiliated nursing home. None of them had any serious systemic diseases. The Dementia Behavior Disturbance scale (DBD), originally developed by Baumgarten et al, and the Mini-Mental State (MMS) were used for the evaluation of behavioral problems and cognitive status, respectively. In the DAT group, a significant correlation was recognized between DBD and MMS scores. In the MIX group, however, DBD scores did not correlate with MMS scores. Among patients having MMS scores greater or equal to 20, those with MIX had higher DBD scores (mean 19.3) than those with DAT (mean 13.7), although MMS scores in these two subgroups were comparable. These findings suggest that in DAT, behavioral problems increase in conjunction with cognitive impairments. However, with the addition of cerebrovascular ischemia to Alzheimer pathology, behavioral impairments may progress independently of cognitive decline, with more frequent presentation of troublesome behaviors in the early stage of dementia.
The concentrations of Br, Cu, Fe, Se, Zn, Mg were determined by particle-induced X-ray emission (PIXE) in serum and cerebrospinal fluid (CSF) of 13 untreated, 7 L-dopa treated parkinsonian patients and 25 controls. There were significant positive correlations between serum concentrations and CSF concentrations of Br, Cu, Fe. The Cu/Zn ratio in the serum and the CSF/serum ratio of Br were significantly increased with age in normal controls. The mean CSF concentration of Mg in both treated and untreated parkinsonian patients was lower than in controls. PIXE is a valuable method for multielemental analysis of the serum and CSF.
The purpose of this study was to assess the role of institutions for the elderly, and special nursing homes in particular, with regard to senile dementia. The subjects consisted of 81 cases who were institutionalized in our special nursing home from early November, 1992 to late October, 1993. Of these, 37 cases (45.7%) showed clinical dementia at the time of institutionalization. The severity and respective percentages of dementia were as follows: slight degree 32.4%, moderate degree 27.0% and severe degree 40.6%. The severity of dementia demonstrated significant correlation with age, Hasegawa's Dementia Scale, activity of daily living and physical conditions. The admission rate (40.5%) of the demented group for physical diseases was significantly higher than that (22.7%) of the nondemented group. The majority of families of both groups first sought advice at institutions other than our special nursing home and the welfare office in the city, prior to being institutionalized. The referral rate from such institutions was far higher than that for direct entry from their homes. We consider that special nursing homes, in addition to carrying for daily living requirements, should pay great attention to physical diseases in patients suffering from senile dementia, and cooperate with medical institutes, particularly referring hospitals, and other welfare and health facilities, in this regard.
To estimate the relationship between aging, dementia and changes observed on magnetic resonance imaging (MRI) seen in elderly patients with cerebral thrombosis, MRI findings in 103 patients with an initial stroke event (thrombosis group) were compared with those of 37 patients with hypertension/diabetes (high risk group) and 78 patients without those disorders (low risk group). In addition to the causative lesions in the thrombosis group, periventricular hyperintensities (PVH), spotty lesions (SL), silent infarctions (SI), ventricular dilatation (VD), and cortical atrophy (CA) were analyzed in these groups. Infarctions located in the internal capsule/corona radiata were the most frequent causative lesion. Compared to the low risk group, a high incidence of patchy/diffuse PVH, SI, and severe CA was seen in both the thrombosis group and the high risk group. Widespread PVH and multiple SL increased with age in the thrombosis group, while severe CA was seen in each group. SI and VD tended to increase after age 60, though they were not significant. Dementia, diagnosed in 40 out of 78 patients, increased with age. Multivariate analysis revealed the degree of the effects of MRI findings on dementia to be marked in PVH, brain atrophy, causative lesions, and SL, in that order. These results indicated that diffuse PVH and brain atrophy, developing with age, promoted dementia in the elderly with vascular lesions. Moreover, they suggested that a variety of silent brain lesions recognized on MRI other than infarction can affect symptoms in the elderly.
We conducted a questionnaire survey on the awareness of elderly patients in our hospital concerning medical management. As to the recognition of their own diseases, patients aged 80 or older, showed a lower degree of understanding than those under age 80. The proportion of patients who wished to know about their diagnosis decreased with age, although no statistical significance was recognized. Those who wished to known about their diagnosis, even if it were malignant, reduced significantly depending on the increase in age. In addition, the proportion of patients who would not like to know their diagnosis, if it were malignant, increased significantly as age increased. Proportions of patients who wanted to know other information, such as prognosis, the aims, methods and results of medical examination, the methods and adverse effects of treatment, and the names, effects and side effects of drugs, also decreased significantly as age increased. However, there were no statistical significant differences in the proportion of answers between cases of malignant and non-malignant disease. These data show that elderly patients had more anxiety or fear about malignancy, and wished to know less about medical management than nonelderly patients.
We report one case of parkinsonism induced by cisapride and one case of Parkinson's disease whose symptoms were worsened by cisapride. Case 1. A 75-year-old female who had suffered from constipation and loss of appetite, was treated with cisapride for her gastro-intestinal symptoms. One year later, she developed progressive parkinsonism and depression. She showed parkinsonian gait, cogwheel rigidity and slowness in motion. Two months after cisapride was discontinued, her parkinsonism and depression disappeared. Case 2. A 66-year-old female with Parkinson's disease was given cisapride for constipation. Two months after starting cisapride, her akinesia and rigidity deteriorated gradually, and she became bed-ridden with dysphagia and dyspnea. After cisapride was discontinued, her parkinsonian symptoms improved gradually, and she became ambulant three months later. Cisapride is a benzamide derivative with a prokinetic action. Experimental studies have revealed that it has indirect cholinomimetic effects and potentially stimulates the gastrointestinal motor activity without blocking dopamine recepters or activating muscarinic cholinergic receptors. However, the present cases showed that cisapride could be a dopamine receptor blocker, and either induce or worsen parkinsonism. Therefore, cisapride should be avoided or very carefully used in parkinsonian patients and old people.