In order to identify a characteristic difficulty in rhythmic movements with aging, a total of 380 healthy participants aged from 18 to 85 years (group 1), and 1, 134 elderly community residents aged from 65 to 89 years (group 2), were examined using a finger-tapping test. The test requested the participant to tap in time to a periodic sound train with frequencies of 2, 3, 4, and 5Hz (cycles/sec) for group 1, and with 4Hz for group 2. Tapping deviated towards a faster rate from the stimulus frequency by more than 3 msec at 4Hz and/or 5Hz, “hastened tap” (HT), was found to be characteristic of aging. In group 1, the participants who exhibited HT increased with age and reached more than 35% in their 60s and 70s. In group 2, the percentages of participants with HT at 4Hz were 14.6 (60s), 15.9 (70s) and 29.3 (80s), which were very close to the 16.9% of participants with HT at 4Hz over 65 years in group 1. This figure suggested that more than 50% of participants over 80 years exhibited HT in tapping test at 2 through 5Hz. HT in the elderly appears to be similar to hastened tapping observed typically in patients with Parkinson's disease, suggesting a parallel of extrapyramidal motor dysfunction between normal aging and parkinsonism.
A number of studies have been published which have attemped to define the electrocardiographic (ECG) changes with aging, but most of them were obtained from cross-sectional studies. To distinguish ECG changes related to physiological aging from those associated with arteriosclerosis, we assessed the ECG changes of 500 apparently healthy subjects, aged 60 years and older in 1992, who had been followed at the Keio Health Consulting Center for over 15 years. All subjects had no overt cardiovascular diseases in 1992. We compared the ECG in 1992 with that taken over 15 years ago. Changes in ECG during that period were also reviewed. With aging, the mean axis deviated to the left, the mean QTc interval was shortened, and the mean PR interval was prolonged. ST segmental change, atrial overloading, bundle branch block developed newly in 16%, 8% and 7% of, respectively. There were no relationships among axis deviation, PR interval change, or QTc shortening and coronary risk factors. QTc prolongation and ST segmental change were strongly related to hypertension or impaired glucose tolerance. When ECG changes in those under 65 years old were compared with those over 80 years old, the incidence of ST segmental change in those over 80 years old was significant higher. This study was not a prospective study but suggested each type of ECG change related to aging was affected by physiological and/or pathological factors in a distinct way and had different phases of development and progression.
Cases of Mallory-Weiss syndrome aged over 75 year were analyzed with regard to their clinical features. In a 5-year period, there were 9 such cases, representing 19% of the total number of Mallory-Weiss syndrome cases. Four patients had a history of retching or vomiting, but in the other 5 patients, Mallory-Weiss tears occurred during endoscopic examination with slight vomiting reflex or even almost vomiting reflex. The latter cases had a spindle-shaped tear which was located on the lesser curvature at the cardia of the stomach. All patients were manged conservatively by observation without endoscopic hemostatic procedure, because the amount of bleeding was small. The 5 patients were thin and three of them had chronic atrophic gastritis. Mucosal weakness is an important etiologic factor in aged patients who develop Mallory-Weiss syndrome.
This study was designed for the purpose of investigating the factors for longevity in the Tokyo metropolitan area. At first, we examined the social and physical background of centenarians by direct mail in 1992. A total of 398 questionnaires (from 81 males and 308 females) were returned. There was a significant gender difference in mobility, with 38% of males and 10% of females being able to take a walk. However 19% of male centenarians and 28% of female ones were bedridden. Hypertension, respiratory disease and heart disease were found in 22%, 16%, 16%, without any significant gender differences. On the contrary, there were more female centenarians with past histories of bone fracture (34%) than male (10%). This discrepancy suggests that bone fracture may be one of the factors causing the gender differences in mobility. Those who had a high level of education were more frequent in centenarians (27% of males and 8% of females) than in the general population of their contemporaries in Japan (less than 2%). The average age at death of the centenarians' parents was 69.6±15.7y/o for their father and 71.2±17.2y/o for their mother. These ages were significantly higher than the average life-span in the last decade of the 19th century, according to the First Life Tables in Japan. The possibility is suggested that longevity was inherited in these centenarians' families.
MRI of 31 patients with dementia of the Alzheimer type (DAT) (mean age 74.7 years) were studied to detect characteristic findings, and compared with those of 24 normal elderly controls (mean age 74.1 years). Atrophy was quantitated by planimetric and linear measurements, and periventricular and deep white matter signal abnormalities were assessed by subjective ratings. Although we observed significant differences between the DAT patients and controls, there was overlap in each of the measurements. Of these, the ratio of the temporal horn area and the pattern of linear measurements (the width of the temporal horn body-the medial temporal lobe width-the interuncal distance) best distinguished the DAT patients from controls. Twenty-five patients (81%) had a ratio of the temporal horn area larger than the value of the mean+2SD of the controls. AV-shaped pattern, in which the medial temporal lobe width was smaller than the other two values, was demonstrated in 84% of the patients and only 8% of the controls. Although signal abnormalities were not useful for diagnostic purposes, periventricular hyperintensities were more commonly seen in the DAT patients than in the controls, and correlated with cognitive function. MRI studies suggest that the assessment of medial temporal lobe atrophy is useful in the diagnosis of DAT, and periventricular hyperintensity may be related in some way to the disease process.
In order to clarify the therapeutic policy for hypertension in the elderly, we mailed a questionnaire to 147 specialists in Japan and received 123 replies. The upper age limit for antihypertensive treatment was considered to be 80-85 years old by about 50% of the specialists, but the other 50% did not consider an upper age limit. The range of the systolic blood pressure (BP) for which drug treatment was indicated in those without cardiovascular complications was considered to be increased with age, being 160mmHg and higher in those aged 60-69, 160-170mmHg and higher in those aged 70-79, and 170-180mmHg and higher in those aged 80-89, while the level of diastolic BP requiring treatment was considered to be 90-95mmHg and higher in all age ranges. The goal of BP control was considered to be less than 150/90mmHg in those aged 60-69, and less than 160/90mmHg in those aged 70-79 by the majority of the specialists, and to be higher in those aged 80-90, i.e. less than 170-180/95-100mmHg by more than 20% of the specialists. As the initial selection of antihypertensive regimen, calcium antagonists followed by angiotensin I-converting enzyme inhibitors (ACEI) were selected by the majority, while diuretics, β-blockers and α1 blockers were chosen by the minority. The mean goals of BP control were considered to be slightly higher for elderly hypertensives with chronic cerebral infarction, with arteriosclerosis obliterance, or with renal insufficiency, being 154-159/89-90 and 160-164/90-91mmHg for those aged 70-79 and 80-89, respectively, but to be slightly lower for those with chronic stage cerebral hemorrhage, ischemic heart diseases, diabetes mellitus, and hyperlipidemia, being 152-153/88 and 158-159/89mmHg, for those aged 70-79 and 80-89, respectively. Calcium antagonists were most popular for initial treatment in those with any of these complications. ACEI was seldom used in cases with renal insufficiency. β-blockers were sometimes used in cases with ischemic heart diseases, but were seldom used in those with other cardiovascular complications. Diuretics and α1 blockers were not often used in these patients. The benefits of these various policies for treating hypertension of elderly patients should be evaluated in future long-term intervention trials in Japan.
The present study was performed to examine living conditions of elderly diabetic patients in rural areas in Iwate and Miyagi in northern Honsyu and compared them with similar cases in Tokyo. One hundred and nine cases over 60 years old were interviewed, and results were compared to 109 age- and sex-matched random samples in the Tokyo area. The original Tokyo subjects consisted of 383 outpatients of the Diabetic Clinic of Tokyo Metropolitan Geriatric Hospital. Types of family structure, educational background and total income were quite different in the 3 areas, and patterns of social support depended on area-specific characteristics. Attitudes toward diabetic treatment (acceptance of importance and compliance) in Tokyo were excellent, but the sensation of social burden and dissatisfaction were also at a high level. In contrast, the level of compliance in Iwate was low. Total morale scale scores were similar in the 3 areas. Multivariate analysis (dependent variable is the total morale score) showed significant contribution of levels of ADL and adherent behavioral style only in Tokyo. In contrast, the feeling of social burden was a negative factor in all areas. The quality of life of elderly people with chronic diseases such as diabetes, is affected by ability to adaptation to living conditions.
A 64-year-old male presented with a large decubitus ulcer of the sacrum which had not healed for thirteen years in spite of various conservative treatments. His primary disease was paraplegia following spondylitis. Although he was not ambulatory, he was able to manage a wheelchair. The decubitus, which had a 8×13cm dead space, was successfully closed with a single operation using two fasciocutaneous flaps. The patient was discharged two months postoperatively. The medical cost of his treatment before and after the surgery was investigated. The expense including the surgery and postoperative care until discharge was five times more than the monthly cost of the preoperative period. These findings suggest that a decubitus ulcer which dose not respond to conservative treatments for more than several months should be considered for a surgical management, as long as the patient's general condition permits an operation.
A 73-year-old female being treated for Basedow's disease developed misty vision and hyperemia of the right eye. A local ophthalmologist diagnosed uveitis, and referred her to our department for more detailed examinations. As a result of the detailed examination, neither sarcoidosis, Behcet's disease nor any other condition suggesting autoimmune disease was observed. On the other hand, she was positive for anti-HTLV-I antibody by the EIA and Western blot method, which implied HTLV-I associated uveitis (HAU). Recently, the involvement of HTLV-I related genes in the onset of Basedow's disease has been reported and there is also a report that the positivity of anti-HTLV-I antibody was high in elderly patients with Basedow's diseases, therefore, the possibility of involvement of HTLV-I infection was considered in the etiology of Basedow's disease in the present case.