The authors studied mortality from major causes of death and risk factors in the elderly in a long-term prospective survey conducted in a Japanese suburban community, Hisayama. In the baseline survery in 1961, we scrutinized 1658 residents of the town aged 40 years or older accounting for 92% of the total population in this age range. Of those, 591 residents (245 men and 346 women) aged 60 years or older, who were free from major cardiovascular disease, were selected for the present study. They were followed-up for 26 years from 1961 to 1987. The average age was 67 years for men and 70 years for women, being significantly higher for women than for men. During the follow-up period, 529 subjects (89.5%) died, and 448 were autopsied (autopsy rate 84.7%). The all-cause mortality (per 1, 000 person-years) after adjustment for age was 89.9 for men and 56.7 for women, the former being significantly higher than the latter (p<0.01). The age-adjusted mortality from cerebrovascular disease was estimated to be 21.4 for men and 9.9 for women, i.e. 8.9 and 8.8 from heart disease, and 19.9 and 10.6 from neoplasm, and 18.1 and 12.2 from-pneumonia, respectively. There was significant sex difference in mortality from cerebrovascular disease, neoplasm and pneumonia (p<0.01) but not from heart disease (p>0.1). Multiple Cox's proportional hazards regression analysis showed systolic blood pressure and male sex to be significant risk factors for death by cerebrovascular disease. Systolic blood pressure was also a predictor for death by heart disease. Smoking and high body mass index were significant risk factors for death by neoplasm, while low body mass index was a risk factor for death from pneumonia. Age remained a significant risk factor for these endpoints. The present study revealed that there are differences according to sex for the major causes of death among the aged in a Japanese suburban community. Risk factors for cause-specific deaths were analyzed, and their significance in relation to the prognosis was discussed.

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White matter changes, which are noted in Binswanger's disease and which may be due to ischemia, have previously been explained mainly on the basis of the hemodynamic mechanism. To elucidate the etiopathophysiology of Binswanger's disease from the hemorheology viewpoint, platelet activation in the cerebral circulation was studied in 30 patients with Binswanger's disease, who satisfied the diagnostic criteria of Binswanger's disease proposed by Bennett et al. Plasma β-thromboglobulin concentration gradients (ΔBTG) between the jugular vein and the antecubital vein, as indicators of platelet activation in the cerebral circulation, were determined in these patients (Binswanger's disease group) compared with those of different stroke subtypes groups (lacunar, atherothrombitic, cardioembolic) in the chronic phase and 25 patients with various diseases other than stroke (non-stroke group). Among these groups, the elevation of ΔBTG levels in the Binswanger's disease group (4.55±6.95) were so frequent and prominent that differences were significant, especially in comparison to those of the cardioembolic group, and the non-stroke group. The enhanced platelet activation in the cerebral circulation observed in Binswanger' s disease indicated not only the widespread development of underlying vascular lesions, but also accelerated release reaction of vasoactive substances from platelets into the blood stream, which could biochemically injure the vascular wall and neurons downstream, resulting in Binswanger's disease.

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We sought to identify a marker for Alzheimer's disease (AD) for antemortem diagnosis. To determine whether the detection of reduced blood flow in the parietotemporal cortex, shown by single photon emission CT (SPECT), and of medial temporal lobe atrophy, shown by magnetic resonance imaging (MRI), would be useful in diagnosis, we studied 38 patients with AD diaguosed by the NINCDS-ADRDA criteria and 26 healthy elderly controls. Parietotemporal hypoperfusion was qualitatively assessed by physicians who were unaware of the clinical diagnosis, and the severity of medial temporal lobe atrophy was quantitated by planimetric and linear measurements. Although an accurate diagnosis of AD was made in 80% or more of the patients by SPECT or MRI studies alone, the combination of SPECT and MRI gave a higher diagnostic accuracy, with a sensitivity of 95% and a sepcificity of 92%. Since regional functional or structural changes were detected in 92% of early or mild patients, including possible AD, the combination of SPECT and MRI studies were useful in the early diagnosis of AD. Findings suggest that a functional abnormality in the parietotemporal lobe and an atrophic change in the medial temporal lobe are characteristic of AD, and that SPECT and MIR regional changes may be useful as antemortem diagnostic markers.

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We carried out a questionnaire survey concerning urinary disturbances, among nursing home patients. The answers were obtained from 1, 038 elderly including 355 males and 683 females. Ages, spanned 50-99, with an average age of 79.1. Of the 1, 038 respondents which we obtained through our survey for management of urination, 35.8% of the total said that they are able to urinate without incontinence. Those able to urinate with incontinence accounted for 23.6% of the total. However, 40% of all patients required an adult diaper throughout the day to control their urinary functions. Patients suffering from neurological disorders accounted for 70% of respondents, and a correlation was seen between the extent of dementia and ADL, and excretory control. Urinary functioning in both men and women was found to grow increasingly difficult with age, and medical problems involving urinary difficulty appear to increase with the advance of the aging process. The representative groups for this survery were limited to elderly people in nursing homes, many of whom suffer from neurological disorders such as cerebral infarction. It was found that both male and female patients experience a variety of urinary disturbances.

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We retrospectively studied magnetic resonance (MR) images of the brain in 139 patients (16 cases of Alzheimer's disease, 8 cases of Parkinson's disease, 53 cases of multiple cerebral infarct, 33 cases of other central nervous diseases, and 29 cases of peripheral neuropathy) between the age of 6 and 85 years old with a mean age of 60.6±18.5 to examine the appearance of T2 low signal intensity areas (T₂CLIA) in the cerebral cortex. Motor, occipital, sensory or other cortices were evaluated with long repetition time/echo time (TR/TE) spin-echo sequences and staged into three grades in the moter cortex: none, partial, and whole; and two grades in the others: none or present. In general, T₂CLIA was not seen in any cortex in patients less than 50 years old, then after 50 years old T₂CLIA increased with age. Over 70 years of age T₂CLIA appeared in 50.9% of patients in the whole moter cortex, 88.7 in either whole or partial moter cortex, 47.2% in the occipital cortex, and 20.8% in the sensory cortex. T₂CLIA was not observed in other cortices. The incidence of T₂CLIA appearance inthe motor cortex was significantly higher in all central nervous diseases than in cases of peripheral neuropathy over 70. T₂-CLIA showed a correlation with temporal lobe atrophy and white matter lesions in the motor cortex. In the sensory cortex, T₂CLIA correlated with white matter lesions. These results suggest that T₂-CLIA may correlate with age or accumulation of nonheme iron in the cortex associated with central nervous diseases.

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We investigated pulmonary function and bronchoalveolar lavage fluid (BALF) before and after COP-BLAM III therapy in elderly patients with non-Hodgkin's lymphoma (NHL). The patients consisted of 8 men and 5 women, over 60 years of age, with previously untrated NHL. The PaO₂ averaged 86.5±7.6mmHg before treatment, and 69.3±9.2 mmHg after treatment. Six Patients showed a decrease in PaO₂ to less than 20 mmHg. Percent (%) carbon monoxide diffusion capacity was 91.4± 7.1% before treatment and 69.6±11.5% after-treatment, and 8 patients showed a decrease of at least 20%, whereas there were no definite changes in percent vital capacity or the percent of forced expiratory volume in one second. After BALF collection, the total cell count was slightly increased and the lymphocyte count was also increased after treatment, whereas there were no significant changes in neutrophil or eosinophil counts. There were no significant changes in T-cell or B-cell counts after treatment. The CD4/CD8 was 0.51 before treatment and 1.65 after treatment in patients without pulmonary complications, showing a tendency to increase, while the low ratio before treatment, 0.24, was nearly unchanged after treatment in those who developed pneumonia during their course. Considerable attention should be paid to pulmonary complications. As a result of chemotherapy, lymphocytic infiltration was observed subclinically in the lung, suggesting that changes int he local pulmonary immune system may be involved in the occurrence of pulmonary complications.

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Several investigations revealed the significant effect of anticoagulant therapy for stroke prevention in patients with atrial fibrillation. However, in the elderly population, the optimal therapeutic strategy of secondary prevention for cardioembolic stroke is still controversial. We prospectively evaluated the efficacy and safety of very low-intensity anticoagulant therapy (target range, Thrombotest=20-30%: INR=1.47-1.81) for elderly cardioembolic stroke patients due to nonvalvular atrial fibrillation. Twenty cardioembolic stroke patients (average age 80.0) with nonvalvular atrial fibrillation were included in our study. Anticoagulant therapy began 5 of 7 days after the embolic event. The incidental rate of ischemic stroke recurrence and bleeding complication were evaluated. During mean follow-up of 14.7 month, the annual recurrent rate of ischemic stroke was 8.2% (cardioembolic stroke=4.1%/year, atherothrombotic stroke=0%/year, lacunar stroke=4.1%/year), whereas one non-fatal gastrointestinal bleeding was observed. Our study suggested that even in the elderly population, very low-intensity anticoagulant therapy may be effective, and safe with respect to prevention of bleeding complications, for secondary cardioembolic stroke prevention.

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We report a patient with Takayasu's arteritis associated with antiphospholipid antibodies. An 84-year-old woman gradually developed gait and visual disturbances, dementia, myocardial infarction, and gangrene in al four limbs during a period of 8 years. Persistent inflammatory signs also continued for at least 8 years. Positive reaction for lupus anticoagulant by the diluted Russel viper venous time and positive reactions for cardiolipin antibodies were confirmed. However, she did not develop SLE. MR angiography revealed multiple and extensive occlusive changes in large vessels such as the aorta and its major branches. We believe antiphospholipid antibodies may have been related to severe occlusive vasculopathy in this patient.

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