We examined 6 male and 10 female patients with senile tremor which started at 60 years of age or older. The patients' age on examination ranged from 66 to 82 years (mean: 73.4; SD: 5.4 years). The surface electromyogram (EMG) was recorded from the bilateral biceps brachii, triceps brachii, forearm flexor and forearm extensor muscles. The frequency of the tremor was counted and patterns of grouping discharges were analysed. The effect of mechanical perturbation to the affected muscle on tremor rhythm was also examined. The same investigations were performed in 15 male and 7 female patients with essential tremor with onset age before 60 years as control patients. The mean frequency was 6.2Hz (SD: 1.3Hz) in senile tremor and 7.3Hz (SD: 1.5Hz) in essential tremor. There was a significant difference between the two groups. The mean frequency in control patients whose age on examination was 60 years or over was, however, 6.0Hz (SD: 0.8Hz), and there was no difference from the mean frequency in senile tremor. The frequency in both groups was inversely correlated to the patient's age on examination. The antagonist muscles were reciprocally discharged in 15 patients in the senile tremor group and in 7 in the controls. Mechanical perturbation of the affected muscle re-set the tremor rhythm in all patients examined. Thus, senile tremor had characteristics resembling tremor in the control patients, suggesting that senile tremor may be a subtype of essential tremor.
Visual event-related potentials (ERPs) and reaction times in 29 patients with nondemented Parkinson's disease and 19 age-equivalent normal control subjects were measured during the physical and semantic discrimination tasks. The components of the NA, N2 and P3 and simple and choice reaction times were observed in both kinds of discrimination tasks. There were no significant differences in either the latency or amplitude of the ERP components (NA, N2 and P3) between the Parkinson's disease patients and normal subjects during the physical discrimination tasks, but the patients had significantly prolonged choice reaction time compared with the normal controls. During the semantic discrimination tasks, the N2 and P3 latencies and choice reaction time in patients with Parkinson's disease were significantly longer than those of the normal controls, although there were no differences in NA latency between the two groups. There were no significant differences in any of the amplitudes between these groups. These results suggest that motor preparation is delayed in patients with nondemented Parkinson's disease, although the stimulus evaluation process is largely preserved during the physical discrimination tasks. The results obtained from the semantic discrimination tasks are interpreted as electrophysiological signs of disturbance in stimulus classification and attention process in Parkinson's disease. From the automatic/controlled processes, the present results suggest that the automatic processing stage associated with NA may be less impaired than the attention-controlled processing reflected by N2 in patients with Parkinson's disease.
We investigated osteoporosis and fractures in Parkinson's disease in stage II to V according to Hoehn and Yahr's disability scale. The bone mineral density (BMD) of the lumbar spine was measured in 82 patients (24 males and 58 females) and in 99 age-matched controls (28 males and 71 females) using dual energy X-ray absorptiometry, and compression fractures of the vertebrae were assessed on X-ray films. BMD decreased with age in females and was lower in females 60 years of age or over than in males at the same age. BMD in the female patients was significantly lower than in the female controls. The female patients in stage III to V had lower BMD than those in stage II. Both male and female patients with a body mass index (BMI) below 21 showed a lower BMD than those with a BMI of 21 or more. Five male (20.8%) and 37 female (63.8%) patients were diagnosed as osteoporosis. In particular 77.8% of the females aged 60 years or older had osteoporosis. Thirty-three patients (7 males and 26 females) had experienced fractures or were found to have vertebral compression fractures on X-ray films. These results suggested that osteoporosis and fractures are common in female patients with Parkinson's disease and that prevention of fractures must be important especially for patients with osteoporosis.
The clinical features of acute pulmonary embolism were evaluated and compared between Group A with 38 cases >65 years old and Group B with 73 cases <65 years old. The mortality rate was 58% (22/38) in Group A and 23% (17/73) in Group B (p<0.01). However the size of the obstructive pulmonary vascular bed showed no significant difference in both groups. In group A dyspnea was the most common symptom in 27 of 31 (87%), in comparison with group B [45 of 66 (68%), p<0.05]. In group B, dyspnea and other symptoms appeared abruptly in 44 of 57 (77%), compared with 19 of 36 (53%) in group A (p<0.02). ECG abnormalities including tachycardia, right bundle branchblock and clockwise rotation as well as hypoxemia were present more predominantly in group A. The presentation of pulmonary embolism is variable in the elderly, as in any age group. Many autopsy studies showed a significant rise in incidence of pulmonary embolism in higher age groups. We must keep in mind the characteristics of clinical features in pulmonary embolism in the elderly.
A case-card survey was carried out to understand trends of hypotensive treatment in elderly in comparison with non-elderly subjects. Data were obtained from 2, 897 cases including 1, 422 elderly (≥65 years old) and 1, 475 non-elderly hypertensives (<65 years old) collected from Sapporo Medical University Hospital and related medical facilities. In the total group of 2, 879 cases, frequencies of use of hypotensive drugs were as follows: Ca antagonists, 76.3%, β-blockers, 31.4%; ACE-inhibitors, 25.1%; diuretics, 18.1; α1-blockers, 10.5%; potassium sparing diuretics, 8.8%. In the elderly group, β-blockers and ACE-inhibitors were used less frequently than in non-elderly hypertensives. On the contrary, diuretics were administered more frequently in elderly than in non-elderly subjects. Comparing the usage of hypotonics among different types of medical facilities, higher frequencies of use of β-blockers and diuretics were observed in the university hospital than in general hospitals and private hospitals or clinics. ACE-inhibitors were used less frequently in private facilities than in the university hospital and general hospital. In summary, Ca antagonists were used most frequently in both non-elderly and elderly subjects, and in all three different types of medical facilities. Other hypotonics were used differently according to patients age. There was differences in the usage of drugs apart from Ca antagonists among the three different types of medical facilities.
One hundred twenty patients diagnosed as having dementia at the Center for Elderly Dementia in Hyogo College of Medicine, were recruited for this study to investigate the factors related to the prognosis of dementia. Patients were classified into the following two groups: those staying at home (group 1); those who died at home (group 2). The proportion of various dementias was almost equal in each group: vascular dementia, 30%; senile dementia of Alzheimer's type, 40%; mixed dementia, 20%; Alzheimer's disease, 10%. The average duration of disease in the two groups were not significantly different. The average age of onset in group 2 was higher than that in group 1. The rate of those with severe dementia was higher in group 2 than group 1. Those in group 2 scored less on the Mini-Mental State examination than those in group 1. Symptoms of dementia were assessed by the modified GBS-scale. In group 2, patients scored higher in impaired intellectual and motor functions. The CT findings suggested cortical atrophy, ventricular enlargement and periventricular lucency more often in group 2 than in group 1. Laboratory findings revealed that decrease in red blood cell count, hemoglobin, hematocrit and serum protein were more apparent in group 2 than group 1. It was considered that impaired motor functions, cortical atrophy, white matter lesions, anemia and malnutrition enhanced the probability of death. The study has confirmed that the prognosis of dementia is not only related to intellectual impairment but also deteriorated physical conditions such as motor dysfunction, anemia and malnutrition.
Endothelin-1 (ET-1) is a potent and long-lasting vasoconstrictor peptide. In order to clarify the changes in the level of ET-1 with aging, we measured the ET-1 level in plasma by radioimmunoassay and used 74 healthy subjects including 61 males and 13 females, aged from 30 to 69, who were admitted in the health check center of Ashikaga Red Cross Hospital. None of them had risk factors related to hypertension, obesity, diabetes mellitus or cardiovascular disease. In the male group, the relationship between the level of ET-1 (Y) and age (X) was obtained as follows: Y=0.08857X+0.06363. The correlation between them was significant (γ=0.65894, p<0.05). In the female group also, the increased level of ET-1 (Y) with age (X) showed an excellent linear relationship (Y=0.163091X-4.23, γ=0.762, p<0.002). These studies demonstrated that the level of ET-1 increased in relation to aging and the increased ET-1 production with aging may be consistent with deterioration of endothelial function.
A 76-year-old woman was admitted to our hospital because of productive cough, fever and anorexia in January 1995. She had suffered from bronchial asthma for 25 years. From 1983, exacerbation of PIE was recorded three times, on which occasions prednisolone and antibiotics were quite effective. On admission, marked leukocytosis (28, 000/μl) and eosinophilia (18, 000/μl) were found. However, plasma IgE level was normal, and specific antigen for eosinophilia was not detected by RAST or the skin allergic reaction test. Chest X-ray film and CT scan revealed extensive bilateral pulmonary infiltration. Increase in eosinophils (33%) was demonstrated in bronchoalveolar lavage. Furthermore, biopsy specimen of the affected lung revealed diffuse infiltration of eosinophils into alveolar septa. On the basis of these findings, the patient was diagnosed as chronic eosinophilic pneumonia (PIE syndrome). Hyponatremia (117mEq/l) was persistent after the hydration with normal saline. Plasma ADH was not suppressed (2.29pg/ml) in spite of hypoosmolality of plasma. Laboratory examination showed that renal, adrenal and thyroid function as well as plasma renin activity were normal. Taking these findings together, she was diagnosed as having SIADH. Treatment with prednisolone improved not only the PIE syndrome but also SIADH.