Vascular dementia (VD) and Alzheimer-type dementia (ATD) are two main causes of dementia in the aged, accounting for more than 90% of cases with dementia. VD has been reported to be more frequent than ATD in Japan, but recent epidemiological studies in Gunma prefecture and other locations reveal the incidence of ATD becoming slightly higher than that of VD. This reversal of VD/ATD incidence ratio is suggestd to be due to decrease of the incidence of VD based on the recent development of treatment of cerebrovascular disease. With regard to ATD, various approaches to clarify its etiology are now in progress mainly invloving research on the mechanism of formation of neurofibrillary tangles and senile plaques which characterize the pathology of ATD. Studies on hereditary types of ATD suggest that the etiologies of ATD are heterogeneous, but the deposition of β-protein followed by τ-protein with resulting dementia seems to be the common process of ATD. Some biological diagnostic markers are now being examined to evaluate their use in early diagnosis. On the other hand, VD occurs mainly due to cerebral infarction, and can be classified due to the responsible lesions. Our study with positron emission tomography reveals that most cases with VD show decrease of the cerebral metabolic ratio in bilateral frontal lobes. VD is clinically characterized by its temporal profile and neurological findings. VD may becoming a type of preventable, treatable dementia.

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Mechanisms of aging involve genetic programs and error accumulation. Cellular aging is an aspect of organismal aging from a point of view of agedependent declines of tissue cells during the postreproductive aging process and a parallelism between enhanced individual and cellular aging in some genetic progeroid syndromes. Cellular senescence involves the gene-directed inhibition of replicative potential of cells. Cell fusion analysis has indicated that senescent normal and presenescent Werner syndrome cells cause the dominant suppression of DNA synthesis in the partner of either actively growing cells or any cells of the four complementation groups of immortalized human cells. Membrane proteins produced in senescent cells showed the biphasic DNA synthesis-inhibiting activity when assayed for young cells. Senescent cells showed the strong transcriptional repressions of early serum responsive genes (c-fos, c-jun, c-myc), late responsive genes of transcription factor E2F1 and cyclin E. In addition, the protein levels of CDK2 and cyclin E are also extremely low, with an increased level of the p53-dependent p21 Cip 1 protein which inhibits the kinase activity of cyclins/CDKs by forming complexes. Such characteristic molecular factors and mechanisms feature ireversible G1-arrest in cellular senescence.

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We studied the usefulness of bronchoscopy in the diagnosis of pulmonary complications in elderly patients with non-Hodgkin's lymphoma (NHL). The subjects were 12 patients 65 or older with NHL. Two of these patients underwent transbronchial lung biopsies (TBLB), all of them underwent bronchioalvage (BAL) and 2 with tumors underwent transbronchial biopsies of the tumors. Diagnosis wlas obtained in 8 out of 12 patients (66.7%). Two patients showed infiltration of lymphoma cells, 2 had cytomegalovirus (CMV) infection, 1 had pneumocystosis (P. carinii), 2 had fungal infections and 1 had a bacterial infection. TBLB was performed in 2 patients with platelet counts of over 5×10⁴/μl. Lymphoma cell infiltration was diagnosed in one of these patients and a fungal infection in the other. BAL was performed on all patients. CMV was detected in 2 cases by the PCR method, P. carinii was detected in 1 case and aspergillus in 1 case. Klebsiella pneumonia was diagnosed in 1 patient. Since respiratory tract complications are often serious in NHL and the prognosis depends on early diagnosis and treatment, it is important to perform bronchoscopy on elderly patients and obtain a definitive diagnosis.

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Platelets are deeply involved in the onset of thrombosis, such as cerebral thrombosis and myocardial infarction. In large-sized platelets, the enzyme activity is increased, and adhesion and release potential as well as coagulability are also increased, resulting in paticularly active involvement in thrombogenesis. This indicates that changes in the platelet count (PLT) and mean platelet volume (MPV) reflect the state of thrombogenesis. However, there have been only a relatively few reports on PLT and MPV in the elderly, although thrombosis frequently occurs in this population. Therefore, we measured platelet parameters in men without thrombotic diseases, hematological diseases, hepatic diseases, or malignant tumors, in order to determine changes in PLT and MPV in aged men and the effects of various factors (hypertesion, hyperlipidemia, diabetes, obesity, and smoking/ drinking) on these changes. A total of 2, 061 men, aged 30-83 (264 cases in their 30s, 810 cases in their 40s, 742 cases in their 50s, 209 cases in their 60s, 32 cases in their 70s and 3 cases in their 80s), were used as subjects. In addition, 36 men aged 30-34 (mean age 32.6±1.2 years) and 35 men aged over 70 (mean age 73.0±3.5 years) were designated as the young and aged groups, respectively. Compared with the young group, the frequency of hypertension and that of diabetes were significantly higher or tended to be higher in the aged group, whereas the frequency of smoking tended to be smaller in the aged group. With aging, mean PLT and plateletcrit values significantly decreased, and the distribution width of platelet sizes and mean MPV values significantly increased or tended to increase. In hypertensive, diabetic, and/or obese men, PLT values tended to decrease, and MPV values significantly increased or tended to increase. PLT values tended to increase in hyperlipemic men; MPV values tended to decrease in smokers; PLT values tended to decrease in drinkers in the young group. When the influences of age, mean blood pressure, triglyceride, HDL-cholesterol, LDL-cholesterol, fasting blood glucose, and smoking/drinking on changes in PLT and MPV were analyzed, it was found that triglyceride and age greatly affected changes in PLT, and mean blood pressure greatly affected in MPV. PLT was affected by serum triglyceride, and decreased with aging. Although MPV values in aged men tended to increase, as compared with younger men, this tendency was thought not to be a simple age-related change, but was more closely related to a high incidence of hypertension in the elderly.

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In order to improve the adequacy and safety of the transportation for the elderly people, the effects of and the desire for continuing driving were analyzed. A questionnaire was sent to 500 car manufacturing retirees, male aged 60 years old and more, living in Kawagawa prefecture near Tokyo. Responses were obtained from 296 people (59.6%). Of these 196 were currently licensed and 149 still drove. Three quarters of the respondents drove for daily shopping and more than 50% drove for medical treatment, visiting friends and other purposes. The purposes for driving correlated with each other (p<0.05: φ test) and 80% drove more than 3 days per week; One motivating factor for driving was to pick up family members or friends (48%) in addition to daily transportation means (93%), while 61% desired to continuing driving while making full use of the safety devices of the cars. Correspondence analysis showed that the role of driving correlated with a desire to utilize automobile safety devices. It is concluded that we should consider the needs of driving for the elderly, their satisfaction in driving or being driven by them, and should plan medical assessment, improvement in the traffic environment and social support, for example, arranging contacts between elderly driver and elderly with limited transportation options.

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Leiomyosarcoma of the esophagus is an uncommon disease of which only 97 cases including the present case have been reported in Japan. We report a case of the tumor which showed multiple hematogenous metastases after surgery. A 73-year-old male was admitted complaining of dysphagia and vomiting. Esophagography and endoscopy revealed a large protruding lesion in the lower esophagus. CT scanning revealed threefold-sized extramural mass. Boring biopsies failed to yield evidence of malignancy. However, we performed surgical treatment because of the uncommon size for a benign tumor. The excised tumor was 11×9×5cm in size and was diagnosed histologically as leiomyosarcoma of the esophagus without any nodular involvement. Metastatic tumor in the right rib was found 14 months after the operation. Radiotherapy failed to decrease tumor size but eliminated pain. Bone metastases appeared successively and the patient died 3 years and 4 months after operation. Chemotherapy had no effect. Autopsy revealed metastases to the ribs, vertebrae, sternum, pelvic kidneys and diaphragm, but no local recurrence. There is a great need for the development of effective anti-cancer drugs for leiomyosarcomas, particularly in cases with extensive metastasis, such as presented here.

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The patient was a 94-year-old woman. She was admitted on our hospital for ileus due to incarceration of a right femoral hernia on October 29, 1993. Although an emergency operation was necessary she refused, therefore we continued to have conservative therapy. After repeated persuation, she agreed the operation which was performed under spinal anesthesia on November 17. The peritoneal cavity was opened through a transverse incision of the lower abdomen. Some bloody ascites was encountered. Part of the jejunum was incarcerated through right femoral canal and was completely obstructed, with ischemic but no necrotic changes. It was excised. She resumed oral intake on the 7th postoperative day and was discharged on the 77th postoperative day. Initially due to her opposition we could not perform the operation, but after persistent persuation she aggreed and survived. Good communications between the doctor and the patient, and of course informed consent, was very important in such cases.

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We reported a survival case of a 78-year-old female with disseminated tuberculosis complicated with severe respiratory failure, pancytopenia, DIC, drug induced fever and pneumothorax. Atypical symptoms and presence of chronic illness make the early diagnosis of disseminated tuberculosis in the elderly difficult. In this report, we emphasized that both a high awareness of possible clinical diagnoses and the performance of some clinical procedures including bronchoalveolar lavage were useful. Disseminated tuberculosis in the elderly with multiple complications which is rare condition, was discussed.

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