We investigated the relationship between clinic blood pressure (BP) and ambulatory blood pressure (ABP) in 297 elderly patients who underwent 24 hour ABP monitoring as a non-academic clinical references. Among 107 cases who were normotensive in office BP measurements, 33 cases (30.8%) proved to be hypertensive with more than 140mmHg in ambulatory systolic BP. Those patients should be referred to as home hypertension or white coat normotension. On the other hand, among 187 patients who were hypertensive in the clinic, 78 cases (41.7%) turned out to be white coat hypertension with an ambulatory daytime systolic BP of less than 140mmHg. Ambulatory systolic BP in white coat hypertension was comparable with that in the non-hypertensive group although their BP in the clinic was significantly higher than the latter (p<0.02). Ambulatory systolic BP in the home hypertension group was significantly higher than that in the normotension but was comparable with that in true hypertension. The number of the antihypertensive drugs prescribed in the white coat hypertensive group tended to be geater than that in other groups although that in the home hypertensive group was similar to the other groups. The incidence of cerebro vascular disease in each group was similar.
The purpose of this study was to assess the background to the longevity of 36 centenarians in Nagoya city and to compare 14 institutionalized centenarians out of those 36 with 202 individuals in the 70-99 age group in our special nursing home, particularly with regard to blood chemistry and immunity tests. The reasons for their social longevity in terms of profile appeared to be attention to eating habits, abstention from smoking and drinking, occupations with adequate exercise. The incidence of dementia was 65.6% among them. We evaluated centenarians from the viewpoint of Hasegawa's Dementia Scale (HDS) and comprehensive functional assessment of the elderly consisted of the revised version of Hasegawa's Dementia Scale (HDSR), and examintion of activity of daily living (ADL), physical perception, and social life. All were postiviely associated. Thus centenarians independent of physical assistance demonstrated significantly higher systolic blood pressure, and respective scores for HDS, HDSR, ADL, physical perception and social life than their dependent counterparts, were less likely to be institutionalized and suffered from fewer disorders. In particular none were diagnosed as positive for cerebral hemorrhage, infarction and dementia. Age demonstrated significant positive or negative correlation with the following values in blood chemistry and immunity tests: blood cell counts, hemoglobin concentration, hematocrit value, albumin, total protein, total cholesterol, low density lipoprotein cholesterol, creatinine, blood cell nitrogen, uric acid, helper T cell, and IgA immunoglobulin.
Cerebral blood flow (CBF) at rest was measured by 123I-IMP SPECT and the standing test was conducted by 99mTc-HMPAO SEPCT in patients with dementia of Alzheimer's type (DAT) and vascular dementia (VD) in order to evaluate cerebral autoregulation and to consider the diagnostic significance of this determination and test. CBF at rest decreased significantly in all regions in the DAT and VD groups compared to the control groups (healthy aged persons, group C). The value of mean CBF also decreased significantly in the DAT (40.1ml/100g/min) and VD groups (41.3) as compared to group C (51.0). In the DAT groups, the CBF was significantly lower in the parietal region compared to VD groups, and CBF and Hasegawa's dementia score showed a positive correlation in the temporal and parietal regions. Decreases in blood pressure upon standing were about 10mmHg in all three groups, but the decrease rate in mean CBF was significantly greater in the VD groups (20.2%) than in the C (5.0%) and DAT groups (4.0%). The dysautoregulation index (D.I.; Δ% CBF mmHg), used as a measurement of cerebral autoregulation, was significantly higher in the VD groups (1.7) than in the C (0.5) and DAT groups (0.3). This index made it possible to make differential diagnosis in some patients in whom it was impossible using CBF at rest, probably due to impaired cerebral autoregulation and atherosclerotic changes in VD patients. Our findings suggest that D.I. provides information on the condition of patients that cannot be obtained with CBF at rest and assists in differential diagnosis.
A 67-year-old woman with idiopathic orthostatic hypotension was presented. The patient started to experience faintness on standing since 1993. During a physical examination, her systolic blood pressure fell from 148 to 50mmHg on standing. Blood pressure responses to the mental arithmetic test and hyperventilation stress were normal. However, cold pressor test failed to increase blood pressure. These observations, with the finding that phase IV response on Valsalva's maneuver was absent, indicate afferent sympathetic nervous dysfunction. Peripheral neuropathy including diabetes mellitus and involvement of central nervous system such as multiple system atrophy were excluded. Holter ECG examination revealed a 3.9 second sinus arrest and bradycardia (total beats 88901/day). The blunted responses of the heart rate to atropine as well as isoproterenol further suggested the presence of sick sinus syndrome. Amezinium administration significantly improved her orthostatic hypotension and eliminated sinus arrest. These findings indicate that sympathetic nervous dysfunction could account for at least a part of the sick sinus syndrome in this patient.
We describe a case of hemoglobinopathy detected on admission for examination for high blood glucose levels and abnormal liver function. In 1991, it was pointed out that he had postprandial hyperglycemia. In 1994, at age 60, he had lassitude and anorexia. He was admitted to our hospital on the suspicion of diabetes mellitus and liver disease. Glycosylated hemoglobin levels was very high, but the 75 gram oral glucose torelance test result was wsithin the normal range. After abstinence from alcohol, his glutamic oxaloacetic transaminase, glutamic pyruvic transaminase and ganma glutamyl traspeptidase became normal. Diabetes was excluded and abnormal hemoglobinopathy had been suspected. We analyzed his abnormal hemoglobin. In isoelectro-phoresis a fast moving variant was detected suggesting the presence of abnormal hemoglobin at the cathode. We fractionated hemolytic globin by CM-chromatography and detected an abnormal peak before the α chain band. Subsequently, we sequenced isolated abnormal α chain and detected the substitution of Ariginine for Glutamamine at position 92 (Hb J Cape Town). So far he has not demonstrated any symptoms or signs of HbJ Cape Town. Hemoglobinopathy is not uncommon in aged people.
A 70-year-old female was admitted to a general hospital in a rural area due to left putamenal cerebral hemorrhage in December 1994. She had right hemiplegia and was totally aphasic. In May 1995, she was moved to Tokyo where her son lives, and was admitted to Tokyo Metropolitan Geriatric Hospital in order to prepare a home care system. her family's support (serving her favorite dishes) allowed enteral tube feeding to be halted. After one month, she could absorb enough energy to maintain her serum albumin level. The total calories ingested orally was comparable to that of enteral feeding but the fat composition was 62% of that of enteral feeding (fat was 19.6% and 31.7% of the total calories in the two diets, respectively). Her cholesterol level decreased from 286mg/dl to 197mg/dl. Nutrient-balanced tube feeding is useful, but may disturb lipid metabolism in patients used to having vegetable-rich diets.