To sudy vascular lesions of the spinal cord in aged persons, we examined the number and distribution of radicular arteries and macroscopic arteriosclerosis of the spinal vascular system in 91 autopsied spinal cords. The average number of anterior radicular arteries per spinal cord was five. The anterior radicular artery appeared most frequently at the level of the 6th and 7th cervical segment, the 4th and 9th thoracic segment, and the 1st lumbar segment. Adamkiewicz's artery appeared most frequently at the 9th thoracic segment. Adamkiewicz's artery usually entered the spinal cord from the left side. Arteriosclerotic changes in the spinal arteries were less severe than those in other arteries. Only one spinal cord had atheromatous plaques in the anterior spinal artery. Transverse sections at each segmental level of 603 autopsied spinal cords were examined histopathologically and medial thickeing of the anterior spinal artery was found in 16 cords (2.7%). The thickening of the arterial wall was much more pronounced in cords from patients with severe hypertension, myocardial infarction, and cerebral vascular lesions than in other specimens. Endothelial thickening appeared most frequently in lower cervical, lower thoracic, and upper lumbar segments. The endothelial thickening was mainly caused by fibroelastosis and proliferation of smooth muscle cells. We found no spinal cord infarctions. Arteriosclerotic changes in the spinal arteries were very rare, which may explain the low incidence of vascular lesions in the spinal cord. The number of anterior radicular arteries and the level at which they enter the spinal cord varied greatly. These observations indicate that the number and level of entrance of radicular arteries should be considered in patients with spinal vascular disorders.
Blood glucose levels are abnormally low in Alzheimer's dementia. We therefore examined glucose metabolism before death in relation to Alzheimer's dementia as determined at autopsy in 106 men and 161 women. (1) The mean age was 81.8±8.6 years for men and 85.8±7.9 years for women (p<0.001). The fasting plasma glucose level and hemoglobin Alc levels did not differ by sex. (2) Alzheimer's dementia was detected in 88 patients (25.5%). More women than men had the disease, but the difference was not significant. (3) Only 8.8% (3/34) of patients with diabetes mellitus had Alzheimer's dementia, as compared with 27.9% of patients without diabetes mellitus (65/233, p<0.03). (4) The fasting plasma glucose level was 89.9±13.4mg/dl in patients with Alzheimer's dementia and 102.9±34.5mg/dl in those without the disease. The hemoglobin Alc level was 5.7±0.8% in patients with Alzheimer's dementia and 6.4±1.5% in those without the disease. Both the fasting glucose level and hemoglobin Alc level were significantly lower in patients with Alzheimer's dementia than in those without the disease, p<0.01. These data suggest that the development of Alzheimer's dementia is suppressed by the high plasma glucose levels in patients with diabetes mellitus.
Factors related to changes in symptoms after the great Hanshin Earthquake in patients with dementia were studied. Interviews were conducted with family members of thirty patients given the diagnosis of dementia at the Center for Elderly Dementia of Hyogo College of Medicine between August 1993 and December 1994. The earthquake occurred on January 17, 1995, and the interviews were conducted three months later. Patients were classified into two groups: Group 1: those whose symptoms changed after the earthquake (n=13); Group 2: those whose symptoms did not change after the earthquake (n=17). Symptoms were exacerbated within 1 week after the earthquake. The percentage of patients with mild dementia was higher in Group 1 than in Group 2. Scores on the Mini-Mental State examination and on Hasegawa's dementia scale were lower in Group 2 than in Group 1. On a modified GBS-scale, patients in Group 2 scored higher than those in Group 1 in impaired intellectual function and in reduced motivation, and they scored lower than those in Group 1 in impaired emotional function. CT scans showed that cortical atrophy and ventricular enlargement were greater in Group 2 than in Group 1. These findings suggest that after the earthquake symptoms became more severe in patients with mild dementia at an early stage, who have anxiety, irritability, and emotional lability.
Decay-accelerating factor (DAF) is a membrane glycoprotein that prevents complement activation on blood cells. Among CD8+ T cells, DAF-negative cells can be distinguished from DAF-positive cells. We computed the proportion of DAF-negative CD8+ T cells in the peripheral blood of 59 normal healthy subjects, 27 to 93 years old, and analyzed the differences between subjects of different ages. The proportion of CD8+ T cells that were DAF-negative correlated significantly and positively with age. We also studied these lymphocytes in patients with cerebrovascular dementia, Alzheimer's dementia, cancer, rheumatoid arthritis and systemic lupus erythematosus. The proportion of CD8+ T cells that were DAF-negative did not correlate significantly with age in patients with cerebrovascular dementia, Alzheimer's dementia or cancer, but it correlated significantly and positively with age in patients with rheumatoid arthritis and in those with systemic lupus erythematosus. Therefore, healthy subjects and patients with various diseases can be classified according to age and to the proportion of CD8+ T cells that are DAF-negative. This proportion can then be used as an index of aging and of host defense function.
Movement-related cortical potentials (MRCP) were measured in young normal subjects (age<40) and aged normal subjects (age≥60). All were right-handed. MRCPs were recorded for voluntary self-paced extension of the right middle finger or the right foot. For the middle finger extension the latency and slope of the Bereitschaftspotential (BP) and the negative slope (NS') were measured at the contralateral hand motor area, and for the foot movement they were measured from Cz. MRCPs for the finger extension were examined in 12 young subjects (5 men, 7 women, 22-38 years old, mean age 26.3±5.2 years) and 18 aged subjects (9 men, 9 women, 60-82 years old, mean age 69.4±7.2 years). BP latency and NS' latency were significantly longer in the aged subjects than in the young subjects (p<0.001 and p<0.05, respectively). MRCPs for the foot movement were measured in 10 young subjects (3 men, 7 women, 22-38 years old, mean age 27.1±5.4 years) and 10 aged subjects (5 men, 5 women, 60-82 years old, mean age 70.3±8.1 years). BP latency was significantly longer in the aged subjects than in the young subjects (p<0.05), but NS' latency was not. For both finger and foot extension, neither BP slope nor NS' slope differed significantly between the groups, although both slopes were steeper in the young subjects than the aged ones. These findings sugest that the time required by the cerebrum to prepare for voluntary movement and the period of preparation for movement are longer in aged subjects than in young subjects.
We studied circadian variation in blood pressure in elderly patients with hypertension, using three criteria for “non-dipper”. Ambulatory blood pressure monitoring was done in 107 elderly outpatients whose average 24-hour systolic blood pressure was greater than 140mmHg. Daytime was distinguished from nighttime by the level of physical activity as measurd with an activity sensor and a questionnaire. The three criteria for “non-dipper” were as follows: 1. A nocturnal decline in systolic blood pressure that was less than 10% of the daytime average blood pressure. 2. A nocturnal decline in systolic blood pressure that was less than 10mmHg. 3. A nighttime average systolic blood pressure that was greater than the daytime average systolic blood pressure. The nocturnal decrease in blood pressure was smaller in older patietns than in younger patients. In patients over 80 years old, it was 6.0mmHg (p<0.05, as compared with patients aged 60-69 and with patients aged 70-79). The percentages of patients classified as “non-dippers” according to the criteria listed above were 53.3%, 37.4%, and 15.9%, respectively. Older patients were more likely than younger patients to be classified as “non-dippers”. When defined according to criterion #1, “non-dippers” made up 83.3% of those over 80 years old. These results was consistent with a continuous age-relted decline in neuroendocrine regulation involving both peripheral and central nervous system.
The bone mineral density (BMD) of calcanei dissected from 30 cadavers (14 males and 16 females; ages 61 to 100) was measured by dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT), while the stiffness was measured by ultrasound bone densitometry (USD). There was high correlation between BMD by DXA and average bone density by QCT (R=0.94), but poor correlation between BMD by DXA and stiffness by USD (R=0.55). However, the correlation coefficient of stiffness to BMD was much higher in the female calcanei (R=0.74) than in the male calcanei (R=0.32). Analyzing the three elements, stiffness, speed of sound (SOS) and broadband ultrasound attenuation (BUA), it was clear that SOS rather than stiffness correlated strongly to BMD by DXA and to bone density of trabeculated bones by QCT (R=0.618; 0.699 respectively). The value of BUA shows more relationship to the width of the calcanei than the area of X-ray projection from the side (R=0.561).
A 70-year-old woman was admitted to our hospital in November 1992 for evaluation of anemia. Physical examination revealed anemia, jaundice, swelling of axial and inguinal lymph nodes, and splenomegaly. Abnormal hematological findings were as follows: Hb of 3.9g/dl, reticulocyte count of 58.2% (61.7×104/μl), hyperplasia of normal erythroblasts in bone marrow, and eosinophilia (21.0%, 2352/μl) in peripheral blood. Routine laboratory examinations revealed polycolonal hypergammaglobulinemia 3.0g/dl, a high level of serum LDH (797 IU/l) and a total bilirubin of 2.4mg/dl (indirect, 1.6mg/dl). The serum haptoglobin level was very low (<5mg/dl). Results of serological examinations were as follows: IgG of 3366mg/dl, CH50 of 16.0U/ml, positive Coombs test 2+, and positive tests for antinuclear antibody, rheumatoid factor, and cold agglutinin. CRP was negative. PHA-stimulated lymphocyte blast formation, NK activity, and ADCC activity were found to be suppressed, and the percentage of CD4-positive lymphocytes in peripheral blood was also low. An axillary lymph node biopsy revealed reactive lymphadenitis. No signs or history suggested allergy, collagen disease, or parasitic infection. Autoimmune hemolytic anemia (AIHA) complicated by immunologic abnormalities and eosinophilia was diagnosed. Oral prednisolone markedly reduced the hemolytic anemia, eosinophilia, lymph node swelling, and splenomegaly, but NK activity remained low.
Alpha-glucosidase inhibitor can suppress postprandial hyperglycemia by delaying the absorption of carbohydrates in the intestine, and may be useful in obese patients with non-insulin-dependent diabetes mellitus (NIDDM) and preserved insulin secretion. We encountered an obese elderly patient with NIDDM in whom gait disturbance had developed after cerebral hemorrhage and who suffered from ileus after treatment with voglibose. The patient had received voglibose which is reported to cause fewer abdominal symptoms than acarbose, for 15 days. The patient, a 63-year-old woman, was given a diagnosis of NIDDM in February 1995, and was treated with a sulfonylurea agent. However, her glycemic control remained poor and she was admitted to our hospital in April 1995. Her body mass index was 30.5kg/m2 and laboratory investigation revealed a fasting plasma glucose level of 211mg/dl, a postprandial (2h) plasma glucose level of 288mg/dl, HbA1c of 9.9%, a fasting insulin level of 9μU/ml, urinary C-peptide excretion of 95.7μg/ day, and an coefficient of variation of R-R value of 2.1%. Fifteen days after glibenclamide was replaced by to voglibose, abdominal pain, nausea, constipation, and ausculatory sounds of gurgling developed, and niveau were noted on an abdominal roentgenogram which indicated that simple ileus had developed. Voglibose was discontinued and the patient was treated with an enema and hot air. She recovered from simple ileus on the next day. This patient had had two abdominal surgeries and a cerebral hemorrhage, and her daily physical activities were limited, which might have contributed to ileus. In elderly patients with NIDDM, a history of abdominal surgery and the amount of daily exercise must be considered when deciding whether or not to give alpha-glucosidase inhibitors.