In order to clarify the relationship between brain atrophy and asymptomatic cerebral lesions, total of 235 subjects (130 males and 105 females), who had neither neurologic deficits nor organic lesions on cerebral computed tomography, were studied. The subjects' ages ranged from 40 to 86 years (mean 66). They were divided into two groups: 90 controls without hypertension or diabetes mallitus (Group C), and 145 patients with essential hypertension (Group H). Brain atrophy was diagnosed using the caudate head index (CHI). Asymptomatic cerebral lesions on magnetic resonance imaging were defined as asymptomatic lacunae and white matter lesions. Caudate head index was higher in Group H than it was in Group C, and CHI in both groups was significantly correlated with the number of asymptomatic lacunae and the severity of white matter lesions on magnetic resonance imaging. These results indicate that brain atrophy may progress along with asymptomatic cerebral lesions.
This longitudinal study was performed in order to clarify the effects of long-term antihypertensive medication on common carotid hemodynamics. A total of 84 patients (54 males and 30 females), who had been receiving treatment with antihypertensive medications for 5 years, were enrolled in this study. The subjects' ages ranged from 62 to 74 (mean 67). They were divided into three groups: 40 were treated with diuretics only (Group D), 28 with calcium antagonists only (Group C), and 16 with angiotensin converting enzyme inhibitors only (Group A). Mean blood flow volume (BF) and circulation resistance (Z) at the common carotid artery were measured by an ultrasonic quantitative flow measurement system. Blood flow volume, Z, and mean blood pressure (MBP) were measured twice over a 5-year period in patients and in 49 age-matched normal controls (Group N). Annual reductions in BF (ΔBF) and MBP (ΔMBP), and annual increases in Z (ΔZ) were calculated. Blood flow volume of Group D showed larger decreases than that of the other three groups. Circulation resistance of Group C showed smaller increases than that of Group N. Reductions of BF and Z of Group A were similar to those of Group N. Reductions of Z of Group C showed a significant correlation with ΔMBP. These results indicate that calcium antagonists may have beneficial effects on common carotid hemodynamics in elderly patients with essential hypertension.
It has been suggested that pulmonary rehabilitation compined with inspiratory muscle training (IMT) might improve pulmonary function and respiratory muscle strength in elderly patients with chronic obstructive pulmonary disease (COPD). To test this hypothesis, inspiratory muscle strength (PImax), expiratory muscle strength (PEmax) and resting pulmonary function were measured in 13 elderly patients with COPD (aged 70.3±2.7 years). Inspiratory muscle training (IMT) was performed for 15min twice a day, using a pressure threshold device, for a total of 12 weeks. The inspiratory threshold was set at 15% of maximal inspiratory pressure (PImax) for each individual. Pulmonary rehabilitation was performed for 12-h sessions over a 12-week period. Patients with COPD were assigned randomly to two groups: pulmonary rehabilitation combined with IMT (group A) (n=7), and conventional pulmonary rehabilitation only (group B) (n=6). Functional residual capacity (FRC) decreased significantly from 4.3±0.4L at baseline to 3.9±0.4L after rehabilitation (p<0.01), Vp significantly increased from 4.6±0.8L/sec at baseline to 5.1±0.7L/sec after rehabilitation (p<0.05) and the PImax increased significantly from 51.5±5.4cmH2O at baseline to 80.9±7.0cmH2 O after rehabilitation (p<0.02) in group A. However, these variables did not change in group B. There was no improvement in the 10-minutes walking distance of group A, but there was a significant increase in that of group B. It can be concluded that pulmonary rehabilitation combined with IMT improves pulmonary function and inspiratory muscle strength in elderly patients with COPD.
In order to investigate the effect of body mass index (BMI, kg/m2) on life expectancy, 2053 Hisayama residents, aged 40 years or older were studied for 13 years from 1974. During the follow-up period, 419 subjects died; of these, 39 deaths due to accident or suicide were excluded from further analysis. On initial examination, male subjects with BMI≥27 had significantly higher age-adjusted prevalence rates of hypertension, glucose intolerance, hypercholesterolemia, electrocardiogram abnormalities and proteinuria, as compared with those with 23-25 BMI. In contrast, the frequency of male smokers was inversely associated with BMI levels. Female prevalence rates of glucose intolerance, hypercholesterolemia and proteinuria were significantly higher in 25-27 BMI than in 23-25. Body Mass Index showed a U-shaped relationship with all-cause mortality rates with the lowest rate in 23-27 BMI for men and in 23-25 BMI for women. These associations remained substantially unchanged, even after controlling for age, systolic blood pressure, glucose intolerance, serum cholesterol, proteinuria, electrocardiogram abnormalities, alcohol consumption, and smoking habits. When analyzing the BMI mortality relationship by cause of death, age- and sex-adjusted mortality rates from myocardial infarction and stroke significantly increased in subjects with BMI≥27 compared with those with 23-25 BMI. In contrast, there was a decreasing risk of death from malignant neoplasms with rising BMI levels, but the relationship was not significant. Mortality from pneumonia and other causes showed a U-shaped relationship with significantly higher rates seen in BMI<19 than in 23-25 BMI. These data indicate that BMI has a U-shaped relationship with total mortality in the general Japanse population, which results from various associations between BMI and cause-specific mortality rates.
Depressive symptoms and personality traits 90+ years population were examined. Data were obtained from 33 aged people(mean 93±3.2 years old; range 90-105 years old) using the Hamilton Rating Scale for depression and a questionnaire for the evaluation of type A personality trait (devised by Dr. Maeda). Scores of >11 in the Hamilton Rating Scale for depression were considered indicative of depression. This score was found in 39% of cases. There are four types of depressive symptoms among the 90+ years population: sleep disturbance and somatic complain type; depressive mood type; hypochodrical type; reference of ideas and obsessive-compulsive type. The usual distributions of symptoms is 43, 29, 21 and 7% respectively. According to the questionnaire for type A personality trait among the 33 cases, there were more people with type A personality (n=18; 56%) than there were those with type B (n=15; 44%). Of the total number of cases studied, there was a tendency high scores to be achieved items characteristic of type A personality, such as a thorough native, self-confidence and precision. On the other hand, there are also tendencies for flexibilities and “going-my-way” traints in the 90+ year population. There is a significant correlation between scores in Hamilton Rating Scale for depression and scores in the type A personality questionnaire.