We studied the effect of normal aging on human sleep. The subjects were 105 volunteers between the ages of 10 and 97 years. Polysomnography was done for three consecutive nights. Data collected on the second and third nights were scored according to the manual of Rechtschaffen and Kales. The sleep efficiency and the time percents of stage REM, stage 3, and stage 4 decreased gradually with age. The time percents of wakefulness stage 1, and stage 2 increased gradually with age. Stepwise regression analysis showed that sleep efficiency and the time percent of stage 3+4 were related to age. Sleep in the elderly is said to be characterized by more frequent awakenings, longer periods of light sleep (stage 1+2), shorter periods of deep sleep (stage 3+4) and REM sleep. The present results suggest that polysomnographic changes can be found even in young adults.
Levels of the proteoglycans hyaluronic acid, heparan sulfate, dermatan sulfate and chondroitin sulfate in brains were measured. The samples were from 25 brains obtained at autopsy from patients who had senile dementia of Alzheimer's type (SDAT) (60 to 97 years old) and 10 brains from non-demented elderly subjects (75 to 101 years old). Proteoglycan levels in the brains of patients with SDAT were twice as high in the hippocampus and four times higher in the superior frontal gyrus than the levels in brains of non-demented elderly subjecyts. The content of heparan sulfate proteoglycan was greatest nine times higher in the hippocampus and seven times higher in the superior frontal gyrus. By immuno-electronmicroscopic examination, heparan sulfate proteoglycan was found in the basement membranes of capillaries, and in a portion of the cores of the senile plaques.
Studies with single photon emission computed tomography (SPECT) have shown temporoparietal (TP) hypoperfusion in patients with Alzheimer's disease (AD). We evaluated the utility of this findings in the diagnosis of AD. SPECT images with 123I-iodoamphetamine were analyzed qualitatively by a rater without knowledge of the subject's clinical status. Sixty-seven of 302 consecutive patients were judged as having TP hypoperfusion by SPECT imaging. This perfusion pattern was observed in 44 of 51 patients with AD, in 5 with mixed dementia, 8 with cerebrovascular disease (including 5 with dementia), 4 with Parkinson's disease (including 2 with dementia), 1 with normal pressure hydrocephalus, 1 with slowly progressive aphasia, 1 with progressive autonomic failure, 2 with age-associated memory impairment, and 1 with unclassified dementia. The sensitivity for AD was 86.3% (44 of 51 AD), and the specificity was 91.2% (229 of 251 non-AD). Next, we looked for differences in perfusion images between patients with AD and without AD. Some patients without AD had additional hypoperfusion beyond TP areas: deep gray matter hypoperfusion and diffuse frontal hypoperfusion, which could be used to differentiate them from the patients with AD. Others could not be distinguished from patients with AD by their perfusion pattern. Although patients with other cerebral disorders occasionally have TP hypoperfusion, this finding makes the diagnosis of AD very likely.
Apical hypertrophic cardiomyopathy (apical HCM) has been believed to be a special type of hypertrophic cardiomyopathy. It usually occurs in middle-aged or elderly men and the prognosis is thought to be good. However, recent reports suggest that approximately 10% of middle-aged patients with apical HCM have cardiac events and poor outcomes. We studied electrocardiograms and echocardiograms, the occurrence of cardiac events, and clinical characteristics in elderly patients with apical HCM (13 men and 7 women, 61 to 95 years old, mean age 74±7). Three of 20 patients (15%) had cardiac events (sudden death, 1; heart failure, 1; chest pain. 1), 2 had cerebral infarction with atrial fibrillation, and 2 died of non-cardiac causes. There were no differences in age, sex, medication, complications, or in initial values of electrocardiographic or echocardiographic variables between patients who had and did not have cardiac events. However, left ventricular end-systolic dimension (LVEDs) and left atrial diameter at the time of the last evaluation were larger in patients who had cardiac events than in those who did not (26 vs. 34mm, p=0.019, 33 vs. 38mm, p=0.1325, respectively). These results suggest that the prognosis for patients with apical HCM is not necessarily good, and that enlargement of the LVEDs might be used to predict cardiac events in elderly patients with apical HCM.
We hypothesized that an intensive personal educational program would reduce the number of hospital admissions due to acute exacerbations of chronic airflow obstruction in elderly patients. The educational program was designed to improve self-management of asthma in these patients. We compared the number of patients admitted for treatment of acute asthma attacks at Tokyo Metropolitan Geriatric Hospital from April 1987 through March 1989 (before the program began) with the number admitted from April 1991 through March 1993 (after the program began). Fewer patients were admitted in the latter period than in the former. During the latter period, fewer patients were admitted due to mild or moderate asthma attacks, but there was no such difference in the number admitted due to near-fatal attacks.
We studied the relationship between decubitus ulcers and changes in skin blood flow with respect to the presence or absence of a decompression medium. We also studied the relationship between decubitus ulcers and the results of biochemical tests that reflect nutritional status. Two groups of inpatients with decubitus ulcers in areas other than the sacral region were studied: One used cloth diapers and the other used paper diapers. Skin blood flow was measured with a laser Doppler blood flowmeter and a sheet of polyurethane (decompression medium) in the sacral region. Data were also obtained from patients with and without decubitus ulcers, and whose levels of albumin, total cholesterol, and triglyceride for three months were known. When the decompression medium was used, skin blood flow changed significantly after body position was changed in the patients who used paper diapers. Nutritional analyses showed significant differences in the levels of albumin and total cholesterol between patients with and without decubitus ulcers. The levels of albumin and total cholesterol were lower in the patients with decubitus ulcers than in those without decubitus ulcers. Because the cloth diapers acted as a compression factor, even an externally applied decompression medium did not suppress the reductions in skin blood flow.
Clinical assessment and laboratory testing are important in predicting longevity and the outcomes of chronic diseases in the elderly. We therefore studied the prognostic utility of clinical and laboratory findings. A group of 168 elderly patients (70-97 years of age) with chronic diseases who were admitted to Kashiwazaki Kosei Hospital was studied. Data on 13 potentially prognostic factors were analyzed: dementia, being bedridden, anorexia, edema of the lower limbs, urinary incontinence, dyspnea, fever, hepatic dysfunction, renal dysfunction, anemia, hypoalbuminenmia, inflammation, and electrocardiographic abnormality. Kaplan-Meier survival curves were constructed, and either the log-rank or Wilcoxon method was used to look for significant differences in survival between patients with and without the factors listed above. Regression analysis was then done with the Coxproportional-hazardsmodel to study the factors that contributed to the shortest survival. Patients lived longer if they were not bedridden, anorexic, incontinent of urine, hypoalbuminemic, or if they had no inflammation (p<0.005). Analysis with the proportional-hazardsmodel revealed significant contributions from seven factors (p<0.05): being bedridden, anorexia, urinary incontinence, hepatic dysfunction, hypoalbuminemia, inflammation, and electrocardiographic abnormalities. The survival curve obtained by using these factors as independent variables in the proportional-hazardsmodel was similar to the Kaplan-Meier survival curve.
Objective: We sought to clarify the chracteristics of gastric cancer in the elderly. Methods: We examined 549 specimens of gastric cancers. All specimens were obtained at autopsy from patients who were over 65 years old. We analyzed the relations among five factors: age of the patient, histological type, macroscopic appearance, grade of invasion and location. Rsults: Older patients were more likely to have papillary adenocarcinoma, tubular adenocarcinoma, and Borrmann-2 and 3 lesions. Papillary and tubular adenocarcinoma together accounted for 14 of 84 Borrman-4 lesions (16.3%). Borrmann-1 signet-ring-cell carcinomas were observed in two cases. Tubular adenocarcinomas made up 31 in 38 depressed-type early carcinomas (81.6%). Over half of the papillary and tubular adenocarcinomas were confined to the mucosal or submucosal layers, but over 60% of the poorly differentiated adenocarcinomas or signet-ring-cell carcinomas had invaded the extraserosal layer. Papillary and tubular adenocarcinomas were commonly found in the lower part of the stomach, but poorly differentiated adenocarcinomas and signet-ring-cell carcinomas were found in all parts of the stomach. Conclusions: Unlike specimens obtained during surgery, many of those obtained at autopsy were from older patients, and the gastric cancers were advanced. Compared to many reports about specimens obtained during surgery, tubular or papillary adenocarcinomas are not a few histological type in Borrmann-4 lesions in this study. Surgical specimens of depressed-type early cancer in younger patients are most commonly found to be signet-ring-cell carcinoma, but tubular adenocarcinoma was common in this study. We found many differences between specimens obtained at autopsy and during surgery. These findings indicate that autopsy studies can reveal some otherwise-obscure characteristics of gastric cancer in the elderly.
We examined the associations between cerebral infarction (CI), asymptomatic arteriosclerosis obliterans (ASO), and known risk factors for these diseases. The subjects were 67 elderly patients (11 men and 56 women, mean±SD age of 79.6±8.5 years). in 44 patients CI was diagnosed by CT scan; 23 were classified as having cortical infarction and 21 as having lacunar infarction. In 41 patients asymptomatic ASO was diagnosed by an ankle-pressure index (API) of less than 0.9. To identify risk factors for these diseases, we examined the association among these diseases and hypertension (blood pressure≥140/90mmHg), hypercholesterolemia (total cholesterol concentration≥220mg/dl), hypertriglyceridemia (triglyceride concentration≥150mg/dl), low HDL-cholesterolemia (HDL-C concentration <40mg/dl), high LDL-cholesterolemia (LDL-C concentration≥150mg/dl), and glucose intolerance (fasting blood sugar concentration≥110mg/dl). The incidence of asymptomatic ASO in the subjects with CI was significantly higher than that in the subjects without CI (χ2 test; p<0.05, oddsratio 6.4), including cortical infarction (p<0.05, odds ratio 8.9) and lacunar infarction (p<0.05, odds ratio 3.8). Patients with lacunar infarction were more likely to have hypertension than were controls (p<0.05). Cortical infarction was not associated with these risk factors. Both low HDL-C and high LDL-G were more common in patients with asymptomatic ASO than patients without asymptomatic ASO (p<0.05). These results indicate that CI and asymptomatic ASO are strongly associated in the elderly, especially in subjects with cortical infarction, and that aging itself contributes to cortical infarction.
An 82-year-old woman was admitted to our hospital because of hematemesis. She had had a feeling of a foreign substance in her throat for one week after having eaten fish. On admission she had a fever of 38°C, Hb of 5.8g/dl, CRP level of 8.8mg/dl, and bilateral pleural effusions. Endoscopy revealed a deep longitudinal laceration with active bleeding in the esophagus that also caused mediastinitis. Endoscopic hemostatis and closure of the laceration was done with hemostatic clips. The esophageal injury seemed to have been caused by a fish bone. After the treatments described here were carried out, the patient's condition rapidly improved.
The case is a 79-year-old man who came to our hospital with melena as chief complaint. Emergency endoscopy showed spurting bleeding from a small ulcer. We diagnosed as Post-Bulbar Dieulafoy's ulcer and performed hemostatic procedure with hemostatic clipps. The forth endoscopy (7 days after admission) showed fresh clot and oozing bleeding after the third hemostatic clipping. Although we performed hemostatic procedure with the injection therapy of hypertonic saline epinephrine solution (HSE). The effective hemostatic procedure is discussed with reference to some related literature.
A 67-year-old woman presented with a 1-year history of gradual weight loss, reduced mental activity, muscle weakness, and urinary dysfunction. Neurological examination revealed mild lethargy, severe muscular atrophy, and diminished deep tendon reflexes in the extremities. The levels of vitamin B1 and folate in blood were low: 1.9μg/dl (normal range 2.0-7.2) and 0.7ng/ml (normal range 4.0-12.0), respectively. A lumbar puncture was done. The pressure of the cerebrospinal fluid was within normal limits, the level of protein was very high (467mg/dl), and only a few lymphocytes were seen. A nerve-conduction study showed low amplitudes of action potentials and slow conduction velocities in both the motor and sensory nerves. Myelin irregularity, “onion bulb formation”, and axonal atrophy were seen in a specimen obtained by sural nerve biopsy. A T2-weighted magnetic resonance image of the brain showed ventricular dilatation, high-intensity signals around the lateral ventricles, and a flow-void sign of the cerebral aqueduct. Radioisotope cisternography (111In-DTPA) disclosed ventricular reflux and slow clearance of the tracer from the ventricles. These findings indicated the presence of chronic inflammatory demyelinating polyneuropathy, nutritional polyneuropathy, vitamin B1 deficiency, folate deficiency, and normal-pressure hydrocephalus. In this patient, the high level of protein in the cerebrospinal fluid may have caused the hydrocephalus.