Near-death experience (NDE) was studied in a series of 48 consecutive patients who were admitted to hospital in a deep coma (level III on the III-3 coma scale) due to cardiac arrest, pulmonary failure, cerebrovascular accident, and/or other life-threatening disease. When the patients recovered from coma without complications such as aphasia, dementia or mental disturbance, they were interviewed by the same physician following the same protocol consisting of 25 questions about their experience during the period of deep coma. Of 48 patients interviewed, 14 (37%) had a vivid and undeniably personal experience during their unconscious state. Factors attributable to the NDE were assessed by the following three methods. First, The frequency and odds ratio were examined in terms of gender, age, underlying disease, occupation, religion, education, site of accident, duration of comatose state, drugs and treatment for resuscitation, and drugs being taken at the time of interview. There were no specific factors significantly related to the NDE. Next, background factors were compared between the NDE positive and negative groups to detect a particular factor related to the NDE. However, there were no factors that showed significant frequency in the NDE-positive group. Finally, discriminatory analysis was performed to detect discriminatory factors in the occurrence of NDE by selecting NDE as an objective variable and background factors as explanatory variables. However, the discriminatory equation gained was not significant. Thus, there were no background factors that could explain the occurrence of NDE. Among the NDE reported, there were such elements as flying in a dark void apace with dim light ahead, encountering dead relatives or friends, standing at the boundary of brook, river or pond, and returning to the world in response to a voice calling from behind. These elements are common to those reported by investigators abroad, except for the lack of a tunnel experience. As for the influence of the NDE on life subsequent to the experience, the majority of patients who had had a NDE stated that they became more sincere to towards every aspect of life and held spiritual values in high esteem than before. This was quite a contrast to the attitudes in the non-NDE patients who looked upon the comatose episode as arising from an underlying disease and considered it a health problem only. Most of the NDE patients considered that death was neither fearful nor difficult, but calm and peaceful if it occurs in a manner similar to that in their NDE. From this study, a picture can be down of the dying process, based on empirical information, it can also be seen that a NDE causes the individual to develop a sincere introspective depth. It is possible that these findings may be applicable to elderly patients in terminal care.
To evaluate the relation between blood pressure and diastolic function in the elderly, 28 apparently healthy volunteers underwent blood pressure measurements, echocardiographic examinations, and radionuclide angiography acquired in list mode. Casual blood pressure did not correlate with diastolic indices measured either by echocardiography or by a radionuclide method, except for peak filling rate during atrial contraction assessed by radionuclide angiography (r=0.39, p<0.05). Ambulatory blood pressure monitoring revealed significant correlations between peak filling rate during atrial contraction assessed by radionuclide angiography and blood pressure measured over 24 hours, while awake and during sleep. The time to peak filling rate and the velocity of early diastolic filling were found to correlate with blood pressure, but the best correlation was between blood pressure during sleep and peak filling rate during atrial contraction (r=0.53, p<0.005). These results show a direct relation between blood pressure and diastolic function in the elderly, which in stronger during sleep than during wakefulness.
The prevalence rates of affective disorders among the elderly in a rural community according to the criteria of the third edition of Diagnostic and Statistical Manual of Mental Disorders were investigated. The survey used a two-phase method which combined a self-administered depression scale and diagnostic interviews by psychiatrists. The subjects were all 766 persons aged 65 years or older in a rural village in Japan. In the first phase, 698 persons completed a self-administered scale, the Center for Epidemiologic Studies Depression scale (CES-D). In the second phase, 83 persons scoring 12 points or more on the CES-D and an additional 8 persons who, for unknown reason, did not respond to the CES-D were assessed by psychiatrists using a modified version of the Diagnostic Interview Schedule. The subjects' physical health and life events, the presence of dementia, and other factors were taken into account when diagnoses were made. The point prevalence rates of depression without dementia as a comorbid condition by category were as follows: major depression, 0.5%; dysthymic disorder, 0.3%; and atypical depression, 0.4%. The point prevalence rates of depression with dementia as a comorbid condition were as follows: major depression, 0.7%; dysthymic disorder, 0.4%; and atypical depression, 0.4%. Major depression was more prevalent in women than in men and was more prevalent in persons aged 75 years of older than in younger subjects.
We compared the usefulness of two methods for diagnosing asymptomatic brain infarction: an ultrasonic quantitative flow measurement system (QFM) and a transcranial Doppler arteriography (TCDA). A total of 137 patients (73 men and 64 women) who underwent magnetic resonance imaging of the brain, QFM, and TCDA were enrolled. Their ages ranged from 41 to 83 years (mean age, 63 years). The patients were divided into 3 groups: 45 without cerebrovascular disease (Group N); 40 with asymptomatic brain infarction (Group AS); and 52 with lacunar infarction (Group LI). The mean blood flow in the common carotid artery (CCA-BF) was measured by QFM. The mean blood velocity and Fourier pulsatility index in the middle cerebral artery (MCA-BV, MCA-PI) were measured by TCDA. In Group N, 28 patients were examined twice at a mean interval of 2 years; 19 remained without asymptomatic brain infarction (Group N1), and asymptomatic brain infarction developed in the remaining 9 (Group N2). The 3 groups differed significantly in MCA-PI (N<AS<LI), but not in CCA-BF or in MCA-BV. The MCA-PI in Group N2 was higher than that in Group N1. These results indicate that the Fourier pulsatility index determined by TCDA may be useful for detecting the onset of asymptomatic brain infarction.
A 70-year-old man, with mild-type myotonic dystrophy (MyD) diagnosed by molecular genetic analysis when he was 68 years old, complained of worsening intermittent claudication during the past 2 years. Doppler examination revealed severe stenosis and obstruction in his leg arteries, which we diagnosed as arteriosclerosis obliterans (ASO). We then found him to be suffering from dementia, which was confirmed by dementia scale tests (Mini Mental State, 20/30; Hasegawas' Dementia Scale-Revision, 15/30). Even in mild-type MyD, as MyD is one of the progeria syndromes, the abnormal genes of MyD may accelerate the aging processes.
A 66-year-old woman with a 7-year history of Parkinsons' disease was admitted to our hospital because of a high fever and disturbance of consciousness. She had been treated with levodopa/benserazide hydrochloride and trihexyphenidyl hydrochloride until admission. On admission, the patient was comatose, her temperature was 40.5°C, her blood pressure was 54/-mmHg, and her pulse rate was 130 beats min. Laboratory tests showed leukocytosis, a high level of creatine kinase in serum and evidence of hyperosmolar non-ketotic diabetic coma (blood glucose, 1, 080mg/dl) and of disseminated intravascular coagulation (DIC). A continuous insulin infusion, antibiotics, nafamostat mesilate, and urinastatin were given, after which the DIC, hyperglycemia, and the level of consciousness were improved. However, levels of creatine kinase, myoglobin, transaminase, and amylase in serum continued to increase, and multiple organ failure was suspected. Furthermore, she became less responsive, diaphoretic, and tremulous; fever and mild rigidity developed. The peak creatine kinase and myoglobin were 11, 095U/l and 12, 520ng/ml, respectively. A diagnosis of malignant syndrome was made, and treatment with levodopa/carbidopa and dantrolene was begun. Within several days, the clinical and laboratory findings improved. We report here a rare case of malignant syndrome associated with DIC followed by diabetic coma in an elderly patient with Parkinsons' disease during L-dopa therapy. Timely diagnosis and treatment of malignant syndrome are important in the management of elderly patients with Parkinsons' disease, because DIC and multiple organ failure may occur in the early stages of malignant syndrome.