The results of longitudinal studies in geriatric medicine were reviewed by referring to relatively recent publications. “Longidufinal studies” comprised not only cohort studies but also prospective case-control studies in the broad sense. Poor self-rated health, weight loss, hypoalbuminemia, inability to perform activities of daily living, low levels of physical activity, and cognitive dysfunction, all of which could be manifestations of chronic diseases, might shorten longevity. Cardiomegaly or left ventricular hypertrophy on ECG were again found to be important risk factors for cardiovascular disease in the aged, because of their relation to atherosclerosis. There is no evidence regarding the contribution of hyperlipidemia to the risk of cardiovascular disease in the aged, although insulin resistance can increase serum triglyceride levels and reduced level of high-density lipoprotein cholesterol even in the aged. Mortality due to stroke and heart disease have been decreasing in most developed countries, and several recent community-based studies have also shown decreases in the incidence of cerebral stroke. Large-scale case-control studies on the pharmacological treatment of hyperlipidemia have resulted in both primary and secondary prevention of coronary heart disease. However, information concerning the effects of treatment for hyperlipidemia on coronary heart disease in the aged is limited. Results of large-scale case-control studies indicate that pharmacological treatment of elderly hypertensive patients can reduce cardiovascular morbidity and mortality, and angiotensin-converting enzyme inhibitors have recently been shown ot be useful.
123I-metaiodobenzylguanidine (MIBG) myocardial single photon emission computed tomography (SPECT), 123I-beta-metyliodophenyl pentadecanoic acid (BMIPP) myocardial SPECT, and holter ECG recording were performed in patients with non-Hodgkin's lymphoma who underwent chemotherapy including pirarubicin (THP), in an attempt at early detection of cardiac toxicity from THP. Twenty-six patients with untreated non-Hodgkin's lymphoma who received THP-COPBLM therapy were studied. For THP-COPBLM therapy, THP was administered at a dose of 40mg/m2 every 21 days and the total dose was 250mg/m2 on average (40-400mg/m2). 1) The washout rate (WR) correlated with the total THP dose, and was considered to be a useful index of cardiac sympathetic nervous dysfunction. 2) The left ventricular ejection fraction (LVEF) correlated negatively with the total dose of THP. 3) The total dose of THP showed a correlated positively with the extent score and severity score determined by BMIPP. 4) The WR correlated with the frequency of premature ventricular contraction. Animal studies have indicated that THP has less cardiac toxicity than doxorubicin, but the present study showed that cardiac toxicity occurred at a total THP dose of about 360mg/m2 in elderly patients. Accordingly, when THP is used to treat elderly patients, multimodal evaluation of cardiac function is necessary to detect cardiotoxicity and to determine the optimal dosage.
Aspiration pneumonia is a major cause of death among frail elderly patients. Pulmonary aspiration is commonly reported in association with episodes of pneumonia, but the clinical significance and outcome in patients with recurrent pulmonary aspiration remain uncertain. We studied outcomes retrospectively in elderly patients with recurrent aspiration. A total of 38 patients (M25, F13; mean age 81.4yr) who were recognized to have undergone repeated aspiration were enrolled. Of them, 89.5% had suffered cerebrovascular disorder or other neurological disorders as the major underlying disease, and 63.2% showed moderate or severe cognitive impairment. Activities of daily living (ADL) were low and 97.4% were bedridden. At the time of enrollment, 79% had aspiration pneumonia or aspiration bronchitis. The mean number of admissions during the observation period was 2.3, and 60.9% of admissions were due to pneumonia. Of the patients observed, 84.2% died during the observation period; the median survival time was 736 days. Major causes of death were pneumonia, respiratory failure, and asphyxia (65.6%). Percutaneous endoscopic gastrostomy (PEG) was carried out in 16 patients and these patients survived longer than patients who did not undergo PEG, although 75% of the PEG group died of pneumonia. We conclude that: 1) repeated pulmonary aspiration mostly occurrs with underlying diseases of cerebrovascular disorders, dementia, and deterioration of ADL, and 2) although the prognosis following repeated pulmonary aspiration was poor, PEG contributed to a longer survival, but did not prevent pneumonia.
We examined age-related changes in the IgE-mediated allergic reaction in patients with late-onset asthma, whose asthma first occurred at over 40 years. (1) The number of patients with a high serum IgE level (over 300IU/ml) was larger in patients with an age of onset between 40 and 49 (40-49 years group) and in patients older than 60 at age of onset (60-year group) than in patients with an age of onset between 50 and 59 (50-59 year group). (2) A positive RAST score to house dust mite (HDm) allergen was more frequently found in the 40-49 year group and in the 60-year group than in the 50-59 year group. Frequency of positive RAST score to HDm in the 50-59 year group was significantly lower (p<0.01) than in early-onset asthma patients (age at onset less than 39 years). (3) Frequency of family history of asthma in the 50-59 years group was high, being equal to that of early-onset asthma patients. (4) In the 50-59 year group, the frequency of severe asthma was comparatively higher than that of the other groups. The frequency of IgE-mediated allergic reaction changed in regard to age of onset of asthma, and allergic reactions in late-onset asthma partially resembled those of early-onset asthma. These results suggest that an atopic constitution is related to the onset of bronchial asthma in the elderly.
We investigated seven brains from patients 99-105 years of age with a clinical diagnosis of Alzheimer-type dementia (ATD). The pathological findings were as follows. 1) These cases could be divided into two groups: cases with localized cortical atrophy in the medial part of the temporal lobe, and a case with diffuse atrophy in the cerebral cortex. Atrophied cortex in both groups showed laminar degeneration consisting of neuronal loss, neuropil loosening and astrocytosis resulting in fibrillary gliosis, which was particularly marked in the 2nd and 3rd layers of the cerebral cortex. In contrast, the structure of the six cortical layers was preserved when there was no laminar degeneration. Laminar degeneration correlated with cortical atrophy. 2) Cases with localized atrophy were further divided into two groups: group 1 (4 cases) showed small numbers of senile plaques (SPs) and large numbers of neurofibrillary tangles (NFTs) in CA1 of the hippocamupus, subiculum, and parahippohcampul gyrus, while group 2 (2 cases) showed widespread and numerous SPs and NFTs in the cerebral cortex. The distribution of SPs and NFTs in group 2 was similar to that of the case (group 3) with diffuse cortical atrophy. It was considered that group 2 was limbic type ATD and that group 3 was neocortical type ATD, because both groups met our pathological diagnostic criteria ATD. In contrast, group 1 could not be regarded as ATD because the numbers of SPs and NFTs were below those found in ATD, even though this group showed laminar degeneration the same as that of groups 2 and 3. It therefore is likely that group 1 is a unique type of degenerative dementia, pathogenetically different from ATD.
Data from an 18-year prospective study were used to investigate the effect of accumulation of arteriosclerotic risk factors in elderly people on cerebrovascular and cardiovascular disease mortality rates. Risk factors include smoking, hypertension, diabetes mellitus, hyperlipidemia, and obesity. We compared survival rates between a group with few risk factors (<two risk factors) and a group with many risk factors (≥two risk factors) in four groups of subjects: middle-aged men (<61-years-old) and middle-aged women and elderly men (≥61-yeam-old) and elderly women. In the elderly male group, the survival rate was lower in subjects with many risk factors than in those with few risk factors. In the middle-aged male group, however, there was no difference between the two risk groups. On the other hand, in the middle-aged female group, the survival rate was lower in subjects with many risk factors than in those with few risk factors, while no difference was found between the two risk groups in the elderly female group. The results indicated that the effects of an accumulation of risk factors are different in men and women and greater in elderly men than in elderly women.
In this study 112 elderly inpatients (55 men, 57 women) were recruited. 1. Twelve elderly inpatients (5 men, 7 women) aged 82.5±7.4years (M±SD) were investigated during 3 periods of dietary intake; good intake (period I), tube nutrition (period II) and fasting with intravenous fluid infusion (period III). Calorie, protein, carbohydrate, fat and cholesterol intakes were greater in period I than in periods II and III. Serum total and LDL cholesterols were lowest in period III, when serum HDL cholesterol, triglyceride and total protein were lower in period III than in period I. 2. One hundred elderly inpatients (50 men, 50 women) were divided into 4 groups according to type of decreased serum lipid and a control group. Serum total cholesterol only was decreased in group I, both serum total and HDL cholesterols were decreased in group II, both serum total cholesterol and triglyceride were decreased in group III, all 3 lipids were decreased in group IV and lipid levels did not change in the control group. There were 5 patients in group I, 28 patients in group II, 20 patients in group III, 27 patients in group IV and 20 patients in the control group. The patient's age ranged from 80.3 to 88.4years and body mass index ranged from 14.7 to 18.4kg/m2. Serum total protein decreased significantly in groups II-IV, to 5.6 to 5.7g/dl. Serum total protein, and total cholesterol correlated positively (r=0.525, p<0.01), as did Calorie ingestion and serum total cholesterol levels (r=0.554, p<0.001). Therefore, severe hypocholesterolemia was accompanied by malnutrition and a decrease in Calorie or cholesterol intake. Serum total cholesterol levels during observation decreased most in group IV, followed by group II similar to serum HDL cholesterol levels. The amount of nutrient intake was smallest in group IV, resulting in an extreme lowering of all 3 serum lipid levels.