The prevalence of dementia in Japan in 1985 for people aged 65 years or older was 4.8%. Vascular dementia (VD) has been reported to be the commonest subtype. A report from Tokyo in 1970 showed that it was 2.8 times more frequent than Alzheimer type dementia (SDAT). We assessed the prevalence of dementia in a rural area (population: 12, 931. 25.3% were 65 years or older in 1994) in Kyoko. First, we questioned subjects about their demographic circumstances, memory disturbance, apraxia (agnosia) and daily activities. Our questionnaire was answered by 3, 132 (95.8%) subjects, and 2, 280 of them agreed to be examined by neurologists. Those who met the appropriate criteria of the DSM-III-R and NINCDS-ADRDA were diagnosed with dementia. By use of the Hachinski ischemic score (HIS), we distinguished VD from non-vascular dementia. In this study patients with non-vascular dementia were diagnosed with SDAT by the neurologists. Analysis of the data revealed that 4.8% of the study population was demented. According to the HIS results, only 3 of 15 had vascular dementia. The prevalence of dementia was the same as the average prevalence in Japan, even though the elderly population of this town was twice as high as the average. It is hard to determine the prevalence of dementia in any community. Many factors must be taken into consideration: the coverage rate, the criteria for dementia, and whether to include institutionalized residents. The prevalence of dementia will increase with the aging of the population, and we must collect accurate data in order to plan efficiently.
A new tetrazolium compound, WST-1, a sodium salt of 4-[3-(4-iodophenyl)-2-(4-nitrophenyl)-2H-5-tetrazolio]-1, 3-benzendeisulfonate, was introduced into clinical chemistry. The compound's dehydrogenase activities are useful in the colorimetric determination of the bioreducibility of cells. It proved to have a sensitivity similar to MTT, and produces a highly colored formazan dye under reductive conditions. Compared with the MTT assay, we found the WST-1 assay to be more sensitive, more convenient, and more exact. We used the new assay to study aging-related changes in human lymphocyte blastformation. Four groups of healthy adults aged 40-49 years (N=40), 50-59 years (N=40), 60-69 years (N=40), 70-76 years, (N=40) were examined. Moreover, we studied lymphocytes from 16 patients (47-74 years) with probable Alzheimer's disease. For healthy controls, a negative correlation (r=-0.3108, p<0.05) between age and enzyme activity was noted. The regression equation was: Y=-0.0085X+1.473 where X and Y designate the age of the individual and enzyme activity (absorbance), respectively. On the other hand, for patients with Alzheimer's disease, age and enzyme activity did not correlate. These results indicate that the WST-1 assay may be useful in the study of changes associated with aging, and also more so than the MTT assay.
Usefulness and problems of percutaneous endoscopic gastrostomy (PEG) placement in a geriatric hospital where most patients were severely demented or bed-ridden were evaluated. The variables examined were acute complications, chronic complications, restraint of patients before and after PEG placement, change in physical activity, and ability of oral intake. Results showed that both acute and chronic complications were not rare, but these problems are not peculiar to geriatric hospitals. Quality of life (QOL) was clearly improved. Restraint could be reduced or stopped in 65.2% of restrained patients after PEG tube placement, activity was improved in 55.5% of patients, and oral intake became possible in 14.0% of patients. There were also some improvements in the management of PEG, as the incidence of self-extubation decreased, and tube exchange became easier. In conclusion, it is possible to insert and manage the PEG tubes even in geriatric hospitals, and PEG tubes are quite useful in managing patients with chronic disease and in improving QOL.
Rapid demographic aging has made caring for the elderly an increasingly important social issue in Japan. To study current conditions of the oldest elderly citizens, we investigated the dietary practices of centenarians in the Tokyo metropolitan area. First, we compared the food intake of centenarians with that of octogenarians. Next, to identify dietary trends, we investigated whether food intake by centenarians had changed significantly between 1981 and 1995. Nutritional intake by the centenarians and octogenarians in 1995 was about 60% and 75% that of the control, respectively. However, the nutritional intake of well nourished centenarians was similar to that of the octogenarians. Cognitive function and daily activity have an influence on nutritional intake. The centenarians were similar to the control subjects in their consumption of dairy products, sweets, and fruit. However, their intake of cereals, meat, fish, and fatty oils was less than 60% that of the control, which indicates their preference for soft and sugary foods. The pattern of dietary practices of centenarians in 1981 was similar. Although the total food intake of centenarians amounted to 60% of the control in 1995, energy intake per kilogram of body weight averaged over 30kcal. As to dietary trends, centenarians in 1981 ate more cereals, eggs, algae products, and legumes than did their 1995 counterparts. This finding seems to reflect a generational difference in diatary habits.
We encountered a patient with enterohemorrhagic Escherichia coli (EHEC) O157: H7 infection and secondary hemolytic uremic syndrome (HUS). The patient was a 79-year-old woman with hypertension, constipation, and asymmptomatic cholelithiasis. She complained of nausea and abdominal pain, and had bloody stool. EHEC O157 was detected by fecal culture. The bloody stool resolved after treatment with antibiotics, but the patient was hospitalized on July 23, 1996 because of abdominal distention. HUS was diagnosed because of proteinuria, hematuria, thrombocytopenia, hemolytic anemia, fragmentation of red blood cells, and increased serum LDH. Treatment was focused on plasma exchange, administration of antibiotics, large doses of γ-globulin, haptoglobin replacement, and anticoagulation. Within about 2 weeks, the level of hemoglobin, the number of platelets, and the serum LDH had normalized, and the patient recovered from HUS. The decreased intestinal movement continued. On August 23, acute cholecystitis was diagnosed, and percutaneous transhepatic gall bladder drainage was done. Another exacerbation was noted on October 13, and cholecystectomy was done on November 12, when the patient's status had inproved after instillation of antibiotics. Macroscopically, the gallbladder wall was thickened. Histopathological examination showed diffuse infiltration of lymphocytes into the mucosa, chronic cholecystitis was diagnosed. Because the postoperative course was satisfactory, the patient was discharged from the hospital on December 15. Acute exacerbation of chronic cholecystitis might have been caused by decreased cholic excretion after the marked decrease in intestinal movement due to O157 infection and secondary HUS. Because elderly people frequently have anamnesis of the digestive system, considerable attention should be paid to the management of anamnesis, as well as O157 infection and secondary HUS.
A 77-year-old woman had suffered from memory disturbance and disorientation for two years before she was admitted to the hospital because of confusion. Her score on the Hasegawa dementia scale revised (HDS-R) was 12 points at the time of the first medical examination. No other abnormalities could be found except for a blood glucose concentration of 34mg/dl. A Magnetic Resonance Image (MRI) of the brain showed some small lacunae on both sides in the frontal white matter and basal ganglia. After hospitalization, glucose was administered and the blood glucose concentration increased, but the dementia-like symptoms did not resolve. She was discharged because the symptoms were too difficult to control in the general hospital. Although dementia-like symptoms were present even after discharge, they did not necessarily appear during fasting. Six months later she was rehospitalized. The insulin-blood sugar ratio was at least 0.3 and abdominal echogram showed a 1-cm tumor at the tail of pancreas. The pancreas tail was removed and the tumor cells were reacted with anti-insulin-antibodies. One month after the operation, the dementia-like symptoms had resolved. The HDS-R score was improved to 27 points (normal range) 40 days after the operation. The amount of the slow waves in the electroencephalogram decreased 5 months after the operation. The dementia-like symptoms observed in this case could be regarded as the Durchgangssyndrom of Wieck. This syndrome is observed transiently at the time of recovery of deterioration of disturbances of consciousness. But it is treatable. This patient was an interesting case that showed Durchgangssyndrom mimiking dementia associated with insulinoma.
We report a 79-year-old woman case of slowly progressive IDDM (SPIDDM) with rheumatoid arthrhtis (RA) and Hashimoto disease. High titer of anti-glutamic acid decarboxylase antibody (GAD) with a value of 16, 400U/ml (normal value: less than 5U/ml) and deteriorated secretion of insulin, and clinical course led to the diagnosis of SPIDDM. Both anti-islet cell and anti-insulin antibodies were negative. One year prior to the diagnosis, at 78 years of age, she was newly diagnosed with NIDDM and had been medicated with sulfonylurea and voglibose, resulting her glucose levels well-controlled. Four months before admission, a gradual increase of plasma glucose was noticed, while oral hypoglycemic agents were fully administrated. On admission, her glycemic control was revealed as follows; a fasting blood glucose level of 458mg/dl and an HbA1C level of 14.3%. Urinary CPR was 22.5μg/day. Her insulin secretion was proved not to be induced with intravenous glucagon injection. Hyperinsulinemic euglycemic glucose clamp test showed the normal glucose uptake ratio; 9.5mg/kg/min. Moderate doses of subcutaneous insulin (20 units daily) were effective on her diabetes control. She was newly diagnosed with Hashimoto disease that required thyroid hormone replacement 50μg per day after having developed NIDDM. High titer of anti-thyroglobulin antibody (46.9U/ml) and anti-thyroid peroxydase antibody (81.5U/ml) were observed. The patient had been medicated for RA with anti-inflammatory drugs since her early seventieth. Rheumatoid factor was elevated to 127.7IU/L and, anti-nuclear antibody (×80) and anti-DNA antibody (×80) were present. It may be of interest that a specific phenotype of HLA; A24 (9) and DR9 recognized to be susceptible to IDDM was detected in the high-elderly onset SPIDDM. Taken together HLA typing with her history of both RA and Hashimoto disease, our case may provide the information to the mechanism of pathogenesis of SPIDDM. Furthermore, to our knowledge, this is the first case of SPIDDM in the aged; 75-year-old or more.