摘要:

Recently, new serum glycated protein assays (ie, serum fructosamine) have been developed. Fructosamine assays objectively monitor short‐term glycemic control and, when used in conjunction with HgA1C, enhance the clinical information obtained and greatly aid in the clinical management of diabetes. Because they rely on glycation of serum proteins, the clinical utility of these assays in the elderly may be altered secondary to the hypoproteinemia that often is seen in these states. Therefore, we investigated the role of glycated serum proteins (ie, fructosamine level) in monitoring elderly diabetics over a 4‐month period of observation. We found that the fasting blood glucose over the 4‐month period correlated well with the serum fructosamine activity (r =0.79, P<.001) and HgA1C (r =0.78, P<.001). In addition, we found that the mean daily glucose, as determined by outpatient monitoring, correlated well to both the fructosamine activity (r =0.66, P<.001) and HgA1C (r =0.74, P<.001). We found no effect on the measurement of the fructosamine assay by the level of albumin seen in these patients. Our study suggests that serum fructosamine and HgA1C are equally effective in monitoring the elderly patient, as has been established in the younger diabetic, and no correction need be made in the fructosamine assay to compensate for variable serum protein levels seen clinically in the el

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02262.x

年代:1989

数据来源: WILEY

摘要:

The prevalence of diabetes is greatest among older persons, yet few studies have specifically addressed the impact of age on diabetic complications. The present study examines the prevalence of four diabetic complications: retinopathy, peripheral neuropathy, autonomic neuropathy, and hypertension, as well as depression, in older male patients with noninsulin‐dependent diabetes. Participants ranged in age from 53 to 80 years. Multiple risk factors, including age, duration of illness, type of treatment, metabolic control, and obesity were evaluated as predictors of these complications using logistic regression. Results suggest a significant increase in the prevalence of retinopathy with aging, independent of the effects of metabolic control, duration of illness, and other risk variables. Age was also related to prevalence of peripheral neuropathy symptoms, hypertension, and impotence. Current metabolic control was significantly associated with retinopathy, peripheral neuropathy, and hypertension prevalence. Time since diagnosis was only independently related to impotence and hypertension. These findings suggest that the increase in many diabetic complications in older persons cannot be wholely accounted for by simple disease status variables, and may result from an interaction of diabetes variables and general age‐related chan

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02263.x

年代:1989

数据来源: WILEY

摘要:

Alzheimer's disease is a progressive deterioration of neuropsychological functioning. One of the main neuropathological correlates of the disease is a drop‐out of cholinergic neurons within the central nervous system. The neuropeptide that is responsible for water homeostasis and defense against dehydration, vasopressin, is also under direct cholinergic control. Several studies have suggested that in Alzheimer's disease there has been a trend toward lower vasopressin levels than in age‐matched controls. In order to improve discrimination of normal from diminished vasopressin levels, nine subjects with Alzheimer's disease (mean age 65 ± 2 years) and nine age‐ and sex‐matched controls (68 ± 3 years) underwent a mild provocative challenge of overnight fluid restriction. Individuals with Alzheimer's disease had a greater degree of dehydration, with overnight serum osmolality of 313 ± 4 vs 300 ± 3 Mosmol/kg, P =.01, and diminished “thirst” as measured by water ingested in one hour of ad libitum water intake. Eight of the nine with Alzheimer's disease had levels of vasopressin which, by extrapolation, appear to be subnormal for their serum osmolalities, whereas seven of the nine control subjects has vasopressin levels within or above the reference range (P<.05). Elderly individuals with Alzheimer's disease may be at increased risk of dehydration during periods of fluid restriction due to the loss of normal physiological responses of “thirst” and va

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02264.x

年代:1989

数据来源: WILEY

摘要:

The Early Assessment Self Inventory (EASI), a rapid self‐administered screening test for cognitive impairment in the elderly, was constructed to permit individuals to be assessed in a group or singly without examiner intervention. This paper‐and‐pencil device requires a fourth‐grade reading level and makes minimal demands on literacy while assessing orientation, recent and remote memory, language, visual‐construction, calculation, and attention. In the present study, the EASI was group‐administered to 146 elderly persons attending senior centers and completed individually without examiner intervention by 19 outpatients at a memory disorders clinic. Participants were 60 to 95 years old with 5 to 18 years of education. The EASI demonstrated good internal consistency and test‐retest reliability and was significantly correlated with the Mini‐Mental State Exam and the Mattis Dementia Rating Scale, both widely used screening instruments. Neuropsychological measures of memory, attention, and verbal fluency correlated as well with the EASI as with the examiner‐administered screening instruments, suggesting that the EASI may provide an efficient method of screening for cog

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02265.x

年代:1989

数据来源: WILEY

摘要:

The Geriatric Depression Scale (GDS) has been shown to be an effective screening test for depression in selected geriatric populations. However, it has not been evaluated as a screening test for depression among elderly adults with dementia of the Alzheimer type. Over a two‐year period 283 patients were seen in a geriatric assessment center and were screened for depression using the Geriatric Depression Scale. They also received a clinical psychiatric diagnosis by one of two geropsychiatrists. Patients with a Clinical Dementia Rating (CDR) of 0 (cognitively intact)(n =70) and those with mild Alzheimer's disease (CDR of 1)(n =72) were selected for comparison. The data were analyzed using Receiver Operating Characteristic Curves (ROCs) in order to compare the utility of the Geriatric Depression Scale in these two groups. ROC curves, which plot sensitivity against false positives, have come into increasing use as a method of examining the clinical performance of tests. The area lying beneath the curve (AUC) can be estimated and used as a quantitative measure of test performance (equivalent to the Wilcoxon rank sum). In the intact group, the Geriatric Depression Scale produced a ROC curve with an AUC of 0.85 (percent score = 1), which is significant(z =7.28, P<.0001). In the group composed of those with Alzheimer's disease, the Geriatric Depression Scale yielded a ROC curve with an AUC of 0.66, which was not significantly different from chance(z =1.92, P =NS). This study provides empirical evidence that while the Geriatric Depression Scale is an accurate screening test for depression in cognitively intact geriatric populations, it does not maintain its validity in populations that contain large numbers of patients with dementia of the Alzheimer typ

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02266.x

年代:1989

数据来源: WILEY

摘要:

Investigations of the natural history of blood pressure have generally evaluated mean systolic and diastolic pressure changes. While informative, this information is not directly applicable to clinical practice settings, in which patients are usually classified as normotensive or hypertensive. We measured the actual incidence of hypertension, using two different definitions, in an ambulatory elderly population of 2,584 individuals over an 8‐year period. Using the less stringent blood pressure definition (systolic blood pressure>140 mmHg and diastolic blood pressure≥90 mmHg), 884 (34.2%) participants were normotensive and 1,700 (65.8%) were hypertensive at an initial screening. The average annual incidence of hypertension over the subsequent eight years was13.2%,and life tables demonstrated a gradual risk of developing hypertension. The development of hypertension was not associated with gender or age; while older age groups had a greater chance of developing hypertension than younger, the difference did not reach statistical significa

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02267.x

年代:1989

数据来源: WILEY

摘要:

While atypical presentation of pneumonia in elderly patients is thought to be common, its incidence and factors predisposing to it are unknown. This study documents presenting symptoms of pneumonia in 48 patients, aged 65 or older, admitted to the medical service at a Veterans Administration Medical Center. Seventeen subjects (35%) had a classic constellation of symptoms which included both fever and cough. A chief complaint suggestive of pneumonia, defined as cough, fever, or shortness of breath, occurred in 27 subjects (56%). Five subjects (10%) had no symptoms suggestive of pneumonia even with a detailed history. Absence of a classic constellation of pneumonia symptoms correlated with advanced age (P =.0045), cognitive impairment at admission (P =.022), and baseline functional impairment (P =.028). Neither nutritional status as measured by serum albumin nor medical status as measured by number of medical problems and number of medications predicted an atypical presentation of pneumonia. Nineteen subjects (39%) did not have a documented fever, and 15 subjects (31%) did not have a leukocytosis. Absence of fever or leukocytosis did not correlate with age, number of medical problems, number of medications, cognitive status, functional status, or serum albumin. We conclude that a classic constellation of symptoms, signs and laboratory findings is frequently absent but some suggestive symptom is usually present in this population of elderly veterans with community‐acquired pneumonia. Patients with advanced age, cognitive impairment at admission, and baseline functional impairment are most likely to have an atypical presentation of pneumoni

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02268.x

年代:1989

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02269.x

年代:1989

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02270.x

年代:1989

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02271.x

年代:1989

数据来源: WILEY