摘要:

Autopsy studies indicating that cholinergic neurons are selectively lost in patients with Alzheimer's disease (AD) and senile dementia of the Alzheimer type (SDAT) suggest that peripheral markers for central cholinergic activity would be useful in diagnosis. The present studies found that cerebrospinal fluid (CSF) concentrations of acetylcholine (ACh) correlated with the degree of cognitive impairment (r= .70) in a sample of carefully diagnosed patients with AD/SDAT, but metabolites of other neurotransmitters were not related to cognitive state; this suggests that CSF ACh may be a valid measure of cholinergic degeneration. cortisol and growth hormone were measured in plasma samples drawn from patients and controls every 30 minutes from 2100 to 1100 hours the next day. Mean plasma cortisol concentrations were higher in patients with AD/SDAT than in controls and correlated inversely with CSF methoxy‐hydroxyphenylglycol (MHPG) (r= .61) and positively with degree of cognitive impairment (r= +.53); as anticholinergic drugs suppress cortisol this finding indicates that cortisol dysregulation may be a marker for abnormalities in other neurotransmitter systems, particularly the noradrenergic system. Growth hormone secretion was not different in patients and controls but was positively correlated with CSF MHPG (r= + .63

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb04184.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Two studies investigated the ability of physostigmine, given both intravenously and orally, to reduce symptoms of Alzheimer's disease. Intravenous physostigmine significantly and reliably enhanced memory in 13 of 16 patients tested, but the dose producing the improvement varied among patients. Oral physostigmine decreased overall symptom severity in a reliable way in seven of 12 patients tested. The extent of improvement was correlated with the increase in mean cortisol secretion produced by physostigmine, suggesting that the drug improved behavior and cognition only to the extent that it had a specific central cholinomimetic effect. There was no significant association between response to physostigmine and results of a dexamethasone suppression test and physostigmine had no effect on growth hormone secretion.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb04185.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Diastolic left ventricular function was comparatively assessed in 19 healthy elderly individuals (mean age 71 years) and in 20 young normal subjects (mean age 26 years), using digitized echocardiograms. Peak and average filling rates were slower in the group of elderly subjects than in the younger population (128 ± 26 and 75 ± 11v182 ± 37 and 92 ± 17 mm per second, respectively,P<.001). The duration of the rapid filling phase and the time to peak filling rate were significantly longer in the older than in the younger population (207 ± 39 and 125 ± 21v174 ± 38 and 90 ± 26 ms, respectively,P<.01). The atrial contribution to total ventricular filling was 18 ± 6% in the elderly and 10 ± 3% in the young (P<.001). The group differences of most of these measurements of diastolic function retained statistical significance after correction for heart rate. Measurements of left ventricular systolic function were similar in both age groups. The authors conclude that aging is associated with a decline of left ventricular compliance, unrelated to heart rate or systolic performance. The contribution of atrial contraction to ventricular filling is quantitatively larger in elderly in

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb04186.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Of patients referred to a geriatric service, 66 were identified who were clearly anemic (hemoglobin less than 12 g in men, less than 11 g in women) but whose cause of anemia was not readily identifiable by noninvasive measures. The difficulty in distinguishing iron deficiency from chronic disease as a cause of anemia by noninvasive means (serum iron, total iron binding capacity, transferrin saturation ratio, and serum ferritin), is highlighted by the poor power of these investigations when compared with bone marrow iron stores. A transferrin saturation ratio of less than 11% and a serum ferritin of less than 45 pg/L serve better than currently accepted values to identify iron deficiency in this population.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb04187.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

This study is based on data for Massachusetts residents who were burned between July 1, 1978 and June 30, 1979 and who were treated as hospital inpatients in any of the 240 hospitals participating in the New England Regional Burn Program. Demographic information and information regarding the nature of the burn injury and consumer products involved were obtained by review of the medical record for each case. One hundred seven (9%) of the 1237 burn victims identified were aged 65 years or older, yielding a burn incidence rate equal to 15.5 burns per 100,000 person‐years compared with a rate of 23.8 burns per 100,000 person‐years for younger Massachusetts residents. The burn mortality rate for the elderly who survived long enough to be hospitalized was 2.6 deaths per 100,000 person‐years compared with a rate of 0.4 deaths per 100,000 person‐years for younger individuals. For survivors, the average length of hospital stay for elderly victims was 28.6 days compared with 12.0 days for younger individuals. Clothing ignition, stoves and ovens, smoking materials, and bathroom showers and tubs contributed significantly to the causes of burning among the elderly. In addition, evidence was found suggesting that elderly patients receive medical care relatively later after injury, thus considerably complicating their

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb04188.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

The authors analyzed clinical research articles (1980 to 1982) in four general medical journals: NewEngland Journal of Medicine, Annals of Internal Medicine, Journal of the American Medical Association, andBritish Medical Journal.Of the 1943 articles surveyed, 38.2% were judged to be clinically “relevant” to the elderly. “Relevant” articles were further analyzed to determine whether they contained enough older subjects to enable the reader to draw any inferences about the particular disease or diagnostic or treatment modality studied. Criteria for “age sufficiency” included: mean age of study group () greater than or equal to 60 years; if was less than 60 years, two SD or the range included at least one patient aged 70 years; and greater than or equal to 20% of the study group was older than 60 years. Overall, slightly more than 50% of clinically relevant articles had too few older subjects by the authors' quite liberal age criteria. No statistically significant differences were found among the four journals. Of the age‐relevant articles, 25.5% had a mean age of sample studied of greater than or equal to 60 years, 10.9% of greater than or equal to 65 years, 5.6% of greater than or equal to 70 years, and 2.3% of greater than or equal to 75 years. The average age of all subjects studied for three conditions commonly found among the elderly was calculated: coronary artery disease (51.7 years); hypertension (49.8 years); and cancer (52.9 years). The authors concluded that many of the original articles of these four journals did not include (for 1980 to 1982) enough older subjects in their study samples to enable readers to draw any valid inferences about the older popu

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb04189.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

The performance of candidates on the geriatric medicine items on the American Board of Internal Medicine's 1980, 1981, and 1982 Certifying Examinations was analyzed. For the 1981 and 1982 examinations, candidates who trained in residency programs having a special emphasis on geriatric medicine performed significantly better on the geriatric items than did candidates who attended other residency programs, regardless of overall medical knowledge. This finding suggests the efficacy of training in geriatric medicine as measured by a written examination.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb04190.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb04191.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb04192.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

In the recent past, public and professional attention has focused on the question of whether and when it is appropriate to discontinue nutritional support from patients unable or unwilling to ingest food orally. This article addresses the special problems raised by patients who resist medical feeding. It discusses the following issues relevant to this patient group: competency to make treatment choices, decision making on behalf of incompetent patients, the competent patient's right of self‐determination, and procedures for reviewing treatment decisions. Legal decisions bearing on the nourishment question are analyzed as well. Although the author concludes that cessation of nourishment is morally and legally permissible in a few cases, she also cautions that the option should be carefully and narrowly applie

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb04193.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY