International Journal of Gerontology最新文献

We report a case of an 84-year-old widow from Taiwan who meets a classic presentation of symptomatology from very late-onset schizophrenia-like psychosis (VLOSLP). After 2 decades of reference idea, she subsequently suffered from persecutory, partition delusion and multimodal hallucinations. Acute psychiatric hospitalization was arranged for diagnostic workup and antipsychotics treatment. No laboratory abnormalities were found. We gave olanzapine and gradually titrated to 20 mg/day, and her psychotic symptoms were relieved in a month, then discharged. This case report is aimed to discuss the clinical characteristics, nosology, and treatment of VLOSLP. Further exploration of VLOSLP should be considered because of its unique clinical feature and course.

Background

Severe frailty, which is the highest level of frailty, leads to multiple health impairments that may individually affect the plasma-free amino acid (PFAA) profile. However, the PFAA profile of severely frail patients has not been clarified. The aim of this study was to describe the PFAA profile of severely frail elderly patients.

Methods

Elderly patients (aged ≥65 years) who were admitted to the Nukada Institute for Medical and Biological Research (Chiba, Japan) were included. Severe frailty was defined using the Canadian Study of Health and Aging Clinical Frailty Scale. Subjects were divided into non-frail and severely frail groups. The PFAA profile and clinical characteristics of the subjects were analyzed.

Results

Compared to the non-frail group (n = 31), the severely frail group (n = 28) had lower body mass index (BMI), serum albumin, serum prealbumin, hemoglobin, and blood pressure and higher C-reactive protein. Seventy-nine percent of severely frail patients had cognitive impairment. Severely frail patients had significantly lower essential amino acid (EAA) plasma concentrations than non-frail patients. Multiple linear regression analysis identified that valine (p = 0.005) was strongly associated with BMI. Valine (p = 0.004), leucine (p = 0.004), tryptophan (p = 0.006), lysine (p < 0.001), and total EAA (p < 0.001) levels were significantly associated with serum prealbumin levels.

Conclusion

Severely frail patients had multiple health impairments. BMI and nutritional status were most significantly associated with low EAA levels.

Background

Both Trail Making Test (TMT) and Stroop Color and Word Test (SCWT) are the most popular neuropsychological tests for assessing executive function. This study aimed to examine alternate form reliability of the Chinese version of the TMT Part B (C-TMT-B) and test-retest reliability of the Chinese version of the TMT and SCWT among older adults.

Methods

Twenty participants were recruited in the alternate form reliability study and another 20 participants were recruited in the test-retest reliability study. Original version of the TMT-A and TMT-B and the Chinese version of the TMT-B and SCWT were used as the measurement tools. A retest was conducted 3–7 days later to assess its reliability. The reliability of tests was estimated with intraclass correlation coefficient (ICC) estimates and their 95% confident intervals.

Results

The alternate form reliability of C-TMT-B was moderate to excellent with ICC of 0.89 and 95% confident interval of 0.63–0.96. Test-retest reliability coefficients for TMT-A, C-TMT-B, C-SCWT with congruous condition, and C-SCWT with incongruous condition were estimated as 0.82, 0.93, 0.91, and 0.91, respectively.

Conclusion

Our findings suggest that the Chinese version of the TMT and SCWT are reliable instruments for measuring executive function among older adults.

Background

Home visits by primary care physicians to elderly patients in Japan have increased as part of a government initiative to relieve pressure on acute care hospitals. However, there is evidence of discrepancies between diagnoses in the primary care and hospital settings.

Methods

We conducted a retrospective cross-sectional study using two years of medical records from a primary care center to investigate diagnostic accuracy of acutely ill elderly patients in the primary care setting, and reasons for emergency hospital admissions. We analyzed data from all cases where extra home visits were needed due to acute illness, and used inferential statistics to compare initial diagnosis with final diagnosis and analyze the factors affecting diagnostic accuracy.

Results

We analyzed 591 cases (mean age of patients: 85 years). The most common reasons for emergency hospitalization were respiratory, gastrointestinal, or cardiovascular diseases. There was a significant difference in initial diagnostic accuracy between respiratory diseases, gastrointestinal diseases, and other conditions (p = 0.005); an accurate diagnosis was likely for respiratory diseases but unlikely for gastrointestinal diseases. Polypharmacy (≥8 medications) was associated with low diagnostic accuracy on multivariable logistic regression analysis (odds ratio, 0.24; 95% confidence interval, 0.06–0.67; p = 0.006).

Conclusion

Primary care providers should note subtle symptoms and the number of medications taken, provide follow-up, and consider gastrointestinal diseases when making a diagnosis following acute changes in an elderly patient.

Background

Visceral fat is considered important in the pathogenesis of metabolic syndrome (MS). Here, we developed a novel method for determining visceral fat by measuring liver–kidney space (LKS) on abdominal sonography and expanded its utilization in the elderly to predict MS.

Methods

To assess the correlation between the LKS and MS, 317 consecutive outpatients scheduled for health evaluation were retrospective analyzed. Anthropometric measurements, blood pressure, fasting blood glucose levels, and lipid profiles were obtained following standard protocols. On sonography, the thickness of visceral fat between the liver and right kidney was measured. We also compared its accuracy to predict MS with sonographic fatty liver changes. A total of 72 elderly patients older than 65 years were evaluated (mean age: 66.02 [65–83]).

Results

In the current study, LKS = 4 mm enabled a better prediction of MS. The area under the receiver operating characteristic curve was 0.626. The sensitivity and specificity for the presence of visceral fat to predict MS in the elderly were 0.58 and 0.73, respectively. The accuracy to predict MS was 68.1% for the measurement of visceral fat compared with 59.6% for sonographic fatty liver change in the elderly.

Conclusion

Measuring LKS by sonography may be a practical method for evaluating visceral fat in the elderly and for predicting MS better than sonographic fatty liver changes. LKS was more associated with abdominal girth and BMI in the elderly from the study supporting the observation that LKS are well correlated with general adiposity.

Background

Alcohol consumption is an important lifestyle factor for a variety of health problems, we investigated whether alcohol consumption is associated with handgrip strength (HGS), which is a useful indicator of sarcopenia, among Japanese community-dwelling persons.

Methods

The present study included 764 men aged 70 (69–70) years and 955 women aged 70 (69–70) years from a rural village. Daily alcohol consumption was measured using the Japanese liquor unit in which a unit corresponds to 22.9 g of ethanol, and the participants were classified into never drinkers, occasional drinkers, daily light drinkers (1–2 units/day), and daily moderate drinkers (2–3 units/day).

Results

HGS were significantly correlated with age in both men and women. HGS increased significantly with increased daily alcohol consumption in both genders, and in men HGS in daily moderate drinkers were significantly greater than those in never, occasional, and daily light drinkers. In women, HGS in daily light and moderate drinkers were significantly greater than those in never drinkers. In men, Multivariate-adjusted HGS were significantly greater in daily light {mean: 33.4 (95% confidence interval: 32.3–34.5) kg} and moderate drinkers {33.6 (32.8–34.0) kg} than in never drinkers {31.7 (30.8–32.7) kg}, and in women multivariate-adjusted HGS in occasional drinkers {21.5 (21.0–22.1) kg} was significantly greater in never drinkers {20.7 (20.5–21.0) kg}.

Conclusion

These results suggest that alcohol consumption may have a protective role in aging-associated decline in muscle strength in community-dwelling persons.

Background

Human hand functions are affected by neurological disturbances. We hypothesized that the degree of somatosensory impairments after stroke may be related to the severity of motor paralysis. In order to examine this hypothesis, we investigated the relationship between the classification of the Brunnstrom stage and tactile sensation impairments in elderly stroke patients.

Methods

Participants were 61 elderly inpatients with hemiparesis after stroke. We measured the tactile-pressure threshold and handgrip strength in both hands and assessed motor impairments of the hand using the six Brunnstrom stages. Differences due to hemiparesis after stroke were examined using paired t-tests. Spearman's rank correlation was performed to elucidate the relationship between Brunnstrom stage scores and the tactile-pressure threshold or handgrip strength.

Results

Significant differences were observed in the tactile-pressure threshold and handgrip strength between the impaired and unimpaired sides (p < 0.01). Furthermore, the Brunnstrom stage showed a negative relationship with the tactile-pressure threshold on the impaired side (r_s = −0.43, p < 0.01) and a positive relationship with handgrip strength (r_s = 0.82, p < 0.01).

Conclusion

These results suggest that the degree of sensory impairments after stroke is related to the severity of motor paralysis classified by the Brunnstrom stage.

Background

To investigate the sleep status of patients with vascular depression (VD) and analyze the characteristics of sleep by polysomnogram.

Methods

50 VD patients, 30 patients with non-vascular depression (NVD) and 50 normal subjects were enrolled. All subjects were evaluated by the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Scale (HAM-A), Pittsburgh Sleep Quality Index (PSQI) and Epworth sleepiness scale (ESS). All these patients were monitored by polysomnography (PSG).

Results

The PSQI scores of the VD patients didn't show difference compared with that of NVD, but both of them were significantly higher than the normal. The ESS scores of VD patients were significantly higher than other groups. The total sleep time (TST), sleep efficiency (SE) and sleep maintenance (SMT) in NVD patients and VD patients were poorer, and the waking time after sleep onset (WASO) and sleep latency (SL) were significantly longer. The N1/N2 ratio was longer, and the N3/REM ratio was shorter in NVD patients and VD patients. The HAMD score was negatively correlated with RL and positively with RD, RA and RI. The RL of VD patients was longer than the normal, and RD and RI were higher in VD patients, there was no difference in RA. The obstructivity and apnea-hypopnea index (AHI) significantly increased in VD patients.

Conclusion

The characteristic PSG findings of the NVD patients were shortening REM sleep latency and REM disinhibition. Characteristics of VD with PSG patients were sleep-related breathing disorders (SRBD) and daytime sleepiness, and disorders of 24-h sleep structure.