Fifty-two patients with cerebrovascular risk factors without neurological abnormalities were examined by magnetic resonance imaging and were evaluated for their periventricular hyperintensity (PVH) on T2-weighted images. We assumed that PVH was not a mere focal finding of the brain but a kind of marker for condition related to arteriosclerosis and cerebral ischemia, and we tried to devise a model screening test, using common parameters available in most ordinary hospitals, to predict PVH. Multiple regression analysis was performed by setting up the PVH% (the volume percentage of PVH to cranial cavity) as a dependent variable and twenty-seven variables associated with general medical examination and brain atrophy as explanatory variables. We found that arteriosclerotic changes in the body as well as brain atrophy were significantly correlated with PVH, and that PVH could be predicted with a high contribution ratio of 0.70. It is clinically important to examine the elderly with our screening test to predict PVH in order to detect the early stages of ischemia.

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Bactericidal clothes reduce infections in elderly bed-bound nursing home patients.

Infections in elderly bed-bound nursing home patients are serious care problems. In order to protect against infections we adopted bactericidal clothes (Sanmo Co., Kyoto, Japan). First, we studied how bactericidal clothes sterilise bacteria in vitro. The bactericidal clothes kill methicillin-resistant Staphylococcus aureus (MRSA), E. Coli, Krebsiella and Pseudomonas aureus, over 99%, 3 h after contact, while these bacteria can survive over 18 h on conventional cotton clothes. Second, ninety elderly patients were divided into two groups; the control group and the "treated" group with bactericidal clothes. In Period 1 neither group received particular treatment for three months and in Period 2 only the treated group used bactericidal clothes for three months. The control group in Period 2 used regular clothes throughout. The number of febrile days was significantly lower for the treated group, compared with the control group. It is suggested that the bactericidal clothes reduce infections in elderly patients.

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Prevalence of senile dementia in a rural community in Japan: the Tajiri project.

Knowledge of the prevalence of dementia in different age groups is needed for the planning of a health policy. This study shows the prevalence of dementia and magnetic resonance imaging (MRI) findings in elderly people aged 65 years and over, living in the town of Tajiri in the northern part of Japan. They were shown by two cognitive screening tests, the Mini-Mental State examination (MMS) and the Dementia Screening Test (DST) and medical diagnosis. Two subject groups were assessed, those who completed both tests (Subjects I, n=2066) and those from among the 200 'MRI-administered subjects' who were interviewed and diagnosed (Subjects II, n=170). For Subjects I, there were 6.3 and 10.2% 'dementia range' according to the severe and mild criteria, respectively. As for Subjects II, 9.4% were clinically diagnosed as having dementia. They met the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria of probable Alzheimer's disease (AD) or possible AD with cerebrovascular disease. The estimated prevalence rate of dementia was 8.0%. Visual ratings of brain atrophy using MRI disclosed two distribution patterns. The 'continuous' pattern of the frontal and temporal lobes atrophy suggest that both are affected by the aging process, while a 'discontinuous' pattern of the hippocampal atrophy could indicate a pathologic background such as early changes of AD.

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PubMedDate not supplied

Intracranial internal carotid artery stenosis.

The advent of EC/IC Bypass surgery has focused attention on selected patients who might benefit from this innovative procedure. There is a poverty of natural history data pertaining to all such lesions. Two centres (Memphis, Tennessee and London, Ontario) pooled their resources to carry out a retrospective review of 58 patients with angiographically-proven intracranial internal carotid artery stenosis. Only 33% of the patients were alive and free from subsequent cerebral vascular events at the end of the mean follow-up of 30 months. Forty-three percent of the patients died during follow-up: 36% due to stroke and 44% because of cardiac disease. Forty-three percent of the patients suffered cerebral vascular events during the follow-up period: there were 17 strokes (29%) including 9 fatal strokes. The incidence of ipsilateral stroke was 19%; 65% of the strokes were appropriate to the stenotic intracranial carotid lesion under study. The annual ipsilateral stroke rate for patients with this lesion was 7.6% per year. This lesion detected on angiography is indicative of severe atheroma, and carries a serious risk of death due to ischemic heart disease or stroke.

Adult↗

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Autoimmune hemolytic anemia and myasthenia gravis.

A case of autoimmune hemolytic anemia associated with myasthenia gravis in a 33-year-old female is presented. The association of autoimmune hemolytic anemia and myasthenia gravis is a very rare event, with only eight cases reported. The known association of these two diseases is reviewed. To our knowledge, this is the first reported case in which autoimmune hemolytic anemia preceded systemic myasthenia gravis.

Adult↗

PubMedDate not supplied

Hemispatial visual-searching impairment correlated with decreased contralateral parietal blood flow in Alzheimer disease.

BACKGROUND: Impairment of visuospatial attention in Alzheimer disease (AD) has not been fully investigated. Mendez et al reported that patients with AD showed hemispatial biases on visual search tasks. Parietal lobe involvement might be related to such impairment. The Picture Description Task is one of the most sensitive tests for detecting language disorders and might be also useful in assessing visual search. OBJECTIVE: The applicability of the Picture Description Task for evaluating hemispatial visual search impairment of AD was investigated, as well as whether the hemispheric difference in parietal blood flow is related to such impairment. METHODS: Thirty-four patients with AD and age-matched 16 normal subjects performed the Picture Description Task. The elements of the picture were divided into three portions: the right portions (five elements), the central portions (two elements), and the left portions (five elements), so as to assess the patients' hemispatial visual searching ability. Using single photon emission CT, the absolute regional cerebral blood flow (CBF) values at resting condition were calculated by the method of Kuhl et al. RESULTS: Fourteen patients with AD showed a decreased number of elements pointed out in the left portion of the picture, whereas 12 patients had decreased attention in the right portion. The remaining eight pointed only to the central portion. None of them showed hemispatial neglect on the figure copying tasks. The patients with decreased left spatial attention had lower CBF in the right parietal lobe, and vice versa. A significant negative (biologically meaningful) Spearman correlation was found between the right-left indices of the elements pointed out in the picture and the CBF values. CONCLUSIONS: The results suggest that the Picture Description Task is useful for assessing visual search, and impaired hemispatial visual search in AD is related to decreased contralateral parietal blood flow. The right-left asymmetry of the parietal CBF might be associated with hemispatial visual attention impairments in AD.

Aged↗