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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A man aged 70, showed early disorientation, memory defects, delusions and rages at 66, later mental deterioration with muteness and dysphagia. He died of cardiac failure. The postmortem examination revealed macroscopically and light microscopically the neuropathological findings of atypical senile dementia. Moreover, it is the interesting characteristic in the presented case that there are electron microscopically two types of filaments making the neurofibrillary tangles. One showed the so-called "paired helical filaments", which were observed in the cerebral cortex. The other showed paralled "straight filaments". These "straight filaments" were found in the bilateral hippocampi.
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PMID:Electron microscopic structure of the Alzheimer's neurofibrillary changes in case of atypical senile dementia. 64 61

A man aged 70, descendant of an apparently healthy family, showed disorientation, delusional ideas and rages at 66. Later there was slowly advancing deterioration with muteness, disorientation and dysphagia. He died of cardiac failure. There was the diffuse atrophy of the cerebrum, which was remarkably accentuated on both temporal lobes (poles, T2 and T3), where the loss of nerve cells and proliferation of astrocytes were found in the cortex and pallor and conspicuous fibrillary gliosis were noted in the white matter. These findings fundamentally suggest Pick's disease. On the one hand, numerous senile plaques and Alzheimer's neurofibrillary changes, suggestive of Alzheimer's disease (senile dementia), were observed throughout the cerebral cortex. On the other hand, a few inflated cells were also seen in the cingulate, superior frontal gyri and temporal lobes. Basilar artery was moderately atherosclerotic and cerebrovascular disorders were distributed throughout the cerebral cortex and basal ganglia, especially in the field of supply of middle cerebral artery. This case is similar to rare cases reported by Berlin (1949), Neumann (1949) and Oyanagi et al. (1975). The nosological situation as a disease entity remains to be determined.
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PMID:An autopsy case of atypical senile dementia with atrophy of the temporal lobes--a clinical and histopathological report. 66 3

Survival and excess mortality in 606 dementia patients admitted to a psychogeriatric nursing home were analyzed in a historical prospective 8-year follow up. The overall 2-year survival rate after admission was 55%, 60% for women and 39% for men. Patients with senile dementia of the Alzheimer's type had higher 2-year survival rates than those with multi-infarct dementia (57% vs 41%). Physical impairment, inactivity, dependency as measured on an observational scale, and comorbidity had an adverse effect on survival. Diseases with the lowest two-year survival were myocardial infarction, heart failure, atrial fibrillation, parkinsonism, pulmonary infection, anemia, pressure sores, and malignancies. The mortality rates of dementia patients were higher than those of the general population, especially during the first months after admission. This excess mortality of dementia patients was better described by an additive than by a multiplicative factor, suggesting that dementia can primarily be regarded as an independent, competing mortality risk.
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PMID:The nature of excess mortality in nursing home patients with dementia. 153 62

In a prospective randomized multi-centre study, the mortality following internal fixation surgery for fracture of the upper femur was investigated in 538 elderly patients allocated to receive subarachnoid blockade or general (narcotic-relaxant) anaesthesia. The 28-day mortality was 6.6% with subarachnoid, and 5.9% with general, anaesthesia. The difference was not significant (95% confidence limits: -3.5 to +4.8). At 1 year following surgery, the mortality was 20.4%. Increasing age, ischaemic heart disease, cardiac failure, preoperative arrhythmias and poor ASA status were all associated with increases in early and long term mortality. A delay to surgery of more than 24 h from admission was also associated with an increased 28-day mortality. Senile dementia and admission other than from the patient's own home, were factors associated with a poorer long term outcome. From the point of view of mortality, subarachnoid anaesthesia did not appear to confer any advantages over general anaesthesia in non-prosthetic surgery for hip fracture in the elderly.
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PMID:Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly. 331 Nov

Computed tomography and magnetic resonance imaging in the elderly have demonstrated the common occurrence of deep white-matter lesions in the aging brain. These radiologic lesions (leukoaraiosis) may represent an early marker of dementia. At autopsy, an ischemic periventricular leukoencephalopathy (Binswanger's disease) has been found in most cases. The clinical spectrum of Binswanger's disease appears to range from asymptomatic radiologic lesions to dementia with focal deficits, frontal signs, pseudobulbar palsy, gait difficulties, and urinary incontinence. The name senile dementia of the Binswanger type (SDBT) is proposed for this poorly recognized, vascular form of subcortical dementia. The SDBT probably results from cortical disconnection most likely caused by hypoperfusion. In contrast, multi-infarct dementia is correlated with multiple large and small strokes that cause a loss of over 50 to 100 mL of brain volume. The periventricular white matter is a watershed area irrigated by long, penetrating medullary arteries. Risk factors for SDBT are small-artery diseases, such as hypertension and amyloid angiopathy, impaired autoregulation of cerebral blood flow in the elderly, and periventricular hypoperfusion due to cardiac failure, arrhythmias, and hypotension. The SDBT may be a potentially preventable and treatable form of dementia.
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PMID:Senile dementia of the Binswanger type. A vascular form of dementia in the elderly. 362 88

Comparative studies of the differences in elderly patients with and without cardiovascular disorders were made in regard to complications occurring during and after operation. The subjects included 38 patients (6 men and 32 women) aged 70 to 99 years (mean: 84 years) at Nagoya City Kouseiin Geriatric Hospital who had orthopedic surgery under general anesthesia, between March 1990 and October 1992. Diseases identified in these subjects were sequelae of cerebrovascular disease (38 subjects), heart disease (22 subjects), hypertension (9 subjects), senile dementia (6 subjects), Parkinson's disease (5 subjects), malignant disease (3 subjects) and diabetes mellitus (2 subjects). They were initially divided into 2 groups according to ultrasonic cardiography: a normal group comprising 20 patients without cardiovascular abnormalities, and a disorder group comprising 18 patients with reduction of left ventricule function, left ventricular hypertrophy and/or valvular disease (more than moderate). All subjects were examined with regard to age, weight, the nutrition index proposed by Onodera, activity of daily living (ADL), cardiac output, left ventricular ejection fraction, serum level of BUN and albumin etc. Moreover, the disorder group subjects were divided into 2 groups according to the presence or absence of heart failure occurring after surgery. In addition to the above-mentioned, we also studied the duration of surgery and anesthesia, and water balance during and after surgery. Results showed that the ADL and nutrition index in the disorder group were lower compared to the normal group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Comparative studies on complications occurring during and after surgery in elderly patients with and without cardiovascular disorders]. 829 52

In cardiovascular pharmacotherapy, the main focus is now on statins (HMG-CoA-reductase inhibitors) because of their antihyperlipidaemic and antiatherogenic effect. They are suggested to be beneficial also in senile dementia, stroke and osteoporosis and they can reduce incidence of ventricular arrhythmias in patients with cardioverter-defibrillator. In chronic heart failure, statins should be used with caution since reduced cholesterol levels relate to impaired survival. As an alternative to statins and fibrates, niacin therapy may be considered. ACE inhibitors are of proven benefit for patients with left ventricular dysfunction after acute myocardial infarction; however, in long-term treatment, their protective activity is not superior to that of beta-blockers, diuretics and clonidine. Ca-channel antagonists slightly increase the incidence of cardiovascular complications but reduce the incidence of stroke in high-risk patients. Biventricular pacing has been used with success in patients with severe heart failure and conduction disturbances, and the first permanent artificial ventricle was implanted to a patient with irreversible terminal heart failure in summer 2000. Cardiospecific troponin I may be an uninvasive marker of a procoagulant status indicating e.g. graft failure after cardiac transplantation; T-cadherin belongs to the cell-adhesion molecules and has a role in maintenance of cellular contacts which are critical for the vessel wall architecture. Etamoxir, originally developed for the treatment of diabetes II, has recently been shown to be a potential novel drug for heart failure. Routine use of nitric oxide after congenital heart surgery lessens the risk of pulmonary hypertensive crises.
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PMID:[Cardiology 2000]. 1137 23

Dementia in the elderly used to be rare, but why has it become a major social threat today? There can be many potential answers, but an ultimate one is clear: the longer life expectancy today. This knowledge indicates that "advanced aging" is a primary suspect in the origin of senile dementia. If so, then why can many elderly remain healthy at the same old age? We know, for example, that elderly people commonly have a certain degree of atherosclerosis and osteoporosis, but only some of them develop severe clinical symptoms at the same age. These different outcomes generally can be explained by "risk factors" in life (exercise, diet, individual background, etc). It thus appears to be a general pattern that advanced aging (after age 80) will set the stage for various senile disorders, but risk factors largely determine the onset age as well as individual specificity of their clinical manifestations. In this context, senile disorders including senile dementia would differ fundamentally from the pathogen-caused conventional diseases (AIDS, polio, cancer, Down's, etc.) by origin, incidence, and intervention strategy. This view would call into question the current definition of senile dementia as a conventional "disease" (Alzheimer's). The term "Alzheimer's disease" originally referred to "midlife" dementia, but it is defined today to be the same medical entity as senile dementia on the basis that they both display the same hallmarks and symptoms despite their onset age difference. Now, after in-depth scrutiny, we finally come to realize that they are not the same disease, but as different as heart failure at midlife versus the "same" failure at advanced age (i.e., a conventional disease versus a senile condition). Thus, by eliminating the age difference, the new definition has converted a senile condition into a conventional "disease", thereby changing the course of its scientific inquiry to miss the main targets. This may be why after extensive studies for 25 years, the origin of senile dementia has remained an enigma.
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PMID:Alzheimer movement re-examined 25 years later: is it a "disease" or a senile condition in medical nature? 1150 85

Carnitine is an ammo acid derivative found in high energy demanding tissues (skeletal muscles, myocardium, the liver and the suprarenal glands). It is essential for the intermediary metabolism of fatty acids. Carnitine is indispensable for beta-oxidation of long-chain fatty acids in the mitochondria but also regulates CoA concentration and removal of the produced acyl groups. AcylCoAs act as restraining factor for several enzymes participating in intermediary metabolism. Transformation of AcylCoA into acylcarnitine is an important system for removing the toxic acyl groups. Although primary deficiency is unusual, depletion due to secondary causes, such as a disease or a medication side effect, can occur. Primary carnitine deficiency is caused by a defect in plasma membrane carnitine transporter in muscle and kidneys. Secondary carnitine deficiency is associated with several inborn errors of metabolism and acquired medical or iatrogenic conditions, for example in patients under valproate and zidovuline treatment. In cirrhosis and chronic renal failure, carnitine biosynthesis is impaired or carnitine is lost during hemodialysis. Other chronic conditions like diabetes mellitus, heart failure, Alzheimer disease may cause carnitine deficiency also observed in conditions with increased catabolism as in critical illness. Preterm neonates develop carnitine deficiency due to impaired proximal renal tubule carnitine re-absorption and immature carnitine biosynthesis. Carnitine stabilizes the cellular membrane and raises red blood cell osmotic resistance but has no metabolic influence on lipids in dialysis patients. L-Carnitine has been administered in senile dementia, metabolic nerve diseases, in HIV infection, tuberculosis, myopathies, cardiomyopathies, renal failure anemia and included in baby foods and milk.
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PMID:Carnitine metabolism and deficit--when supplementation is necessary? 1276 64

It is often assumed that aging is a uniform process throughout adulthood because of the approximately linear increase of logarithmic mortality. We explored this assumption by analyzing cause-specific mortality increases in France (1979-1994). Rising rapidly at ages 30-54 years ("middle age") are death rates from malignant neoplasms at various sites, acute myocardial infarction, hypertensive disease, and liver cirrhosis. Steeply increasing at 65-89 years ("old age") are death rates from certain infectious diseases, particularly of the respiratory system; certain types of accidents; nonalcoholic mental disorders (probably due mainly to Alzheimer's disease and senile dementia); heart failure; cerebrovascular disease; and some "vague" categories. The processes at work may be fundamentally different in these two life history stages, such that the mortality rise in middle age reflects specific chronic diseases that develop prematurely in some high-risk individuals, whereas the mortality increase in old age is dominated by senescent processes that eventually raise the vulnerability of almost all individuals to multiple pathologies.
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PMID:Differential patterns of age-related mortality increase in middle age and old age. 1463 Aug 73


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