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The most important aspects of normal and pathological brain ageing are considered from a structural, cellular, hemodynamical, chemical and clinical point of view. It seems admitted that cerebral blood flow and cerebral consumption for oxygen decrease with age but when severe health criteria are used to select normal old subjects, no significant differences exist between normal young and optimally healthy elderly. The question arises whether the blood flow reductions are responsible for the alterations in metabolism, or whether it is simply an autoregulatory response to the lesser metabolic demands of the tissue. The part of cerebral arteriosclerosis is questioned on cerebral flow drop accompanying clinical signs in senile mental impairment. Among some cardiovascular risk factors, hypertension seems to play a leading part in acute and chronic neurological diseases associated with age and with certain types of senile dementia (multi-infarct). However in all other cases, hypertension and cerebral vascular insufficiency, for all that this syndrome exists, seem to have been overestimated to explain chronic senile brain deterioration.
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PMID:[Aging and cerebral vascular sclerosis: myth or reality?]. 629 68

Ergoloid mesylates has been used for 30 years to treat patients with senile dementia. Indications for this drug include hypertension, peripheral vascular disease, and senile dementia of the Alzheimer type. Formerly classified as a cerebral vasodilator, ergoloid mesylates is now considered a metabolic enhancer, but how this action pertains to treatment of senile dementia is uncertain. Prescribed doses of the drug range from 1.5 mg/d to as much as 12 mg/d, but the optimal dose is unknown. Although there is evidence of the short-term efficacy of ergoloid mesylates from numerous controlled trials, many clinicians still consider it to be a placebo. No alternative drug treatments have been proved better. The crucial decision a physician must make is whether to try specific drug therapy or rely solely on supportive care and symptomatic drug treatment. The increasing prevalence of senile dementia has renewed interest in discovering more effective drug treatments for this condition.
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PMID:Ergoloid mesylates for senile dementias: unanswered questions. 637 66

Subcortical arteriosclerotic encephalopathy is a chronic vascular dementia with hydrocephalus characterized clinically by: (i) subacute focal neurological deficit; (ii) acute strokes; (iii) dementia; (iv) motor signs and pseudobulbar palsy; (v) hydrocephalus; (vi) persistent hypertension and systemic vascular disease; and (vii) a lengthy course. The pathogenesis is most probably ischaemic change related to subacute hypertensive encephalopathy. The pathological changes include severe central nervous system disease characterized by loss of white matter with gliosis, and arterial and arteriolar sclerosis of small penetrating cerebral blood vessels. The differential diagnosis includes vascular pseudobulbar palsy, multi-infarct dementia and senile dementia (Alzheimer's disease). Treatment includes blood pressure control as well as management of other factors known to affect vascular disease (diabetes mellitus).
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PMID:Subcortical arteriosclerotic encephalopathy (Binswanger's disease). 682 31

The most important aspects of normal and pathological brain ageing are considered from a structural, cellular, hemodynamical, chemical and clinical point of view. It seems admitted that cerebral blood flow and cerebral consumption for oxygen decrease with age but when severe health criteria are used to select normal old subjects, no significant differences exist between normal young and optimally healthy elderly. The question arises whether the blood flow reductions are responsible for the alterations in metabolism, or whether it is simply an auto-regulatory response to the lesser metabolic demands of the tissue. The part of cerebral arteriosclerosis is questioned on cerebral flow drop accompanying clinical signs in senile mental impairment. Among some cardiovascular risk factors, hypertension seems to play a leading part in acute and chronic neurological diseases associated with age and with certain types of senile dementia (multi-infarct). However in all other cases, hypertension and cerebral vascular insufficiency, for all that this syndrome exists, seem to have been overestimated to explain chronic senile brain deterioration.
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PMID:[Ageing and cerebral vascular sclerosis: myth or reality? (author's transl)]. 704 23

Some clinical and etiological aspects of senile dementia of the Alzheimer type (SDA) were elucidated in a case control study of 63 SDA patients and 91 controls. The SDA patients had significantly more commonly both senile and presenile dementia in parents and sibs than the controls. The occurrence of senile dementia in parents or sibs increased the risk for SDA by about 900% when all other relevant factors were taken into account in multiple logistic risk function analysis. The increase of the risk for SDA associated with the occurrence of presenile dementia in sibs was even greater but not statistically significant because of other factors and sample size. There was a negative correlation between the occurrence of hypertension and angina pectoris and SDA, which may be partly due to selective diagnostic criteria of SDA. The beta-globulin fraction of cerebrospinal fluid was significantly reduced in the electrophoresis in the SDA patients compared with the controls.
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PMID:Clinical and etiological aspects of senile dementia. 717 82

The purpose of this study was to assess the background to the longevity of a 115-year-old woman who was the oldest individual in Japan as of September, 1994. The secrets of her social and medical profile appeared to be hereditary factors, well-balanced meals, no smoking or drinking, sufficient sleep and adequate exercise. From the viewpoints of psychological aspects and comprehensive functional assessment of the elderly, she clearly has a tenacious personality. Furthermore, she has maintained independence in her activities of daily living, and did not suffer from senile dementia until 107 years of age. From the medical standpoint, she has suffered from transient hypertension, but her left ventricle function has remained within the normal echocardiography range and no greatly abnormal values have been observed in blood chemistry tests. She has suffered from pneumonia and urinary tract infection many times since the age of 109, and on these occasions she was promptly admitted to our hospital and received appropriate medical treatment. We consider that this also played an important role in her longevity.
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PMID:[A 115-year-old woman: the oldest individual in Japan]. 759 58

This paper outlines the pattern of drug utilisation in the elderly inpatient population in the nursing homes, Bumhudzo and BS Leon Trust and the two central hospitals, Harare and Parirenyatwa, in urban Harare, during the period, February to September 1990. The total population of elderly patients in the four institutions was calculated at 324 (52 pc) 170 of which were males and 48 pc were females. Of these patients 273 (84 pc) were Black, 44 (14 pc) were White and seven (2 pc) were Asians. Drug use pattern was estimated using the defined daily dose (DDD) system. The pattern of drug use was matched with the disease pattern to detect any discrepancies in drug utilisation. Of the 324 patients interviewed 114 (35 pc) were not on medication. The total number of drug formulations taken by the studied population was 1,117 with a mean of 3.45 drugs per individual at any one moment. Polypharmacology seems rife. The study indicated irrational and over utilisation of centrally acting drugs and vitamins and minerals. The most utilised group of drugs are the cardiovasculars (22 pc of the total) The most common disease conditions encountered in the elderly were hypertension, 7 pc, congestive heart failure, 7 pc, epigastric pain, 6 pc, senile dementia, 5 pc and pneumonia, 5 pc. The responses on sources of drug information available for the elderly revealed that pharmacists are totally unknown to the elderly in this respect. Measures that could be taken to improve elderly drug use are suggested.
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PMID:Drug utilisation in the geriatric population in the nursing homes and central hospitals of urban Harare. 795 24

A clinicopathological study of senile dementia of Alzheimer's type (SDAT) accompanied by the white matter lesions of Binswanger's type was carried out. Fifty-seven patients, who were diagnosed as suffering from SDAT based on clinical and pathological criteria, were classified into two groups based on the white matter lesions of Binswanger's type. Namely, group 1 consisted of the SDAT patients without any subcortical or white matter lesions (30 cases); group 2 consisted of those with white matter lesions of Binswanger's type (11 cases). The other 9 cases included those with vascular lesions and 4 with some of the same pathological changes found in Parkinson's disease. Clinically, group 2 patients showed subcortical symptoms such as urinary incontinence, Parkinsonian gait, being accompanied by hypertension and arrhythmias. Periventricular lucency (CT) were common in group 2. Macroscopically, both groups showed moderately to severe atrophy, and the width of the corpus callosum of group 2 was narrower than that of group 1. There was no difference in cerebral arteriosclerosis between the groups. In microscopic findings, patients in group 2 showed diffuse distribution of cortical changes such as senile plaques as well as Alzheimer's senile plaques as well as Alzheimer's neurofibrillary tangles while those in group 1 showed various types of diffuse or local distribution. Arteriolosclerosis of the white matter were found in both groups. There was no difference in aortic atherosclerosis and/or heart disease. The complication of white matter lesions of Binswanger's type was not a rare finding in SDAT.
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PMID:[A clinicopathological study of senile dementia of Alzheimer's type (SDAT) and white matter lesions of Binswanger's type]. 820 74

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

To elucidate a definite prevalence of dementia and its risk factors in the senescence, 887 subjects aged 65 years or over of Hisayama residents (94.6% of the whole population in the same age-range) were examined from May to December, 1985, as to whether he or she has suffered dementia. Karasawa's "Clinical criteria for the severity of dementia", Hasegawa's Dementia Scale and Hachinski's ischemic score were used as a procedure to identify demented persons. Out of 887 examined, 59 subjects were diagnosed to have had dementia (6.7%) with female to male ratio being 1.2. The prevalence rates of dementia increased with advanced age decades and sharply grew up over tha age of 80 years. Brain morphology in 50 of the 59 dementias was re-evaluated by autopsy and/or CT scan, during a 55-month follow-up period from January 1986 to July 1990. Coincidence rate between clinical evaluation and morphological diagnosis was 90.5% for vascular dementia (VD), 62.5% for senile dementia of Alzheimer type (SDAT), and 28.6% for other or ill-defined dementia (Others). Misdiagnosis of clinical evaluation for VD was mainly due to uncertain history of head trauma, while the subjects suffering from atypical stroke tended to be diagnosed as SDAT. Out of the 21 cases who were initially diagnosed as having other or ill-defined dementia, 8 were re-evaluated as VD, and 7 as SDAT later. Most cases who were finally diagnosed as having VD had multi-infarcts without an episode of stroke attack, while those who were classified to SDAT had less severely undergone dementia. The final type-specific prevalence of dementia was 56% for VD, 26% for SDAT and 18% for Others, respectively. The ratio of VD to SDAT was 2.2, indicating more frequent VD than SDAT. Retrospective case-control study on risk factors of VD was performed using selected parameters obtained at examinations in 1973 or 1978, comparing 27 VD cases and 789 non-demented cases. As a consequence, aging, hypertension, electro-cardiographic abnormalities (Minnesota code 3-1 and/or 4-1, 2, 3) and high hematocrit were taken as important risk factors for VD. These risk factors were very similar to those for lacunar infarcts among Hisayama residents. The difficulty of epidemiologic study on dementia in general population and the accuracy of diagnosis for type of dementia were discussed.
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PMID:[Epidemiologic and clinico-pathologic study on senile dementia in a Japanese community, Hisayama]. 833 7


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