国際生活機能分類(International Classification of Functioning, Disability and Health: ICF)にみた福祉・保健・医療の専門職協働における連携に関する貢献と課題

Mini Mental State

There are a number of ways in which a clinical diagnosis of dementia of the Alzheimer type can be made – the application of clinical criteria is the commonest but ancillary techniques such as neuroima

Clinical Diagnosis of Alzheimer's Disease

Physical function declines in old age, portending disability, increased health expenditures, and mortality. Cellular senescence, leading to tissue dysfunction, may contribute to these consequences of aging, but whether senescence can directly drive age-related pathology and be therapeutically targeted is still unclear. Here we demonstrate that transplanting relatively small numbers of senescent cells into young mice is sufficient to cause persistent physical dysfunction, as well as to spread cellular senescence to host tissues. Transplanting even fewer senescent cells had the same effect in older recipients and was accompanied by reduced survival, indicating the potency of senescent cells in shortening health- and lifespan. The senolytic cocktail, dasatinib plus quercetin, which causes selective elimination of senescent cells, decreased the number of naturally occurring senescent cells and their secretion of frailty-related proinflammatory cytokines in explants of human adipose tissue. Moreover, intermittent oral administration of senolytics to both senescent cell–transplanted young mice and naturally aged mice alleviated physical dysfunction and increased post-treatment survival by 36% while reducing mortality hazard to 65%. Our study provides proof-of-concept evidence that senescent cells can cause physical dysfunction and decreased survival even in young mice, while senolytics can enhance remaining health- and lifespan in old mice.

Senolytics improve physical function and increase lifespan in old age

Subclinical thyroid disease (SCTD) is defined as serum free T4 and free T3 levels within their respective reference ranges in the presence of abnormal serum TSH levels. SCTD is being diagnosed more frequently in clinical practice in young and middle-aged people as well as in the elderly. However, the clinical significance of subclinical thyroid dysfunction is much debated. Subclinical hyper- and hypothyroidism can have repercussions on the cardiovascular system and bone, as well as on other organs and systems. However, the treatment and management of SCTD and population screening are controversial despite the potential risk of progression to overt disease, and there is no consensus on the thyroid hormone and thyrotropin cutoff values at which treatment should be contemplated. Opinions differ regarding tissue effects, symptoms, signs, and cardiovascular risk. Here, we critically review the data on the prevalence and progression of SCTD, its tissue effects, and its prognostic implications. We also examine t...

The clinical significance of subclinical thyroid dysfunction.

Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis

Purpose of reviewAge-related chronic low-grade inflammatory profile (CLIP) has been recognized as an important causative factor for sarcopenia. Here, we report the recent evidence concerning CLIP and sarcopenia.Recent findingsTwenty-one studies were included (12 observational, five interventional st

Chronic low-grade inflammation and age-related sarcopenia.

Overt hypothyroidism is known to be associated with increased serum creatine kinase (CK) levels. However, there is little information on CK levels in subclinical hypothyroidism. The aim of the study was to assess the relationship between CK levels and thyroid function in overt and subclinical hypothyroidism. Thyroid function tests (thyrotropin [TSH], free thyroxine [FT4], free triiodothyronine [FT3]) and the serum levels of CK were obtained from 23 patients admitted to a general hospital for illnesses other than thyroid or muscular diseases, myocardial ischemia, or brain damage. Overt hypothyroidism, based on thyroid function tests, was present in 10 patients, whereas hypothyroidism could be classified as subclinical in the other 13. A positive correlation was observed between CK and thyrotropin, and to a lesser extent between CK and thyroid hormones. Moreover, the correlation between CK and TSH and between CK and FT4 was detectable in subclinical hypothyroidism. Our data suggest that even in subclinical hypothyroidism there is some degree of dysfunction in skeletal muscle metabolism.

Serum creatine kinase levels in overt and subclinical hypothyroidism

Aging is associated with a chronic low-grade inflammatory status that contributes to chronic diseases such as age-related muscle wasting, kidney disease, and diabetes mellitus. Since advanced glycation end products (AGEs) are known to be proinflammatory, this systematic review examined the relation between the dietary intake of AGEs and inflammatory processes. The PubMed and Web of Science databases were screened systematically. Seventeen relevant studies in humans or animals were included. The intervention studies in humans showed mainly a decrease in inflammation in subjects on a low-AGE diet, while an increase in inflammation in subjects on a high-AGE diet was less apparent. About half of the observational studies found a relationship between inflammatory processes and AGEs in food. When the results are considered together, the dietary intake of AGEs appears to be related to inflammatory status and the level of circulating AGEs. Moreover, limiting AGE intake may lead to a decrease in inflammation and chronic diseases related to inflammatory status. Most of the trials were conducted in patients with chronic kidney disease or diabetes, and thus additional studies in healthy individuals are needed. Further investigation is needed to elucidate the effects of lifetime exposure of dietary AGEs on aging and health.

Effect of advanced glycation end product intake on inflammation and aging: a systematic review

doi:10.1111/j.1741-2358.2007.00247.xDenture contamination by yeasts in the elderlyObjectives: The aim of this study was to investigate yeast carriage in healthy denture wearers by swab-bing and to evaluate the effect of denture hygiene habits.Materials and methods: Denture wearers (n = 87) without evidence of denture stomatitis or any otheroral disease were investigated by separately swabbing the ﬁtting surface of the upper denture and thecorresponding palatal mucosa in contact with the appliance. In a group of volunteers, a gel without anyactive compound was spread on the palatal side of the denture once in every morning for 2 weeks.Results: Screening showed Candida colonisation of upper prosthesis in 75.9% of individuals. The mostfrequent species isolated were Candida albicans (77.9% of the positive cultures), Candida glabrata (44.1%)and Candida tropicalis (19.1%). Carriage of more than one yeast species was found in 48.5% of the con-taminated dentures. There was a statistically signiﬁcant association between denture contamination andpalatal mucosa colonisation (chi-squared test: p < 0.0001). Repeated swabbings after 1 week as well asduring a weekly follow-up for 1 month conﬁrmed the denture contamination and its degree of severity. Adaily gel application produced a yeast-count decrease to 10% of the initial value after 2 weeks (chi-squaredtest: p = 0.0134 and p = 0.2841 for prosthesis and palatal mucosa, respectively).Conclusion: This study documented the reliability of oral swabbing when investigating yeast carriage inhealthy denture wearers. Moreover, just a diagnostic tool, sampling upper dentures for Candida could bethe opportunity to verify the patient’s compliance to hygiene advice.Keywords: Candida, dentures, hygiene, yeast.Accepted 28 April 2008

Ingo Beyer

Papers

Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis

Chronic low-grade inflammation and age-related sarcopenia.

Serum creatine kinase levels in overt and subclinical hypothyroidism

Effect of advanced glycation end product intake on inflammation and aging: a systematic review

Denture contamination by yeasts in the elderly