Showing papers in "Aging Clinical and Experimental Research in 1993"

Established Populations for Epidemiologic Studies of the Elderly: Study Design and Methodology

Abstract: A project initiated by the intramural Epidemiology, Demography and Biometry Program of the National Institute on Aging, entitled "Established Populations for Epidemiologic Studies of the Elderly" (EPESE), has developed information on death, chronic conditions, disabilities, and institutionalization for representative samples of elderly people living in communities. The EPESE consists of prospective epidemiologic studies of approximately 14,000 persons 65 years of age and older in four different communities: East Boston, Massachusetts; two rural counties in Iowa; New Haven, Connecticut; and segments of five counties in the north-central Piedmont area of North Carolina. The study design includes an initial baseline household interview followed by continued surveillance of morbidity and mortality. Participants are re-contacted annually in conjunction with the collection of data on cause of death and factors related to hospitalization and nursing home admissions. Concurrently, the investigators developed substudies focused on specific problems of the elderly. The value of this research lies in the longitudinal design which allows for analyses aimed at identifying risk factors of diseases, disabilities, hospitalizations, institutionalization, and mortality.

Molecular genetics of Alzheimer's disease.

Abstract: At present it is not clear whether Alzheimer’s disease is a single disease, a complex syndrome, or a heterogeneous ill-defined group of disorders. In the last few years significant progress has been made in identifying and describing its different manifestations, as well as the underlying biological mechanisms. Modern molecular biology techniques have provided new insights into possible etiological mechanisms. Linkage analysis and gene sequencing studies have produced evidence of a possible locus on chromosome 21 in a small group of families with early onset familial Alzheimer’s disease (FAD). It was shown that another small group of early onset FAD families develops the disease as a result of mutations in the gene coding for the s-amyloid precursor protein, and that in a larger subgroup of early onset families the disease appears to be caused by an unidentified gene on chromosome 14. Several other early onset FAD families are clearly not linked to any of these loci, suggesting that other abnormal genes, probably on different chromosomes, might be the cause of the disease in these families. Finally, it was recently shown that the e4 allele of apolipoprotein E (ApoE) gene, which has been mapped to chromosome 19, is associated with an increased risk of developing the disease in late onset FAD families and sporadic cases. These results not only evidence that Alzheimer’s disease is a genetically heterogeneous disorder, but also delineate new approaches in the study of the etiological and pathogenetic mechanisms of Alzheimer’s disease. (Aging Clin. Exp. Res. 5: 417–425, 1993).

The free radical hypothesis of aging: An appraisal of the current status

Abstract: The objective of this review article is to assess the current status of the predictions of the free radical hypothesis of aging, highlighting some of the controversies surrounding the previous assumptions. Topics for discussion include: metabolic rate and aging, oxidative stress and molecular damage during aging, antioxidants and aging, antioxidant defenses and life spans of different species, and pro-oxidant generation and aging. On the basis of currently available evidence, it is concluded that the free radical hypothesis has neither been proven nor disproven. Some of the earlier assumptions such as that antioxidant intake increases life span, or antioxidant defenses decline with age, or antioxidant defenses are positively correlated with life spans of different species, or that longer life spans are associated with lower autoxidizability, are not clearly supportable. Similarly, the assumption that oxygen free radicals govern the rate of aging via the infliction of molecular damage lacks compelling support. Enough information to lift the free radical hypothesis above the level of speculation has not yet been amassed. Clearly, further studies, some of which specifically focus on disproving this hypothesis, are needed to confirm its veracity. (Aging Clin. Exp. Res. 5: 3–17, 1993)

Cognitive decline in the elderly: A double- blind, placebo- controlled multicenter study on efficacy of phosphatidylserine administration

Abstract: This double-blind study assesses the therapeutic efficacy and the safety of oral treatment with phosphatidylserine (BC-PS) vs placebo (300 mg/day for 6 months) in a group of geriatric patients with cognitive impairment. A total of 494 elderly patients (age between 65 and 93 years), with moderate to severe cognitive decline, according to the Mini Mental State Examination and Global Deterioration Scale, were recruited in 23 Geriatric or General Medicine Units in Northeastern Italy. Sixty-nine patients dropped out within the 6-month trial period. Patients were examined just before starting therapy, and 3 and 6 months thereafter. The efficacy of treatment compared to placebo was measured on the basis of changes occurring in behavior and cognitive performance using the Plutchik Geriatric Rating Scale and the Buschke Selective Reminding Test. Statistically significant improvements in the phosphatidylserine-treated group compared to placebo were observed both in terms of behavioral and cognitive parameters. In addition, clinical evaluation and laboratory tests demonstrated that BC-PS was well tolerated. These results are clinically important since the patients were representative of the geriatric population commonly met in clinical practice.

Oral 5'-methyltetrahydrofolic acid in senile organic mental disorders with depression: results of a double-blind multicenter study.

Abstract: 5′-Methyltetrahydrofolic acid (5′- MTHF) in addition to standard psychotropic medication significantly improved clinical recovery in depressed patients with borderline or definite folate deficiency, and significantly reduced depressive symptoms in elderly normofolatemic patients after 3 weeks of treatment. In this equivalence study the effect of 5′- MTHF on depressive symptoms and cognitive status was compared to Trazodone (TRZ) in normofolatemic elderly patients with mild to moderate dementia and depression. Ninety-six patients with dementia, scoring 12–23 at the Mini Mental State Examination (MMSE) and ≥18 at the Hamilton Depression Rating Scale (HDRS) after a 2-week placebo run-in, were randomized to receive either 5′-MTHF (50 mg/day p.o.) (47 patients) or TRZ (100 mg/day p.o.) (49 patients) in a double-blind design for 8 weeks. HDRS was assessed before, after 4 weeks and at the end of treatment; Rey’s Verbal Memory (RVM) test for immediate and delayed recall was evaluated before and after treatment. After 4 weeks of treatment HDRS score was reduced from 23±5 to 20±6 in the 5′-MTHF (p<0.05 vs baseline), and from 23±3 to 21±4 in the TRZ group (p<0.05 vs baseline). p]A further significant decrease to 18±6 and 19±5 respectively was obtained at the end of the treatment period (p<0.05 vs week 4) with 5′-MTHF and TRZ. HDRS was administered again after a 4-week, drug-free, follow-up period: no change vs the post treatment scores was observed either in the 5′-MTHF or in the TRZ group (18±7 and 19±5 respectively). RVM test for immediate recall was significantly improved (p<0.05) at week 8 vs baseline in the 5′-MTHF group whereas no significant change occurred in the TRZ group. No change in delayed recall was observed after treatment in either group. Tolerability was good for both treatments. This study shows that 5′-MTHF and TRZ are equally effective in improving depressive symptoms in patients with mild to moderate dementia and suggests that pharmacological doses of 5′-MTHF may exert psychotropic effects irrespective of folate status. (Aging Clin. Exp. Res. 1: 63–71, 1993)

Effects of walking, jogging and cycling on strength, flexibility, speed and balance in 60- to 72-year olds

Abstract: The effects of a moderate intensity endurance training program on strength, speed of muscle contraction, balance, gait and flexibility were assessed in fifty 60- to72- year-old men and women who had just completed a 3-month program of flexibility and strengthening exercise. Subjects trained for ∼45 minutes/day, 4.1 days a week, for one year. Before and after the endurance exercise program, exercise participants underwent isometric and dynamic strength testing (Cybex II®), standing balance tests, a gait examination, lower extremity flexibility testing, and a fatigue test for the quadriceps femoris muscle group. Fifteen control subjects who did not exercise were tested at thesame time periods as exercise subjects. Gains made during the low intensity strengthening and flexibility program in strength, range of motion and quadriceps endurance were maintained throughout the year of endurance exercise training. Additional significant improvements in speed of muscular contraction, walking velocity and standing balance occurred with the program of moderate intensity endurance training which produced a 24% increase in VO2max for men and a 21% increase for women. These results provide additional evidence that older adults are able to improve their functional capacity in response to exercise training. (Aging Clin. Exp. Res. 5: 427–434, 1993)

The measurement of Instrumental ADL: Content validity and construct validity

Abstract: A new measure of Instrumental Activities of Daily Living (IADL), which is able to discriminate among the large group of elderly who do not depend on help, was tested for content validity and construct validity. Most assessments of functional ability include Physical ADL (PADL) and Instrumental ADL (IADL). PADL-scales assess the basic capacity of persons to care for themselves. IADL-scales are used to assess somewhat higher levels of performance, such as the ability to perform household chores or go shopping. Data were collected from 734 70-year-old people in Denmark in the county of Copenhagen. The measure of Instrumental ADL included 30 activities in relation to tiredness and reduced speed. Construct validity was tested by the Rasch model for item analysis; internal validity was specifically addressed by assessing the homogeneity of items under different conditions. The Rasch item analysis of IADL showed that 14 items could be combined into two qualitatively different additive scales. The IADL-measure complies with demands for content validity, distinguishes between what the elderly actually do, and what they are capable of doing, and is a good discriminator among the group of elderly persons who do not depend on help. It is also possible to add the items in a valid way. However, to obtain valid IADL-scales, we omitted items that were highly relevant to especially elderly women, such as house-work items. We conclude that the criteria employed for this IADL-measure are somewhat contradictory.

Continuous geriatric care in orthopedic wards: a valuable alternative to orthogeriatric units.

Abstract: The aim of this study was to assess whether assigning a geriatrician to provide daily medical care to geriatric patients in the orthopedic ward can improve the prognosis and reduce the length of stay. Time series analysis was performed in two parts: (1 prospective analysis of two years’ workload, and 2) retrospective analysis of data collected over the 4 years prior to the intervention. Intervention and control populations were pooled, and the effects of geriatric care and patient- related factors on outcome measures were assessed by logistic regression analysis. All subjects were patients aged ⩾ 70 years who attended the orthopedic ward in a university hospital in years 1989–90 (studied group: 287 cases) and in years 1985–88 (control group: 474 cases). In the study period, mortality was 8.4% compared to 18% in 1985–86 (p<0.0006) and 14% in 1987–88 (p<0.01). The operation rate in the study period was 89.9% vs 83.8% in 1985–86 (p<0.02) and 81.8% in 1987–88 (p<0.005). Length of stay was 26.2± 14.4 days vs 32.9± 30.9 days in 1985–86 (p<0.05) and 26.9± 16.5 days in 1987± 88 (NS). Length of stay was more strikingly shortened in the subset of patients with femoral fracture undergoing surgical management (28.5± 12.7 vs 37.6± 32.6 days in 1985–86, p<0.003, and 30.8± 15 days in 1987–88, p<0.02). Given the positive relationship between geriatric care and operation rate (o.r.=1.5, CI=1.1–1.9), the protective effect of surgical treatment on mortality (o.r.=0.6, CI=0.4–0.8) to some extent may mask the collinear effect of geriatric care. We conclude that assigning a geriatrician to assist with the medical care of elderly orthopedic patients in orthopedic wards is associated with increased operation rate, decreased mortality and shortened length of stay. (Aging Clin. Exp. Res. 5: 207- 216, 1993)

Hypoglycemia: a major problem in the management of diabetes in the elderly.

Abstract: The aim of this study was to evaluate the incidence and causes of hypoglycemia requiring hospitalization of diabetic patients treated with insulin or oral antidiabetic agents. From 1975 to 1989, 20 978 patients were treated in the Department of Gastroenterology nd Metabolic Diseases of the Warsaw Medical School; review of their records disclosed that severe hypoglycemia was the cause of admission in 236 cases (1.12%). Two hundred patients (74 older than 60 years) were treated with insulin and 36 (28 older than 60 years) with oral agents. The most frequent cause of hypoglycemia was dietetic error (123 cases), followed by excessive physical effort (55 cases), error in the dose of hypoglycemic drug (22 cases), and alcohol abuse (13 cases). Hypoglycemia was the cause of death in 13 patients (8 aged over 60 years). In another 24 patients (17 aged over 60 years), exacerbation of ischemic heart disease was observed. Serious injuries with bone fracture were experienced by 11 patients (7 aged over 60 years). We conclude that hypoglycemia is still a serious risk for the life and health of diabetic patients treated with insulin or oral agents, especially those in advanced age. For this latter group of patients, more liberal criteria of metabolic control seem to be justified. (Aging Clin. Exp. Res. 5: 117- 121, 1993).

Humoral and cellular immune response to influenza virus vaccination in aged humans

Abstract: Aging is characterized by an increased susceptibility to infectious diseases; influenza virus infection, which is easily managed by an intact immune system, represents a life-threatening disease in aged subjects. We studied 18 healthy aged subjects (> 65 years of age), vaccinated yearly with conventional anti-influenza vaccine, and 9 healthy young volunteers (mean age 26 years), without previous anti-influenza vaccination, who were vaccinated with the conventional trivalent 1990 anti-influenza preparation. Six out of the 18 aged individuals received a second boost of the same vaccine about 4 months later. In all subjects, we analyzed the humoral response to type A and B influenza viruses and the influenza type A virus-specific CTL generation. Among the elderly population with a single vaccination, 6 and 5 subjects seroconverted against type A and type B influenza virus respectively. Young subjects seroconverted in 5 cases against type A, and in 5 cases against type B influenza virus. Seroconversion took place after the second vaccination in only one subject, and the antibody production was type A specific. Influenza type A virus-specific CTL activity was significantly lower in aged subjects, compared with the values observed in the young volunteers (p = 0.017). The second vaccination partially restored this immunological impairment. These data clearly demonstrate that the elderly do not have the same ability as younger subjects to mount an antibody response, and generate influenza type A virus-specific CTL after conventional anti-influenza vaccination. Moreover, a double anti-influenza vaccination generates CTL activity levels comparable to young subjects, although it does not seem to substantially modify the antibody production.

Intake of energy, nutrients and food items in an urban elderly population

Abstract: This study is part of a transcultural investigation under the auspices of the International Union of Nutritional Sciences, where dietary habits are studied with similar methodology in different populations throughout the world. The present paper describes and evaluates the intake of energy and nutrients, and food habits in an urban elderly population in Sweden, in relation to existing standards. The study population comprised 66 males and 122 females, aged 70 years and over (average 78 years) living in the city of Gothenburg. Energy intake was on average 11.5 MJ in males and 9.9 MJ in females. Nutrient intakes were on average above recommendations, and neither intake nor food choice seemed to change much with increasing age. A validation by a 4- day record and 24- hour urinary nitrogen determination was performed in a subsample, and indicated a probable systematic overestimation of at least 10% for protein consumed.The data from this study support the view that people 70 years of age and older in Sweden are generally healthy, active and have good food habits. This population, however, was not a representative sample. They were all living in a well defined area, with a stable social situation, and belonged generally to middle class. With this background the nutrient data seem reasonable. As long as elderly people stay healthy and do not have other serious risk factors, they seem to keep good food habits and nutritional status up into their eighties and nineties. (Aging Clin. Exp. Res. 5: 105- 116, 1993)

Bone mineral density in relation to anthropometric properties, physical activity and smoking in 75-year-old men and women

Abstract: Bone mineral content (BMC, gem−2) and density (BMD, gem−3) were studied in 75-year-old men and women in relation to anthropometric and certain life-style factors This study covered all the men and women born in 1914 who were residents in the city of Jyvaskyla in 1989 (N=388) A hundred and three men and 188 women participated in bone measurements performed at the calcaneus using a 125I-photon absorption method BMC was on average 36% and BMD 17% higher in the men than in the women BMC and BMD associated with body mass in both sexes, and with body fat and use of estrogen in the women There was a negative correlation between the BMD values and the number of cigarettes smoked over the entire life course in both sexes Moderate physical activity was related to higher BMC in the men Men and women who had been physically active earlier in their life tended to show higher BMD values than those who had been more sedentary (Aging Clin Exp Res 5: 55–62, 1993)

The comparative perspective and choice of animal models in aging research

Abstract: The comparative perspective may be defined as the assumption that individual species or populations differ from one another in potentially instructive ways, and that an appropriate analysis of the nature and magnitude of these differences will yield insights into fundamental processes of aging. Modern experimental research on aging has largely lost its comparative focus, and virtually all research on mammals utilizes inbred strains of laboratory rats and mice, two closely related species chosen not for their properties vis a vis aging, but for convenience. In fact, from a mammalian life history perspective, humans are at the opposite end of the aging continuum than these animal models and other small species conducive to laboratory research, mimic human life history much better. The comparative perspective may play four roles in aging research: 1) hypothesis formulation and evaluation; 2) assessing the generality of aging mechanisms, typically requiring a choice of several animal models distantly related to one another; 3) isolation of key factors influencing aging rate, requiring model systems as closely-related to one another as possible, but differing with respect to aging rate (intraspecific variation in aging rate is particularly useful here); 4) choosing of animal models with particular properties in mind, such as the spectacularly effective antioxidant systems of bats. Increasing the range of animal models used in aging research will accelerate progress in understanding and perhaps manipulating human aging. (Aging Clin. Exp. Res. 5: 259–267, 1993).

Cerebral blood flow in patients with dementia of Alzheimer's type.

Abstract: In the normal brain as well as in Alzheimer’s disease (AD), regional cerebral blood flow (CBF) is coupled to metabolic demand and, therefore, changes in CBF reflect variations in neuronal metabolism. The use of radionuclide techniques, such as positron emission tomography (PET) and single photon emission computed tomography (SPECT), provides an accurate assessment of regional functional activity, i.e., CBF and metabolism, and could be very helpful for the differential diagnosis of AD. This disease is characterized by a decrease in global CBF and metabolism. When found, a symmetric bi-parieto-temporal CBF reduction is highly diagnostic for AD, despite the fact that a similar CBF pattern could also be observed in other types of dementia. Many AD patients with parieto-temporal flow reduction also have a diffuse flow reduction in the frontal cortical areas, particularly in advanced stages of the disease. Lateral CBF asymmetry is also very frequent; speech disorders are highly characteristic of left-sided flow reduction, while visuospatial apraxia is dominating in the right-sided cases. In advanced and severe cases of AD, CBF and metabolism tend to be more uniformly reduced throughout the cortex, sparing only the primary visual and sensory-motor cortices. PET and SPECT measurement of brain perfusion and metabolism has added a new dimension to the knowledge of dementia disorders, with a better differential diagnosis between AD and other forms of dementia. The correlation with neuropsychological data has also given new insight into the disease. (Aging Clin. Exp. Res. 5: 19–26, 1993)

Non specific immunity in aged healthy subjects and in patients with chronic bronchitis.

Abstract: We investigated the effects of aging on some functional activities (chemotaxis, phagocytosis, nitroblue tetrazolium reduction and candidacidal activity) of peripheral polymorphonuclear and mononuclear phagocytes in 96 healthy subjects and 89 patients with chronic bronchitis, aged 40 to 100 years. The subjects were divided according to age into younger (40–65 years) and older (66–100 years) individuals. No subject was taking any drug known to affect phagocytic functions. A few abnormalities in PMN and monocyte functions were observed in aged healthy subjects, in comparison to the younger ones; in fact, only the chemotactic response to complement-derived chemotactic factors was significantly impaired in elderly healthy individuals. On the contrary, multiple alterations of phagocyte activities, i.e., chemotaxis, phagocytosis, and candidacidal activity were observed in aged subjects with chronic bronchitis, compared to healthy adults. However, the results obtained in older and younger patients with chronic bronchitis were superimposable. The present data suggest that the decline in functional activities of phagocytes in the aged could depend on the effect of the underlying chronic bronchitis on the cellular components of the non-specific host defense system, rather than a direct effect of the aging process.(Aging Clin. Exp. Res. 5: 357-361, 1993)

Plasma fibrinogen and physiological aging

Abstract: Results of prospective studies indicate that increased fibrinogen concentration is significantly associated with the risk of arteriosclerotic vessel disease. As the fibrinogen concentration is considered to rise with aging, determination of its physiological values with various methods in strictly healthy adult and aged individuals is a prerequisite to evaluating the relative contribution of fibrinogen to cardiovascular diseases. Fibrinogen concentration was determined in 209 healthy subjects, aged 19 to 96 years. Persons over the age of 60 were recruited according to the stringent criteria of the Senieur protocol established for human immunogerontological studies. Fibrinogen concentrations, obtained by heating precipitation and by thrombin clotting time with both electromagnetic water-bath and semiautomatic coagulometer, ranged from 1.55 to 3.70 g/L. A rise in plasma concentration was observed with aging. Independently of age, females exhibited higher concentrations than males. Significantly higher values were observed in subjects over 60 years of age, in both sexes, in comparison with the younger groups. (Aging Clin. Exp. Res. 5: 445–449, 1993)

Circadian secretion of melatonin and thyrotropin in hospitalized aged patients

Abstract: Alterations in periodical functions are known to occur in aging and may be regarded as markers of the aging process itself. Melatonin and Thyroid Stimulating Hormone (TSH) circadian periodicities were studied in 22 aged subjects and in 13 adult controls. The study of rhythmicity was performed by the Cosinor analysis. Elderly subjects were hospitalized because of various concomitant diseases. Circadian periodicity of both hormones was disrupted in the aged group, and the deterioration of melatonin periodicity was significantly correlated with the decay in cognitive functions, quantified by the Mini Mental State evaluation. Diabetes was also found to affect, though not significantly, melatonin, but not TSH, periodicity. Melatonin and TSH nocturnal peaks were decreased in aged people. TSH oscillation amplitudes were inversely correlated with age. No correlation was found between melatonin and TSH secretory features both in adult and in aged subjects. (Aging Clin. Exp. Res. 5: 39–46, 1993)

Medication use by the elderly

Abstract: Medication use is correlated with the age-associated onset of chronic diseases for which drug therapy offers symptomatic relief, and assists in preventing the onset of disabling and life-threatening complications. However, high rates of medication use by older people raise a number of issues, ranging from concerns with rising expenditures for individuals and third-party insurers; increased risk of adverse drug reactions; toxic or interaction effects from concomitant use of multiple pharmaceutical agents, both physician and self-prescribed; and poor compliance with complex medication regimens by the more physically and mentally impaired. Although existing data do not support the theory of age as an independent predictor of drug-specific adverse reactions, older people have typically been excluded from clinical trials in the dynamic and changing field of pharmacotherapy. Furthermore, ingestion of a greater number of different agents clearly exposes individuals to higher risk of adverse reactions and interactions. Recent advances in information technology have facilitated multicenter clinical trials and post-marketing epidemiological surveillance studies of specific and concomitant medication use by individuals of all ages. The employment of such technology by insurers to determine appropriate prescribing or to control costs in the present limited state of knowledge is, however, premature. Furthermore, such techniques will not replace the need for careful clinical review of symptoms and total drug therapy by prescribing physicians, with modification of regimens and provision of appropriate information and instructions to older individuals and their caregivers. (Aging Clin. Exp. Res. 5: 337-347, 1993)

Relationship between health status, fluid intelligence and disability in a non demented elderly population

Abstract: This study examines the impact of overall health status and common chronic medical conditions on cognitive performance in an older population and the effect of poor cognitive performance on functional disability. The study population consisted of 485 subjects who were 77 and 78 years old, and residing in district No. 6 of the city of Florence; all participants underwent a structured interview to collect information on demographics, education, physical health, disability, and cognitive status. Data from 94 subjects, who were previously diagnosed as affected by dementia or other conditions known to be direct causes of cognitive impairment, and from 6 subjects, who scored less than 20 in the Mini-Mental State Examination, were excluded from the analysis. The number of chronic conditions, drugs used, contacts with the physician, days in bed, and days of hospitalization in the last 6 months were considered as indicators of physical health. Functional disability was assessed evaluating both ADLs and IADLs. The Mini-Mental State and the "Blocks" test, a component of the Wechsler Adult Intelligence Scale Revised, were used for the assessment of cognitive status. After adjusting for the level of formal education, physical health status and several specific chronic conditions were predictors of cognitive performance. A significant association was found between a low "Blocks" test score and a decreased level of functional status. In a multivariate model, better performance on the "Blocks" test was associated with a higher score in the disability scale. This association was independent of the effect of education. The results suggest that in the elderly, poor health status is associated with a cognitive impairment that can be measured by the "Blocks" test. However, the role of this association in the pathway from disease to disability remains unclear.

Osteoporosis: assessment of bone loss and remodeling.

Abstract: Osteoporosis, the most common metabolic bone disorder, is a major health problem in older individuals, and especially in postmenopausal women throughout the world. It is characterized by low bone mass, structural deterioration, and an increased risk of fracture. The expected growth in the percentage of the world population over 65 years of age suggests that control of the chronic diseases of the elderly must be a major international priority. In order to design and implement appropriate prevention and treatment strategies for osteoporosis, it is necessary to assess the extent of the disease or condition in populations, and in individuals in a clinical setting. This review focuses on available and emerging techniques to measure bone mass or density, and on the role of biochemical markers of bone remodeling in the prediction of future bone loss. In order to prevent a disease that progresses without any obvious symptoms, it is important to determine not only the current status of bone mass and remodeling but also to develop methods to predict future bone loss. Different information is derived from each of the assessment approaches, and a combination of measures may be necessary to develop accurate predictive models. (Aging Clin. Exp. Res. 5: 81-93, 1993)

FRAR course on laboratory approaches to aging. The role of pathology in rodent experimental gerontology.

Abstract: The distinction between aging and age-related disease is a blurred one at best. Pathologic lesions and diseases, while having obvious importance for the well-being of an individual, are not more indicative of aging than are silent or benign aging changes. All lesions are useful as biomarkers of aging. They are definable, and can be characterized in terms of their prevalence and severity in different species, genotypes, genders, and age groups. Some data from previous studies are presented as examples. Many lesions of aging are quite restricted, in terms of prevalence or severity, to specific genotypes, species or genders. Recognition of the very great diversity of lesion biomarkers between genotypes, genders and species should prevent investigators from extrapolating findings in one genotype-gender to any other.

The effect of age on the level of human ABO blood group antibodies

Abstract: It is generally assumed that cellular and humoral immunity decline in aging humans. Although there have been reports that the naturally- occurring ABO antibodies also decline with age, some of the data are incomplete and others contradictory. Our study involved only healthy women of various ages and included assays of anti- A and anti- B titers in A, B, and O subjects. Statistical analyses of the data showed that while the antibody titers decreased with age, the amount of change was very small relative to the amount of variability among individuals and the variability attributable to blood type and season of the year. Comparisons with a previous study (1) from our laboratory showed that the changes due to aging were also small relative to the variability in titer scores within an individual over the course of a year. Based on this study, we conclude that the decrease in antibody titers with age is of doubtful clinical significance. (Aging Clin. Exp. Res. 5: 177- 184, 1993).

"On the suggestion of Dr. Alzheimer I examined the following four cases." Dedicated to Gaetano Perusini.

Abstract: Gaetano Perusini merits a great deal more credit for his work on the elaboration of the concepts regarding what is now called Alzheimer’s disease (AD). Perusini’s work in Alzheimer’s laboratory and his subsequent studies have been, if not neglected, largely unmentioned. This article is an attempt to report a fascinating piece of medical history in order to redress the balance. Surely, Perusini’s work deserves to be reexamined. The same applies to Fischer’s investigation. Some of the puzzles discussed by Perusini are still unresolved. (Aging Clin. Exp. Res. 5: 135- 139, 1993)

Body composition and its relation to bone mass and fractures in an urban and a rural population

Abstract: A higher incidence of fragility fractures in urban than in rural populations has been described. The present study included 954 randomly selected men and women between the ages of 40 to 80 years living in the cities of Malmo, an urban population, and Sjobo, a typical agricultural community. Lean body mass (LBM) was estimated with a bioelectrical impedance method; bone mineral content (BMC) of the forearm was evaluated by single photon absorptiometry, and strength of the quadriceps, and hamstring muscles of the right knee, and hand grip were measured. The age-related difference in LBM between the ages of 50 to 80 were 7.8 kg in men and 2.9 kg in women. Urban men aged 60 and 70, and women aged 50 and 70 had a 1.8 to 3.7 kg lower LBM than rural subjects. One hundred women(17%) and 28 men (11%) had experienced fragility fractures. Women aged 70 with fragility fractures had 3.1 kg lower LBM than women without fractures, and the age-dependent difference in LBM was greater in the urban and rural women with fracture, than in women without fracture. LBM showed a higher correlation to BMC, in the range of 0.20–0.28, than the correlation between body weight and BMC. Quadriceps muscle strength was lower in the elderly age groups in both sexes, and a 40% decline was seen both in those from the highest and lowest quartiles of LBM. Use of LBM instead of body weight showed higher correlations to flexion strength of the knee and hand grip. The differences in body composition between an urban and a rural population could probably be attributed to differences in life-style factors, such as physical activity. Overall results show the importance of a maintained lean body mass. (Aging Clin. Exp. Res. 5: 47–54, 1993)

Subjective evaluation of sleep and the use of hypnotics in nursing homes.

Abstract: The purpose of the study was to evaluate the sleep habits and the use of hypnotics in the elderly living in nursing homes. The study population consisted of 60 subjects aged 61-99 years who were interviewed by a geriatrician. The use of hypnotics was frequent (53%), but not associated with gender, memory impairment, moving disability, depression, quality of sleep or sleep behaviour. Users of hypnotics had shorter total sleep time (TST) and got up earlier from bed in the morning than the non-users. Most of the subjects perceived their sleep as interrupted but satisfactory. The elderly with impaired memory slept longer, stayed in bed longer, and took their hypnotics significantly earlier than those with normal memory. As we found no explaining factors for the use of hypnotics, we suggest regular evaluation of their administration in nursing homes. The subjective need for hypnotics, not the nursing home practices, should decide the necessity of these drugs and the medication times in nursing home residents.

Analysis of verbal memory and learning by means of selective reminding procedure in Alzheimer and multi-infarct dementias

Abstract: Several studies aimed at defining the characteristics of memory impairment resulting from different etiologic forms of dementia have been inconclusive. These unsatisfactory results might be due to the enrollment of various groups of demented patients not matched for disease severity, as well as the use of different psychometric procedures. The object of the present study was to verify the existence of a different pattern of verbal memory impairment that might be useful in clinical practice in two groups of AD and MID patients who were matched for degree of cognitive deterioration. Thirty- seven AD and 41 MID patients were assessed for memory and learning by means of the Supraspan Verbal Learning test (Selective Reminding by Buschke- Fuld), which provides a simultaneous analysis of storage, retention and retrieval abilities. Twenty- four normal subjects were studied as a control group. No differences in storage and retrieval mean scores were found between the two groups. AD patients showed a higher mean score in random retrieval; the mean score in selective retrieval at the end of learning was significantly higher in MID patients, suggesting a more impaired retrieval from long- term storage in AD than in MID patients. Intrusions, defined as inappropriate recurrences from preceeding tests, were observed more frequently in AD patients. The presence of intrusions and the delayed retrieval score showed a good level of sensitivity and specificity in the differential diagnosis between the two groups. (Aging Clin. Exp. Res. 5: 185- 192, 1993)

A low-level strength training exercise program for frail elderly adults living in an extended attention facility

Abstract: Little is known about low-level, mildly progressive, strength training programs for frail elderly adults who live in extended attention housing. To study the effects of a low-level strength training program, a group of 12 frail elderly adults, aged 70 to 93 years, residing in an extended attention facility, participated in a strength training exercise program using ankle and wrist weights. Baseline measurements of elbow and knee flexor and extensor muscle strength were taken with a handheld dynamometer prior to initiation of the strength training program, and every three weeks during the 12-week period of exercise with weights. Muscle strength of elbow and knee flexors improved significantly by the end of the 12-week period (p < 0.05). Elbow and knee extensors did not show significant increases in muscle strength, but were maintained. It is concluded that muscle strength can be maintained or improved in adults over 70 who live in an extended attention facility using a low-level, mildly progressive, resistive exercise program. The program is safe, inexpensive, practical and can be used in clinical as well as community settings.

Free radicals: Only part of the story?

Abstract: In 1988 a Europe-wide multicentre study on nutrition and health in the elderly (SENECA) was started to examine dietary patterns in the elderly in relation to lifestyle, social and economic conditions, and health and performance. This paper reviews the approaches taken in designing and developing the study, and describes the methodology used to gather comparative international data by standardized procedures.