Age-related differences in an ecologically based study of route learning.

Spatial learning abilities in younger adults and in healthy elderly adults were examined in 2 tasks. In the first task, participants were tested for their ability to recall relevant route information as well as to recognize and to order temporally landmark information observed along the route. Older participants had relatively greater difficulty retracing the route and temporospatially ordering landmarks but were equally good at recognition of landmarks occurring on the route. In the second task, participants memorized a 2-dimensional representation of a route and subsequently navigated the route from memory. Older participants had greater difficulty memorizing the route and navigating it. Errors of omission, commission, wrong, and forced choice were analyzed. Group differences in the pattern of errors differed by task. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Sex differences in disease course: analysis of the Swiss HIV cohort study

The Swiss HIV Cohort Study (SHCS) is a prospective multicentre study of HIV-infected adults. Participants have been followed up at six-monthly intervals since 1988. The purpose of the present study was to examine sex differences in developing AIDS-defining events and in survival among participants of the SHCS (1042 women, 1507 men). A statistically significant higher risk of Pneumocystis carinii pneumonia (PCP) was evident among women. This difference was particularly pronounced in 1989 (hazard ratio 2.11, p = 0.01). Other opportunistic events and survival showed no statistically significant sex differences. The results are compatible with slower introduction of PCP prophylaxis among women. A reason for this may be that women were less likely to be enrolled in clinical trials than men. This hypothesis will be examined in a further study.     

Gender differences in use of stress testing and coronary heart disease mortality: a population-based study in Olmsted County, Minnesota

The distribution of CD57+ T and CD56+ T cells in patients with RA was examined. In control osteoarthritis patients, these cells exist as a minor population in the peripheral blood. Our data show that in patients with RA, CD57+ T cell levels are elevated in peripheral blood, knee joint fluid, knee synovial membrane and bone marrow (BM), compared with peripheral blood of controls. CD57+ T cells are especially high in knee joint fluid and joint-adjacent BM, while CD56+ T cells show no such increase. CD57+ T cells contain a major population of CD8+ cells and higher proportions of CD4-8- cells and gammadelta T cells than do CD57- T cells. CD57+ T cells in peripheral blood and joint fluid increase with the duration of disease. Erythrocyte sedimentation rate (ESR) is inversely correlated with the proportion of CD57+ T cells in the joint fluid. Although RA frequently occurs in patients with CD3+57+ cell leukaemia, and some CD57+ T cells are likely to be involved in the onset of RA, we suggest that CD57+ T cells may rather suppress inflammation of RA, and other cellular components (e.g. granulocytes) may govern the severity of the inflammation of RA. These CD57+ T cells are probably generated extrathymically in the adjacent BM or joint space.     

Serum lipids and incidence of coronary heart disease. Findings from the Systolic Hypertension in the Elderly Program (SHEP)

BACKGROUND: The association of serum lipids with coronary heart disease has been studied extensively in middle-aged men and, to a lesser extent, in similar women. Less well defined are lipid variables predictive of CHD in individuals of age > or = 60 years. METHODS AND RESULTS: The Systolic Hypertension in the Elderly Program recruited 4736 persons (mean age, 72 years; 14% were black; and 43% were men). Mean systolic and diastolic blood pressures were 170 and 77 mm Hg, respectively. Baseline mean total cholesterol was 6.11 mmol/L (236 mg/dL); HDL cholesterol, 1.39 mmol/L (54 mg/dL); and non-HDL cholesterol, 4.72 mmol/L (182 mg/dL). Triglyceride levels were 1.62 mmol/L (144 mg/dL) for fasting participants and 1.78 mmol/L for the total group. LDL cholesterol, estimated in fasting samples with triglycerides of < 4.52 mmol/L, averaged 3.98 mmol/L (154 mg/dL). Mean follow-up was 4.5 years. In multivariate Cox regression analyses, baseline total, non-HDL, and LDL cholesterol levels and the ratios of total, non-HDL, and LDL to HDL cholesterol were significantly related to CHD incidence. HDL cholesterol and triglycerides were not significant in these analyses. In fasting participants with triglyceride levels of < 4.52 mmol/L, a 1.03 mmol/L (40 mg/dL) higher baseline total, non-HDL, or LDL cholesterol was associated with a 30% to 35% higher CHD event rate. CONCLUSIONS: The results of this study support the concept that serum lipids are CHD risk factors in older Americans.     

Improving compliance with immunization in the older adult: results of a randomized cohort study

OBJECTIVE: To compare three approaches for improving compliance with influenza and pneumococcal vaccination of elderly patients. DESIGN: Randomized controlled trial using three parallel group practices at a public urban teaching hospital. SETTING: Public teaching hospital. SUBJECTS: All patients 65 years of age and older (n = 1202) seen by resident physicians (n = 66) attending three ambulatory medical practices from October 1, 1989 to March 31, 1990. INTERVENTIONS: All three provider groups received intensive education in immunization standards. The control group received no further intervention. Staff in the second group offered education to patients at their visits. In the third group, the prevention team, a flowsheet was used, patient education offered, and staff had their tasks redefined to facilitate compliance; for vaccinations, eg, nurses could vaccinate independent of MD initiative. MEASUREMENTS AND MAIN RESULTS: Medical records were reviewed for the 1202 patients seen, including 756 patients seen during both the 1988-89 and 1989-90 influenza seasons, to determine documented offering and receipt of vaccinations. During the intervention period (1989-90), influenza vaccinations were offered significantly more frequently to prevention team patients (68.3%) than to patients in either the patient education (50.4%) or control (47.6%) groups (P = 0.006), even after adjusting for the patients' prior vaccination status, age, gender, race, and high-risk co-morbidity and for physicians' level of training. Likewise, pneumococcal vaccinations were offered more frequently to previously unvaccinated prevention team patients (28.3%) than to patient education (6.5%) or control (5.4%) group patients (P = 0.001), even after adjusting for the factors using multivariate analysis. Compliance rates did not differ between patient education and control subjects for either vaccine. Pre-intervention physician surveys documented higher perceived than actual compliance for both vaccines, with 89.0% and 52.8% of physicians believing that they complied with influenza and pneumococcal vaccination guidelines, respectively. CONCLUSIONS: The results of this trial provide strong support for organizational changes that involve non-physician personnel to enhance vaccination rates among older adults.     

Silent ST-T changes in an epidemiologic cohort study--a marker of hypertension or coronary heart disease, or both: the Reykjavik study

OBJECTIVES: We sought to evaluate the prognostic value and clinical characteristics associated with electrocardiographic (ECG) ST-T changes among men without other manifestations of coronary heart disease. BACKGROUND: Recent achievements in secondary prevention and treatment of coronary heart disease have highlighted the importance of early diagnosis of both symptomatic and silent forms of the disease. The prognostic and clinical importance of ST-T changes in men with no other manifestations of coronary heart disease is still unclear. Do they reflect silent coronary heart disease or hypertension, or both, and what is their independent contribution to prognosis? METHODS: The subjects were 9,139 men born in the years 1907 to 1934 and followed up for 4 to 24 years. On initial visit they were assigned to different categories of coronary heart disease on the basis of Rose chest pain questionnaire, hospital records, 12-lead ECG, history and physical examination. RESULTS: The prevalence of silent ST-T changes among men without overt coronary heart disease was strongly influenced by age, increasing from 2% at age 40 years to 30% at age 80 years. Men with such ST-T changes were older and had higher serum triglyceride levels and worse glucose tolerance than men without such changes or other evidence of coronary heart disease. Their blood pressure was higher, and they more often had an enlarged heart or left ventricular hypertrophy and more often took antihypertensive medication, digitalis or diuretic drugs. Serum cholesterol levels were not different between the two groups. After adjustment for other risk factors, these silent ST-T changes had a risk ratio of 2.0 for death from coronary heart disease and 1.6 for subsequent myocardial infarction or angina pectoris. CONCLUSIONS: Silent ST-T changes that are ischemic by the Minnesota code are probably both a marker of silent coronary heart disease and high blood pressure. They define a distinct group of patients with highly abnormal risk factor profile. Although not specific for coronary heart disease and often transient, they are associated with the development of every clinical manifestation of coronary heart disease and are independent predictors of reduced survival.     

Frequent nut consumption and risk of coronary heart disease in women: prospective cohort study

OBJECTIVE: To examine the relation between nut consumption and risk of coronary heart disease in a cohort of women from the Nurses' Health Study. DESIGN: Prospective cohort study. SETTING: Nurses' Health Study. SUBJECTS: 86 016 women from 34 to 59 years of age without previously diagnosed coronary heart disease, stroke, or cancer at baseline in 1980. MAIN OUTCOME MEASURES: Major coronary heart disease including non-fatal myocardial infarction and fatal coronary heart disease. RESULTS: 1255 major coronary disease events (861 cases of non-fatal myocardial infarction and 394 cases of fatal coronary heart disease) occurred during 14 years of follow up. After adjusting for age, smoking, and other known risk factors for coronary heart disease, women who ate more than five units of nuts (one unit equivalent to 1 oz of nuts) a week (frequent consumption) had a significantly lower risk of total coronary heart disease (relative risk 0.65, 95% confidence interval 0.47 to 0.89, P for trend=0.0009) than women who never ate nuts or who ate less than one unit a month (rare consumption). The magnitude of risk reduction was similar for both fatal coronary heart disease (0.61, 0.35 to 1.05, P for trend=0.007) and non-fatal myocardial infarction (0.68, 0.47 to 1.00, P for trend=0.04). Further adjustment for intakes of dietary fats, fibre, vegetables, and fruits did not alter these results. The inverse association persisted in subgroups stratified by levels of smoking,use of alcohol, use of multivitamin and vitamin E supplements, body mass index, exercise, and intake of vegetables or fruits. CONCLUSIONS: Frequent nut consumption was associated with a reduced risk of both fatal coronary heart disease and non-fatal myocardial infarction. These data, and those from other epidemiological and clinical studies, support a role for nuts in reducing the risk of coronary heart disease.     

Depression in (an) older adult(s): A moderate structuralist viewpoint.

A case study of a 74-yr-old woman is used to illustrate an account of the relationship between aging and depression from a moderate structuralist viewpoint. Depressed behavior in older adults is seen as a set of messages in communicational networks. It is argued that such messages reflect a style of communicating that is encouraged by the interactional rules and messages of both immediate (family and friends) and extended (societal and cultural) systems. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceptions of cultural differences and language use: A field study in a bilingual environment.

Examined the role of perceived cultural differences and patterns of language use regarding intergroup relations in Quebec. The participants were 90 francophone and anglophone executives who were involved in a 3-day program requiring intensive interaction and cooperation to complete their task requirements. A questionnaire administered at the end of the program focused on (a) participants' beliefs about francophone and anglophone differences in approach to and execution of the job, and (b) patterns of language use throughout the 3-day period. Most francophones believed that cultural differences do exist, and they respected the unique attributes of both groups. Most anglophones did not believe in the current existence of cultural differences and felt that the specific characteristics of the 2 groups had been blended over time. The English language was used more than would be predicted on the basis of the number of francophones and anglophones; however, there was greater language parity than has historically been reported. (French summary) (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of noninvasive examinations in the management of ischemic heart disease.IV. Nuclear cardiology in chronic ischemic heart disease

We evaluated the circadian rhythms in the plasma concentrations of cortisol, cortisone and their free forms, and in the cortisone/cortisol ratios by means of reversed-phase high performance liquid chromatography in normal adult subjects. Plasma concentrations of cortisone, as well as cortisol, exhibited a circadian rhythm. The ratios of cortisone/cortisol remained almost constant during the waking hours of normal subjects. Changes in the cortisone/cortisol ratios previously reported in patients with various diseases exceeded the diurnal changes detected in the present study. Thus, the determination of the cortisone/cortisol ratio provides information that is useful in assessing the adrenal function of patients with various diseases.     

Age-related differences in concurrent-task performance of normal adults: Evidence for a decline in processing resources.

A concurrent-task paradigm was used to investigate age-related differences in the attentional capacity of 92 right-handed adults. Young, middle-aged, and elderly Ss were compared as they performed speeded, unimanual finger tapping with and without concurrent silent reading, speaking, and maze completion. There were 2 levels of difficulty for each cognitive task. The decrement in tapping rate from the single- to dual-task condition increased linearly with age. Concurrent-task tapping was slowed more by difficult than by easy tasks, and difficult tasks had a disproportionately disruptive effect on the concurrent performance of elderly Ss. The heightened vulnerability of the elderly to concurrent-task effects cannot be attributed parsimoniously to either general slowing or diminution of a specific resource. Instead, the results suggest a reduction in a general-purpose processing resource with increasing age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Memory training and strategy use in older adults: Results from the ACTIVE study.

Little is known about the long-term effects of memory training in later life on strategy use. Data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (n = 1,401) were used to describe strategy use in a community-dwelling sample of older adults. Strategy clustering scores on verbal list learning tasks of episodic memory were used to test the impact of memory training on strategy use and study longitudinal associations between strategy clustering, memory performance, and everyday functioning. Results suggested that younger, female, white, healthier, and more educated participants show higher strategy clustering scores initially but no characteristics were consistently associated with different trajectories in strategy clustering across all strategy clustering measures together. Memory training had significant immediate effects on all measures of strategy use that were maintained through five years of follow-up. With respect to longitudinal mediation, pre-post training changes in most strategy clustering scores mediate changes in objective memory performance and everyday functioning, implying that strategies can be modified and are closely related to both memory ability and the ability to function independently. This study provides evidence that older adults can be trained to use cognitive strategies, the effects are durable, and strategies are associated with memory and everyday functioning. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Amyloid precursor protein (APP) in the striatum in Alzheimer's disease: an immunohistochemical study

Increasing recognition of diffuse plaques has raised questions about the differences between diffuse and neuritic plaques, particularly in regard to the role of amyloid precursor protein (APP) processing in their formation. To address this issue, corpus striatum (containing almost exclusively diffuse plaques) and cerebral cortex (containing an admixture of plaque types) from patients with Alzheimer's disease (AD) were examined immunohistochemically with antibodies to domain-specific sites of APP (N-terminal, C-terminal, beta A4-related, isoform-specific, and other epitopes). Striatal plaques labeled strongly with beta A4 antibodies as did cortical plaques in AD and the occasional diffuse plaques in cortex from nondemented elderly controls. Weak labeling of some cortical neuritic plaques but not diffuse plaques was observed with antibodies directed against other APP epitopes. Electron microscopy of diffuse plaque-rich striatum in AD cases revealed only rare degenerating neurites without apparent fibrillar amyloid; no changes were noted in the plaque-free striatum of controls. These results suggest that antibodies to beta A4 recognize not only fibrillar amyloid of neuritic plaques but also antigenic determinants of diffuse plaques which lack fibrillar amyloid. Furthermore, the finding that antibodies to non-A4 domains of APP labeled only cortical but not striatal plaques suggests that APP processing mechanisms in cortical and striatal tissues may differ.     

Relations of left ventricular mass to fat-free and adipose body mass: the strong heart study. The Strong Heart Study Investigators

STUDY DESIGN: The effects of nucleus pulposus and various treatments to block tumor necrosis factor alpha activity were evaluated in an experimental set-up using immunohistochemistry and nerve conduction velocity recordings. OBJECTIVES: To assess the presence of tumor necrosis factor alpha in pig nucleus pulposus cells, and to see if block of tumor necrosis factor alpha also blocks the nucleus-pulposus-induced reduction of nerve root conduction velocity. SUMMARY AND BACKGROUND DATA: A meta-analysis of observed effects induced by nucleus pulposus revealed that these effects might relate to one specific cytokine-tumor necrosis factor alpha. METHODS: Series-1: Cultured nucleus pulposus cells were stained immunohistologically with a monoclonal antibody for tumor necrosis factor alpha. Series-2: Nucleus pulposus was harvested from lumbar discs and applied to the sacrococcygeal cauda equina in 13 pigs autologously. Four pigs received 100 mg of doxycycline intravenously; five pigs had a blocking monoclonal antibody to tumor necrosis factor alpha applied locally in the nucleus pulposus, and four pigs remained nontreated, forming a control group. Three days after the application, the nerve root conduction velocity was determined over the application zone by local electrical stimulation. RESULTS: Series-1: Tumor necrosis factor alpha was found to be present in the nucleus pulposus cells. Series-2: The selective antibody to tumor necrosis factor alpha limited the reduction of nerve conduction velocity, although in comparison with the control group this was not statistically significant. However, treatment with doxycycline significantly blocked the nucleus-pulposus-induced reduction of conduction velocity. CONCLUSION: For the first time, a specific substance, tumor necrosis factor alpha, has been linked to the nucleus-pulposus-induced effects of nerve roots after local application. Although the effects of this substance may be synergistic with those of other similar substances, the data of the current study may be of significant importance for the continued understanding of nucleus pulposus' biologic activity, and of possible potential use for future strategies in managing sciatica.     

Coital (cardiac) convulsions: case report of a unique presentation of complete heart block

A 55-year-old man presented with the acute onset of seizures occurring during the post orgasmic phase of sexual intercourse. Evaluation for brain neoplasm was negative. During the hospital stay, the patient developed status epilepticus during which electrocardiogram documented complete heart block. The seizure disorder was corrected with the insertion of a permanent epicardial pacemaker.