Asymptomatic Elderly Subjects Research Articles

USE OF CHLOROQUINE IN ASYMPTOMATIC ELDERLY COVID19 PATIENTS, A PLACEBO OR RATHER A SOURCE OF COMPLICATIONS: A CASE REPORT

Coronavirus 19 is a virus that caused a pandemic that started in Wuhan, CHINA in December 2019. Whatever it is a respiratory tropism virus, it can cause thromboembolic complications. The disease seems to be more severe in older patients with this virus. However, the introduction of treatment for this purpose remains to be discussed in asymptomatic older subjects. We report the case of a 90-year-old man positive for covid 19 but totally asymptomatic on admission. The administration of chloroquine combined with azithromycin caused digestive side effects leading to dehydration, probably resulting in cerebral venous thrombosis on the 5th day of treatment. The review of the literature and in the absence of large cohort studies demonstrating the value of these treatments, leads us to propose treatment on a case-by-case basis and even better to avoid it in asymptomatic elderly subjects without comorbidities.

Quantitative assessment of carotid artery atherosclerosis by three-dimensional magnetic resonance and two-dimensional ultrasound imaging: a comparison study.

It has been proven that magnetic resonance (MR) and ultrasound imaging are useful tools in the quantification of carotid atherosclerotic plaques. However, there are only a few pieces of evidence to illustrate the links of quantitative measurements of carotid plaques between MR and ultrasound imaging. This study looked to compare the quantitative measurements of carotid plaques and investigate their relationship between three-dimensional (3D) MR vessel wall imaging and two-dimensional (2D) ultrasound imaging. Seventy-five asymptomatic elderly subjects (mean age: 73.3±5.7 years; 45 males) with carotid atherosclerotic plaques diagnosed by both ultrasound and MR imaging were included in this study. The plaque size, including the maximum wall thickness (Max WT), plaque length, and plaque area, was measured by 3D MR and ultrasound imaging on longitudinal and cross-sectional views. The quantitative assessments of carotid plaque size were compared and correlated between 3D MR and 2D ultrasound imaging. In total, the quantitative measurements of 101 plaques on longitudinal views or 44 plaques on cross-sectional views of both MR and ultrasound imaging were compared. The Max WT of the plaques (longitudinal: 2.9±0.8 vs. 2.4±0.9 mm; cross-sectional: 3.2±1.1 vs. 2.6±0.7 mm) and plaque areas (longitudinal: 24.3±13.4 vs. 17.0±12.7 mm2; cross-sectional: 24.9±24.6 vs. 16.8±13.3 mm2) measured by MR imaging were found to be significantly higher than those measured by ultrasound imaging (all P<0.001). Moderate to strong correlations were found in Max WT, plaque area, plaque length between 3D MR and ultrasound imaging. The quantitative measurements of carotid plaques using 3D MR and 2D ultrasound are significantly correlated. The plaque area and Max WT measured by 3D MR imaging are more significant than these parameters measured by 2D ultrasound imaging, which might be explained by the resolution of MR imaging and the workflow of measurements.

Physiological variations in the sagittal spine alignment in an asymptomatic elderly population

BACKGROUND CONTEXTSagittal plane alignment is of crucial importance for the treatment of spinal deformities. When planning corrective strategies, spine surgeons need to refer to normative parameters’ ranges which characterize the alignment in the asymptomatic population. Changes are known to occur with age. For the Caucasian population, the reference ranges are extensively documented for the young and middle-aged adults. In contrast, only a few studies have evaluated individuals in advanced age (>60 years) and in groups of limited numbers of subjects (less than 50). PURPOSETo describe the normative parameter ranges of sagittal spine alignment in a large population of asymptomatic elderly subjects. STUDY DESIGN/SETTINGMonocentric, prospective, cross-sectional study. PATIENT SAMPLEOne hundred sixty asymptomatic elderly volunteers (age>60 years, Caucasian heritage), consecutively enrolled. OUTCOME MEASURESSagittal parameters of spine and pelvis: thoracic kyphosis (TK); lumbar lordosis (LL); sacral slope (SS); pelvic incidence (PI); pelvic tilt (PT); sagittal vertical axis (SVA); T1 pelvic angle (TPA); mismatch between PI and LL (PI-LL); Roussouly classification of the lumbopelvic profile. METHODSEach subject underwent one radiographic scan, performed in standing position with EOS low-dose system (EOS Imaging, Paris, France). The radiographic images were processed with sterEOS software allowing identification of the anatomical parameters and the presence of scoliosis. SVA, TPA, and the lumbopelvic profile were manually measured in the lateral images. The results were compared to previous studies describing younger adult populations. The study was supported by the Italian Ministry of Health in the amount of $15,000. The authors declare that there are no conflicts of interests. RESULTSOverall, the average values of the spinopelvic parameters were the followings: TK, 55±14°; LL, 57±12°; PI, 55±11°; SS, 38±10°; PT, 16±7°. The average PI-LL, SVA, and TPA was −3±11°, 25±32 mm, and 14.6±7.4°, respectively. TK, TPA, and SVA were found increasing with age. As for classification of the lumbopelvic profile, 16% of subjects were excluded because they were considered not to belong to any of the Roussouly types. In the classified subjects, the distribution was similar to that of younger adults. Asymptomatic scoliosis (average Cobb angle, 22±7°) was identified in 27% of individuals. CONCLUSIONSThe ranges of values pointed out differences compared to younger adults and represent an important resource for spine surgeons in planning the surgical correction of spinal deformities. The characteristic changes occurring with age, as well as the observed presence of mild or moderate asymptomatic scoliosis, should be carefully taken into account. The classification of the lumbopelvic profile based on the Roussouly scheme revealed some limitations, although similar frequencies were identified compared to younger adults.

DIAGNOSTIC ACCURACY OF A NOVEL CUFFLESS BLOOD PRESSURE MONITOR FOR ATRIAL FIBRILLATION SCREENING IN THE ELDERLY

Objective: Screening for atrial fibrillation (AF) during routine automated blood pressure (BP) monitoring in asymptomatic elderly subjects is an attractive tool. This study validated a novel cuffless BP monitor (Freescan, Maisense) for AF detection during BP measurement in elderly subjects versus reference continuous electrocardiography (ECG). Design and method: Subjects recruited from a hypertension outpatient clinic were instructed to self-measure their BP in the clinic setting using the Freescan cuffless BP monitor (up to 15 attempts until 5 valid BP readings were obtained), with simultaneous ECG monitoring using a Holter device. Data from the device were transferred via Bluetooth to an online data management system, where for each BP measurement an ‘AF’ indication was displayed in case of detected AF and ‘Arrhythmia’ in other arrhythmias. Results: 1,223 Freescan BP measurements with simultaneous automated AF detection were obtained from 132 subjects. Readings reported by the device as ‘unstable’ (uncertainty of displayed rhythm result: 31%) and those reporting error (19%) were discarded. Thus, data of 108 subjects who had 5 valid Freescan BP measurements were analyzed (age 73.9 ± 7.3 years, males 65%, treated for hypertension 85%, AF in ECG 19%). In reading-to-reading analysis (N = 540 valid Freescan readings) the sensitivity, specificity and accuracy of the Freescan device in detecting AF were 70%, 99% and 94%, respectively. In subjects’ analysis (N = 108) and by considering AF diagnosis if > = 3 of 5 Freescan readings indicated AF, the sensitivity, specificity and accuracy of Freescan in detecting AF were 76%, 100%, and 95%, respectively. When the indication ‘Arrhythmia’ was regarded as AF indication, in reading-to-reading analysis the sensitivity, specificity, and accuracy were 95%, 91%, and 92%, respectively, while when using the >=3 of 5 readings for AF diagnosis rule the sensitivity, specificity and accuracy were 100%, 92% and 94%, respectively. Conclusions: The Freescan device appears to have satisfactory diagnostic accuracy for AF screening during routine self-measurement of BP in the elderly, particularly when >=3 of 5 valid readings are considered for diagnosis.

Functional capacity, renal function and vitamin D in community-dwelling oldest old.

The aim of this study was to evaluate the association between the decline in estimated glomerular filtration rate (eGFR) and serum 25(OH)D with the physical and mental functional capacity of elderly individuals aged 80years or older. We evaluated the functional capacity in its multidomain aspects: Geriatric Depression Scale (GDS), Instrumental Activities of Daily Living (IADL), Mental State Mini-Exam (MMSE), Verbal Fluency Test (VF), handgrip strength and time to sit and rise from a chair five times, combined creatinine and cystatin C-based eGFR and 25(OH)D levels in 205 independent asymptomatic and community-dwelling elderly subjects in a cross-sectional study. Every 1year of life, there was reduction of about 10% chance of adequate performance in functional capacity. Each 1ml/min/m2 in eGFR was associated with 2% better chance of adequate performance in the IADL. We found no association between eGFR and cognition. Serum 25(OH)D between 15.00 and 22.29ng/ml increased the chance of better performance in VF, IADL, handgrip strength and sit and rise from the chair compared to the lower level of serum vitamin D. Decreased renal function associated with age compromises the ability to perform activities for independent life in the community, but we did not observe influence in specific domains of cognition and physical performance. Low serum level of 25(OH)D appears to be a marker of greater risk of functional decline than eGFR measurement in independent oldest old dwelling in the community.

Does aging have an impact on hemoglobin? Study in elderly population at rural teaching hospital.

Background:The prevalence of anemia increases with age. Some serious underlying conditions may lead to anemia in the old age. The present study was undertaken to detect and do morphological typing of anemia and further delineate etiological factors in elderly patients.Methods:In this hospital-based prevalence study carried out a tertiary care center over one and half years, a total of 90 patients were fully evaluated for etiology and typing of anemia in elderly (>60 years age) patients. Details of other significant medical and surgical history were noted. Laboratory investigations were conducted, which included complete hemogram, peripheral blood smear, reticulocyte count, erythrocyte sedimentation rate estimation, serum urea, serum creatinine and serum lactate dehydrogenase, bone marrow examination (with Prussian blue marrow iron staining), serum iron and serum total iron-binding capacity, serum ferritin, and stool and urine examination.Results:The mean hemoglobin as per age was 60–64 years- 5.95 gm%, 65–69 years - 6.7 gm%, 70–74 years - 6.58 gm%, and 75–79 years - 6.87 gm%. The difference not being significant (p = 0.33). Morphologically, 53 patients (24 males and 29 females) had microcytic anemia, 27 (17 males and 10 females) had normocytic anemia, and 10 (8 males and 2 females) had macrocytic anemia. Anemia of chronic disease (ACD) was the most common occurrence (50, 55.56%), followed by iron deficiency anemia (IDA) (27, 30%), macrocytic anemia (9, 10%), and others 4 (4.44%). The cause of anemia was found in 10 out of 27 (37.03%) patients in the IDA group, 28 out of 50 (56%) in the ACD group, whereas the etiology was discernible in only one out of nine cases (11.1%) of macrocytic anemias.Conclusion:There was no significant difference observed in the mean hemoglobin levels as the age increased. Morphologically, the majority of the patients had microcytic anemia, followed by normocytic anemia. A population-based study is recommended for further assessment of the prevalence and causes of anemias in asymptomatic elderly subjects.

Sleep apnoea in the asymptomatic elderly: a real issue for the brain?

The link between sleep apnoea and brain structure is unclear; although dysfunction of the hippocampus, middle temporal gyrus and brainstem/cerebellum have been observed previously. However, this link has been little explored in elderly subjects. The aim of this study was to explore the link between sleep apnoea and the brain in an elderly population.226 asymptomatic elderly subjects (age mean±sd 75.3±0.9 years, range 72.3-77.8 years) from the PROOF (Evaluation of Ageing, Autonomic Nervous System Activity and Cardiovascular Events) cohort study were explored using linear voxel-based or cortical thickness with apnoea/hypopnoea index (AHI; mean±sd 15.9±11.5 events·h-1, range 6-63.6 events·h-1) as a covariate of main interest. The brain volumes of 20 control subjects, 18 apnoeic (AHI >29 events·h-1) treated patients and 20 apnoeic untreated patients from this population were compared using voxel-based morphometry, cortical thickness or surface-based analyses.AHI was not associated with any change in local brain volume, cortical thickness or cortex surface. Control subjects, apnoeic treated and untreated patients were not different in terms of local brain volume, cortical thickness or surface.In a specific population of asymptomatic elderly healthy subjects, sleep apnoea does not seem to be associated with a change in local brain volume or in cortical thickness.

Atherosclerotic plaque features and distribution in bilateral carotid arteries of asymptomatic elderly population: A 3D multicontrast MR vessel wall imaging study

PurposeThis study sought to investigate the characteristics of morphology, compositions and distribution of carotid atherosclerotic plaques in asymptomatic elderly population using three dimensional (3D) multicontrast magnetic resonance vessel wall imaging. Materials and methods146 asymptomatic elderly subjects (≥60years) were recruited and underwent 3D multicontrast MR vessel wall imaging for bilateral carotid arteries on a 3.0T MR scanner. The presence of carotid atherosclerotic plaque was determined and the stenosis was measured. The characteristics of plaque morphology and compositions were evaluated and compared among distal internal carotid artery (D-ICA), proximal-ICA (P-ICA), carotid bulb (CB), distal common carotid artery (D-CCA) and proximal-CCA (P-CCA). ResultsOf all recruited 140 subjects (72.1±5.7years, 63 males), 87 (62.1%) had carotid plaques, 17 (12.1%) had high-risk plaques and 51 (36.4%) had multiple plaques. Of all 280 carotid arteries, only 16 (5.7%) had luminal stenosis (21.1%±11.4%). Among carotid arteries without luminal stenosis, the prevalence of plaque and high-risk plaques was 43.2% and 8.3%, respectively. Carotid plaques were mostly found in CB segment (33.9%), followed by P-ICA (13.6%), P-CCA (11.1%), D-CCA (4.6%) and D-ICA (3.6%). Age was independently associated with presence of multiple carotid plaques (odds ratio, 1.835; 95% confidence interval, 1.196–2.815; P=0.005). ConclusionCarotid artery atherosclerotic plaques are prevalent and a substantial number of high-risk plaques can be found in the asymptomatic elderly subjects. Longitudinal studies are warranted to investigate the risk of having ischemic stroke for asymptomatic elderly individuals with carotid artery high risk plaques.

Coronary artery calcium score and CT angiography in asymptomatic elderly patients with high pretest probability for coronary artery disease.

To evaluate the role of coronary artery calcium scoring (CACS) and/or coronary CT angiography (CCTA) in asymptomatic elderly patients with high pretest probability for coronary artery disease (CAD). Forty-eight consecutive asymptomatic elderly (>65 years) subjects who had a high pretest probability and underwent CACS/CCTA were included. Each CCTA was evaluated for adequacy for assessment of coronary stenosis. Significant stenosis (>50% diameter narrowing) was assessed on evaluable CT images and by invasive catheter angiography (ICA). All subjects were men with mean CACS of 880 ± 1779. Among those with low (0-99), intermediate (100-399), and high (400-999) CACS, ICA-verified significant stenosis was present in 8% (1/13), 23% (2/13), and 67% (8/12), respectively. Among those with very high CACS (≥ 1000) (n = 10), 90% of CCTAs were not evaluable for stenosis. In asymptomatic elderly subjects with high pretest probability, CACS followed by CCTA may be considered for those with intermediate to high CACS.

Amyloid PET imaging: a challenge for research in clinical neuroimaging

The development of amyloid targeting PET radioligands is one of the most challenging research and clinical neuroimaging endeavours. The first radiopharmaceutical developed by investigators at the University of Pittsburgh, a derivative of a histopathologic dye (thioflavin-S) used to identify fibrillary Ab-amyloid in microscopic brain tissue sections, was N-methyl-[C]2-(40-methylaminophenyl)-6hydroxybenzothiazole (now termed [C]Pittsburgh Compound-B or [C]PiB) [1]. Shortly following the advent of [C]PiB, several commercial entities began development of radio-fluorinated amyloid probes that would have potential translational clinical uses. At the time of this writing, there are a few probes approved for clinical use by Food and Drug Administration (FDA) and European Medicine Agency (EMA) and several others still in the pipeline. As today, based on the available data, results obtained by PET with amyloid radiopharmaceuticals should not be considered as diagnostic for Alzheimer disease (AD), but rather indicative of the presence of cerebral amyloid deposition. Ab deposition may be found in fact in disorders other than AD, such as dementia with Lewy bodies and amyloid angiopathy. Further researche will solve these issues, possibly increasing the spectrum of applications for amyloid PET imaging. The Society of Nuclear Medicine and Molecular Imaging has recently released Guidelines for the clinical application of amyloid imaging, emphasizing a conservative approach [2]. The SNMMI Guidelines suggest appropriate use of clinical amyloid imaging for distinguishing dementias with a moderate-to-high burden of fibrillary Abamyloid vs. those without amyloid deposition. The specificities of PET findings with the use of the clinically approved tracers have each been confirmed by direct comparisons of PET imaging with subsequent neuropathologic diagnosis at autopsy. Patients with dementia due to Alzheimer disease and some patients with dementia with Lewy bodies are expected to have abnormal (‘‘positive’’) amyloid scans, while patients with other forms of neurodegenerative disorders, such as the frontotemporal dementia spectrum (FTD), Creutzfeld–Jacob disease, and others, to have normal (‘‘negative’’) amyloid scans. Amyloid imaging might be of prognostic value in subjects with mild cognitive impairment (MCI), in whom there is a significant increased risk for progression to AD over 2–3 years following a ‘‘positive’’ amyloid PET scan. On the other hand, amyloid imaging is appropriate neither in patients with typical AD and in asymptomatic elderly subjects, as the imaging results would not lead to changes in diagnostic classification or clinical management, in particular, ‘‘positive’’ amyloid scans may be observed in elderly individuals, that remain asymptomatic for a decade in spite of such finding. It remains possible that some of these individuals may never develop dementia—follow-up research studies are underway at present to evaluate this possibility. Conversely, when patients exhibit deficits and course that are typical of AD, the vast majority will demonstrate ‘‘positive’’ amyloid scans, and the incremental contribution to diagnosis and management will be small. Up to now, the types of patients and clinical circumstances in which amyloid PET imaging could be used are limited to patients with atypical dementia or in clinical K. Frey University of Michigan, Ann Arbor, MI, USA

Abstract WMP51: High-sensitivity C-reactive Protein In Asymptomatic Elderly Subjects Is Associated With a Higher Risk For Silent Brain Infarction

Objective: Inflammatory processes are involved in the pathogenesis of atherosclerosis, and it has been known that high-sensitivity C-reactive protein (hs-CRP) is associated with coronary heart disease. However, the association of hs-CRP with subclinical cerebrovascular disease is less well established. We investigated the association of hs-CRP with silent brain infarction (SBI) as a marker of subclinical cerebrovascular disease in elderly subjects without history of overt stroke. Methods: Neurologically asymptomatic elderly subjects (n=1,443; age ≥ 65 years) who visited for routine health check-ups were included in this study. The level of hs-CRP was measured and the presence of SBI was determined by brain MRI. Results: A total of 223 subjects (15.5%) had one or more SBIs, and the average hs-CRP level was significantly higher in subjects with SBI (2.2 mg/L) than in those without (1.4 mg/L). Compared with the lowest hs-CRP group (0-0.9mg/L), the proportion of SBI in the highest hs-CRP group (≥ 3 mg/L) was increased (27.1% vs. 13.6%). After adjusting by age, gender and the history of hypertension, diabetes, smoking, hyperlipidemia and coronary heart disease, the risk of SBI was increased significantly two-fold in the highest hs-CRP group compared with the lowest group. Conclusion: Elevated hs-CRP level was found to be associated with the presence of SBI. This result suggests that inflammatory processes may be related to the subclinical cerebrovascular disease.

No significant association of aspirin use with cerebral microbleeds in the asymptomatic elderly

Background and purposeCerebral microbleeds (CMBs) may predict future risk for intracerebral hemorrhage (ICH). ICH is one of the most important complications of aspirin use. The association between aspirin use and CMBs is still controversial. In this context, we sought to investigate whether aspirin use is associated with CMBs in subjects without previous history of stroke. MethodsAsymptomatic elderly subjects (n=1452; age≥65years) who visited for routine health check-ups were included in this study. CMBs were evaluated through T2*-weighted gradient-recalled echo MRI. Information about aspirin or warfarin use was obtained using a structured questionnaire. ResultsA total of 138 subjects (9.5%) were found to have CMBs. In the group of aspirin use, 43 subjects (11.2%) had CMBs; among them 9 (2.3%) had strictly lobar microbleeds and 34 (8.9%) had deep or infratentorial microbleeds. Compared with the non-use group, the risk for CMBs did not increase in the group of aspirin use (adjusted odds ratio, 1.10; 95% confidence interval, 0.73–1.66). For the group of aspirin use above 5years, the proportion of CMBs (11.1%) did not increase compared with the group of short-term use (≤5years, 9.5%, p=0.99) and non-use group (8.9%, p=0.66). ConclusionsWe found that the prevalence of CMBs did not increase in the group of aspirin use, and the presence of CMBs was not associated with the duration of aspirin use in asymptomatic elderly subjects without a history of stroke or transient ischemic attack.

Association of obesity with cerebral microbleeds in neurologically asymptomatic elderly subjects

Obesity is associated with an increased risk of cardiovascular disease, but few studies have investigated the effects of obesity on subclinical cerebrovascular disease. Cerebral microbleeds (CMBs) are radiological markers of cerebral small vessel disease and reflect underlying vasculopathy. In this context, we assessed whether obesity was related to CMBs and to CMB subtypes categorized by location. Neurologically asymptomatic elderly subjects (n = 1,251; age ≥ 65 years) who visited for routine health check-ups were included in this study. Cerebral microbleeds were evaluated through T2*-weighted gradient-recalled echo MRI. The subjects were categorized into two groups depending on CMB location: strictly lobar and deep or infratentorial microbleeds. Body mass index was calculated, and obesity was defined using the World Health Organization Western Pacific Regional Office criteria. A total of 120 (9.6 %) subjects were found to have CMBs. As the severity of obesity increased, the prevalence of CMBs increased. Compared with the normal weight group and after controlling possible confounders, the risk of deep or infratentorial microbleeds was significantly increased in the overweight group [odds ratio (OR) 2.32, 95 % confidence interval (CI) 1.19-4.53], and the obese group (OR 2.17, 95 % CI 1.14-4.13). However, the ORs for the strictly lobar microbleeds were not increased in either the overweight or obese groups. Obesity was associated with deep or infratentorial microbleeds. This finding suggests that obesity affects cerebral small vessels through arteriosclerotic vasculopathy. Based on our findings, we postulate that obesity is associated with the presence of subclinical and bleeding-prone cerebrovascular disease in the elderly.

Vascular Risk Factors, White Matter Hyperintensities and Hippocampal Volume in Normal Elderly Individuals

Background/Aims: Hippocampal atrophy has been identified as marker for the development of Alzheimer’s dementia (AD). To what extent vascular risk factors and white matter hyperintensities (WMH) affect hippocampal volume (HV) in asymptomatic elderly subjects and thus may impact such a predictive capacity is controversial. Methods: We analysed 287 participants of the Austrian Stroke Prevention Study (mean age 66.6 ± 6.6 years) with a Mini Mental State Examination score ≧27 who were free of neuropsychiatric disease and had undergone MRI including coronal T₁-weighted sequences allowing for semi-automatic assessment of HV. Global brain volume (BV) was measured using SIENAX. WMH were rated according to the Fazekas scale and segmented to obtain WMH volumes. Results: Higher age was associated with lower absolute and normalized HV, a lower BV and higher WMH volume. None of the vascular risk factors had an impact on HV except for high-density lipoprotein. This effect disappeared after normalization of HV. WMH severity and volume did not affect HV either. Conclusion: Our data indicate HV loss in parallel with the whole brain and suggest no specific vulnerability towards vascular risk factors or age-related WMH in a cognitively intact normal elderly population. This also supports the utility of HV measurements to identify impending AD.

Total hip arthroplasty in the elderly: impact on functional performance

To compare gait and functional performance parameters in elderly subjects who had or had not total hip arthroplasty (THA).Our sample comprised 23 elderly subjects (72±6.5 years of age) with a mean of 2.6±1.3 years following THA, named the arthroplasty group (AG) and 23 asymptomatic elderly subjects (70.1±5.9 years of age), named the control group (CG). Case and control subjects were paired by gender, age, body mass index and level of physical activity. The GAITRite® system was used to analyze various gait parameters in four situations: usual speed (US), fast speed (FS), slow speed (SS) and dual task (DT); the Dynamic Gait Index (DGI) and Timed Up and Go test (TUG) methods were used to evaluate functional capacity. The statistical analyses were carried out using the Shapiro-Wilk test, Student's-t-tests for independent samples, chi-square tests, ANOVA for repeated measurements and paired Student's-t-tests.The AG had the worst results for gait speed (AG=1.18±0.13 and CG=1.39±0.09; p=0.012), symmetry index (SI) of step length (AG=3.60±1.01 and CG=1.12±0.59; p=0.000), SI of step time (AG=-2.65±0.92 and CG=0.99±0.74; p=0.000), SI of stance phase (AG=-2.55 and CG=-1.04±0.50; p=0.005), SI of single support phase (AG=-2.17±0.78 and CG=1.21±0.51; p=0.003), DGI (AG=20.04±1.91 and CG=21.69±1.45; p=0.001) and TUG (AG=14.67±1.94 and CG=10.08±1.49; p=0.001).Elderly subjects with a history of THA had changes in gait parameters and lower performance in TUG test even 2.6±1,3 years after surgery, which suggests functional impairment.

Sonographic evaluation of the shoulder in asymptomatic elderly subjects with diabetes

BackgroundThe prevalence of rotator cuff tears increases with age and several studies have shown that diabetes is associated with symptomatic shoulder pathologies. Aim of our research was to evaluate the prevalence of shoulder lesions in a population of asymptomatic elderly subjects, normal and with non insulin - dependent diabetes mellitus.MethodsThe study was performed on 48 subjects with diabetes and 32 controls (mean age: 71.5 ± 4.8 and 70.7 ± 4.5, respectively), who did not complain shoulder pain or dysfunction. An ultrasound examination was performed on both shoulders according to a standard protocol, utilizing multiplanar scans.ResultsTendons thickness was greater in diabetics than in controls (Supraspinatus Tendon: 6.2 ± 0.09 mm vs 5.2 ± 0.7 mm, p < 0.001; Biceps Tendon: 4 ± 0.8 mm vs 3.2 ± 0.4 mm, p < 0.001). Sonographic appearances of degenerative features in the rotator cuff and biceps were more frequently observed in diabetics (Supraspinatus Tendon: 42.7% vs 20.3%, p < 0.003; Biceps Tendon: 27% vs 7.8%, p < 0.002).Subjects with diabetes exhibited more tears in the Supraspinatus Tendon (Minor tears: 15 (15.8%) vs 2 (3.1%), p < 0.03; Major tears: 15 (15.8%) vs 5 (7.8%), p = ns), but not in the long head of Biceps. More effusions in subacromial bursa were observed in diabetics (23.9% vs 10.9%, p < 0.03) as well as tenosynovitis in biceps tendon (33.3% vs 10.9%, p < 0.001).In both groups, pathological findings were prevalent on the dominant side, but no difference related to duration of diabetes was found.ConclusionsOur results suggest that age - related rotator cuff tendon degenerative changes are more common in diabetics.Ultrasound is an useful tool for discovering in pre - symptomatic stages the subjects that may undergo shoulder symptomatic pathologies.

Plasma level of sICAM-1 is associated with the extent of white matter lesion among asymptomatic elderly subjects

Objective Inflammatory endothelial activation mediated by intercellular adhesion molecule-1 (ICAM-1) plays a role in the pathogenesis of large- and small-vessel disease. We explored the association between soluble ICAM-1 (sICAM-1) and white matter lesion (WML) as a manifestation of cerebral small-vessel disease. Methods One hundred and seventy-five elderly individuals aged ≥ 60 without neurological deficits were studied. Subcortical deep white matter hyperintensity (SDWMH) and periventricular hyperintensity (PVH) were rated separately. Lesions in each category were then divided into three groups (grade 0-I, grade II, grade III) according to the Fazekas scale. Results Plasma sICAM-1 levels were positively associated with grades of WML (for SDWMH: 297.4 ± 135.6 ng/mL in grade 0-I, 391.3 ± 145.5 ng/mL in grade II, and 450.2 ± 232.9 ng/mL in grade III, p < 0.001; for PVH: 282.5 ± 116.5 ng/mL in grade 0-I, 402.3 ± 160.4 ng/mL in grade II, and 428.1 ± 227.7 ng/mL in grade III, p < 0.001). Multivariate analysis showed higher sICAM-1 levels, age and hypertension were the independent risk factors associated with the presence and severity of WML. More than 4-fold increased risk of WML was observed in patients with the highest quartile of sICAM-1 (all WML OR = 4.694, 95% CI: 1.805–12.204; moderate WML OR = 4.618, 95% CI: 1.543–13.825; severe WML OR = 4.893, 95% CI: 1.236–19.368). Conclusion Increased plasma sICAM-1 suggests inflammatory process may be involved in the pathogenesis of WML.

Performance in the cranio-cervical flexion test is altered in elderly subjects

The cranio-cervical flexion test (CCFT) tests the coordination of the deep and superficial cervical flexor muscles during a cranio-cervical flexion task. The test has revealed impairments in muscle function in younger/middle aged patients with various neck pain disorders. Neck pain and headache are common in elders but it is unknown if age alone affects performance in the CCFT. This study compared performance in the CCFT between healthy asymptomatic elderly and younger subjects. Electromyographic (EMG) amplitude in the sternocleidomastoid (SCM), angle of cranio-cervical flexion and ability to target the pressure levels of each test stage were examined in 44 elderly and 39 young participants. The results indicated that the elderly group had higher measures of normalized EMG signal amplitude in the SCM during the test ( p < 0.001), greater shortfalls from the target pressures of all stages of the test ( p < 0.01), except for the 22 mm Hg stage ( p = 0.13), and larger variability of the cranio-cervical flexion range of motion for the five successive stages of the test (particularly at 26, 28 and 30 mm Hg stages) compared to young subjects. Clinicians must be aware of this occurrence when assessing performance in the CCFT in elders with neck pain.

Basal forebrain atrophy is a presymptomatic marker for Alzheimer's disease

Background Alzheimer's disease (AD) is the most common degenerative neurologic disorder. The onset of symptoms is insidious and follows a long period of progression of an asymptomatic pathology that proceeds in a precise anatomic and temporal sequence. Recent studies with quantitative magnetic resonance imaging techniques have shown the localization of the in vivo pathology of AD and its antecedent, mild cognitive impairment. The objective of the present study was to determine whether a sensitive and reliable marker for the presymptomatic phase of the disorder could be identified by longitudinal analysis of an initially asymptomatic, community-based population. Methods One hundred forty-eight healthy, cognitively normal participants in the Cardiovascular Health Study–Cognition Study had detailed clinical examinations and magnetic resonance imaging scans in 1998–1999 and 2002–2003. Modulated voxel-based morphometry was used to compare regional brain volumes in subjects who remained cognitively normal after 5 to 6 years of follow-up (n = 127) with those who developed probable AD during the same period (n = 21). Results Among normal subjects destined to develop AD, there was significant atrophy in the basal forebrain area as long as 4.5 years before the development of clinical symptoms. When the left hippocampus was also atrophic, the onset of dementia typically occurred earlier than in cases in which the atrophy was confined to basal forebrain. Conclusions Atrophy in the basal forebrain precedes the development of AD in subjects with cognition judged to be normal by neuropsychological testing. The time required to develop dementia appears to be shortened if hippocampal atrophy is also present. These data indicate that atrophy restricted to medial basal forebrain is a biomarker that predicts development of probable AD in asymptomatic elderly subjects.

Asymmetric Dimethylarginine Determines the Improvement of Endothelium-Dependent Vasodilation by Simvastatin: Effect of Combination With Oral L-Arginine

We hypothesized that the level of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of endothelial nitric oxide (NO) synthase (eNOS), might determine the endothelial effects of statins. Endothelial NO synthase is up-regulated by statins. However, statins failed to improve endothelial function in some studies. Asymmetric dimethylarginine inhibits eNOS by a mechanism that is reversible by L-arginine. Ninety-eight clinically asymptomatic elderly subjects had their plasma ADMA levels screened. Those in the highest (high ADMA, n = 15) and lowest quartiles of the ADMA distribution (low ADMA, n = 13) were eligible to receive, in a randomized order, simvastatin (40 mg/day), L-arginine (3 g/day), or a combination of both, each for 3 weeks. Endothelium-dependent vasodilation (EDD) was assessed by brachial artery ultrasound. Simvastatin had no effect on EDD in subjects with high ADMA (6.2 +/- 1.2% vs. 6.1 +/- 0.9%), whereas simvastatin plus L-arginine significantly improved EDD (9.8 +/- 1.5% vs. 5.3 +/- 0.8%; p < 0.01). In subjects with low ADMA, simvastatin improved endothelial function when given alone (9.5 +/- 3.2% vs. 6.1 +/- 3.8%; p < 0.001) or in combination with L-arginine (9.0 +/- 3.1% vs. 6.3 +/- 3.3%; p = 0.001). L-arginine alone improved endothelial function in both groups. Endothelium-independent vasodilation was not affected. Simvastatin does not enhance endothelial function in subjects with elevated ADMA, whereas it does so in patients with low ADMA. Combination of simvastatin with oral L-arginine improves endothelial function in subjects with high ADMA, but has no additional effect in subjects with low ADMA. As NO-mediated effects may play a major role in the therapeutic effects of statins, ADMA concentration is an important factor that influences the "pleiotropic" effects of simvastatin.