Eighth Decade Of Life Research Articles

VITREOMACULAR ADHESION EVOLUTION WITH AGE IN HEALTHY HUMAN EYES.

To quantify the changes in vitreomacular interactions that occur with normal aging in normal eyes. Spectral domain optical coherence tomography (SD-OCT, Spectralis; Heidelberg Engineering, Heidelberg, Germany) foveal scans of subjects with best corrected visual acuity better than 20/40 and no ocular pathology were included in the study. Each scan was analyzed to determine the status of vitreoretinal interface: complete vitreous adhesion, partial posterior vitreous detachment (PVD) with persistent vitreomacular adhesion (VMA), or complete PVD. Area of VMA was delineated using the Spectralis drawing tool and calculated in mm for each scan. Subjects, aged 10 years to 97 years, were divided into 9 age groups according to decade of life. Five hundred and sixty-six SD-OCT scans were analyzed. Area of VMA (mm) decreased sigmoidally (R = 0.99) with each decade of life. With aging, percentage of PVD increased while percentage of complete adhesion decreased. Males were found to have significantly larger area of VMA (mm) compared with females in the fifth through eighth decades of life, P < 0.05. Vitreomacular interface interactions throughout life are age and gender dependent. This adds to our current understanding of the normal aging process undergone by the vitreous, thereby providing assistance in the clinical differentiation between normal and pathologic vitreomacular interactions.

Chapter 2 - Epidemiology and introduction to the clinical presentation of Wilson disease

Our understanding of the epidemiology of Wilson disease has steadily grown since Sternlieb and Scheinberg's first prevalence estimate of 5 per million individuals in 1968. Increasingly sophisticated genetic techniques have led to revised genetic prevalence estimates of 142 per million. Various population isolates exist where the prevalence of Wilson disease is higher still, the highest being 885 per million from within the mountainous region of Rucar in Romania. In Sardinia, where the prevalence of Wilson disease has been calculated at 370 per million births, six mutations account for around 85% of Wilson disease chromosomes identified. Significant variation in the patterns of presentation may however exist, even between individuals carrying the same mutations. At either extremes of presentation are an 8-month-old infant with abnormal liver function tests and individuals diagnosed in their eighth decade of life. Three main patterns of presentation have been recognized - hepatic, neurologic, and psychiatric - prompting their presentation to a diverse range of specialists. Deviations in the family history from the anticipated autosomal-recessive mode of inheritance, with apparent "pseudodominance" and mechanisms of inheritance that include uniparental isodisomy (the inheritance of both chromosomal copies from a single parent), may all further cloud the diagnosis. It can therefore take the efforts of an astute clinician with a high clinical index of suspicion to clinch the diagnosis of this eminently treatable condition.

Acute Complications After Adult Spinal Deformity Surgery in Patients Aged 70 Years and Older

This report is a retrospective case series that examined the acute complications of patients aged 70 years and older undergoing spinal deformity surgery that required fusion of at least 6 levels. To determine the acute complications that patients in the eighth decade of their life experience after spinal reconstructive surgery, and how these complication rates compare with other patient populations undergoing similar procedures. As the mean age of the United States population rises, more older patients with painful spinal deformities can be expected. Although there are similar studies in the literature examining acute complications of patients undergoing major spinal deformity surgery, the complication rates of this unique patient population have not been adequately studied. Twenty patients had complete medical records with at least 6 months of follow-up. All the 20 patients underwent instrumented posterior spinal fusions performed by the same surgeon. Comorbidities, weighted comorbidity index, duration, number of hospital days, estimated blood loss, intensive care unit days, American Society of Anesthesiologist score, and intraoperative and postoperative complications were recorded. The mean age of our patient cohort was 76.6 years (range, 70-84 y). Patients had an average of 4 comorbidities and an American Society of Anesthesiologist score of 2.7. Although the group of patients had a large number of comorbidities, their weighted comorbidity index, according to Charlson and colleagues, was fairly low at 1.05 (range, 0-4). All of the patients were fused at least 6 levels, with the average being 10.75 (range, 6-15). Ninety-five percent of patients experienced a complication of some type. Nine major complications occurred in 7 patients. Spinal deformity surgery in patients at any age has associated risks. These risks are believed to increase with age and the complexity of the procedure. Our results show that, although the risks of major complications are significant, the risk is not greater than in a younger population undergoing the similar procedures. We feel that age alone should not be a contraindication for patients in their eighth decade of life who are incapacitated by their painful spinal deformity.

Phenotypic Similarities Between Late-Onset Autosomal Dominant and Sporadic Alzheimer Disease: A Single-Family Case-Control Study.

The amyloid hypothesis posits that disrupted β-amyloid homeostasis initiates the pathological process resulting in Alzheimer disease (AD). Autosomal dominant AD (ADAD) has an early symptomatic onset and is caused by single-gene mutations that result in overproduction of β-amyloid 42. To the extent that sporadic late-onset AD (LOAD) also results from dysregulated β-amyloid 42, the clinical phenotypes of ADAD and LOAD should be similar when controlling for the effects of age. To use a family with late-onset ADAD caused by a presenilin 1 (PSEN1) gene mutation to mitigate the potential confound of age when comparing ADAD and LOAD. This case-control study was conducted at the Knight Alzheimer Disease Research Center at Washington University, St Louis, Missouri, and other National Institutes of Aging-funded AD centers in the United States. Ten PSEN1 A79V mutation carriers from multiple generations of a family with late-onset ADAD and 12 noncarrier family members were followed up at the Knight Alzheimer Disease Research Center (1985-2015) and 1115 individuals with neuropathologically confirmed LOAD were included from the National Alzheimer Coordinating Center database (September 2005-December 2014). Data analysis was completed in January 2016, including Knight Alzheimer Disease Research Center patient data collected up until the end of 2015. Planned comparison of clinical characteristics between cohorts, including age at symptom onset, associated symptoms and signs, rates of progression, and disease duration. Of the PSEN1 A79V carriers in the family with late-onset ADAD, 4 were female (57%); among those with LOAD, 529 were female (47%). Seven mutation carriers (70%) developed AD dementia, while 3 were yet asymptomatic in their seventh and eighth decades of life. No differences were observed between mutation carriers and individuals with LOAD concerning age at symptom onset (mutation carriers: mean, 75 years [range, 63-77 years] vs those with LOAD: mean, 74 years [range, 60-101 years]; P = .29), presenting symptoms (memory loss in 7 of 7 mutation carriers [100%] vs 958 of 1063 individuals with LOAD [90.1%]; P ≥ .99) and duration (mutation carriers: mean, 9.9 years [range, 2.3-12.8 years] vs those with LOAD: 9 years [range, 1-27 years]; P = .73), and rate of progression of dementia (median annualized change in Clinical Dementia Rating-Sum of Boxes score, mutation carriers: 1.2 [range, 0.1-3.3] vs those with LOAD: 1.9 [range, -3.5 to 11.9]; P = .73). Early emergence of comorbid hallucinations and delusions were observed in 57% of individuals with ADAD (4 of 7) vs 19% of individuals with LOAD (137 of 706) (P = .03). Three of 12 noncarriers (25%) from the PSEN1 A79V family are potential phenocopies as they also developed AD dementia (median age at onset, 76.0 years). In this family, the amyloidogenic PSEN1 A79V mutation recapitulates the clinical attributes of LOAD. Previously reported clinical phenotypic differences between individuals with ADAD and LOAD may reflect age- or mutation-dependent effects.

PHENOTYPIC SIMILARITIES BETWEEN LATE-ONSET AUTOSOMAL DOMINANT AND SPORADIC ALZHEIMER DISEASE: A SINGLE-FAMILY CASE-CONTROL STUDY

Importance The amyloid hypothesis posits that disrupted β-amyloid homeostasis initiates the pathological process resulting in Alzheimer disease (AD). Autosomal dominant AD (ADAD) has an early symptomatic onset and is caused by single-gene mutations that result in overproduction of β-amyloid 42. To the extent that sporadic late-onset AD (LOAD) also results from dysregulated β-amyloid 42, the clinical phenotypes of ADAD and LOAD should be similar when controlling for the effects of age. Objective To use a family with late-onset ADAD caused by a presenilin 1 ( PSEN1 ) gene mutation to mitigate the potential confound of age when comparing ADAD and LOAD. Design, Setting, and Participants This case-control study was conducted at the Knight Alzheimer Disease Research Center at Washington University, St Louis, Missouri, and other National Institutes of Aging–funded AD centers in the United States. Ten PSEN1 A79V mutation carriers from multiple generations of a family with late-onset ADAD and 12 noncarrier family members were followed up at the Knight Alzheimer Disease Research Center (1985-2015) and 1115 individuals with neuropathologically confirmed LOAD were included from the National Alzheimer Coordinating Center database (September 2005-December 2014). Data analysis was completed in January 2016, including Knight Alzheimer Disease Research Center patient data collected up until the end of 2015. Main Outcomes and Measures Planned comparison of clinical characteristics between cohorts, including age at symptom onset, associated symptoms and signs, rates of progression, and disease duration. Results Of the PSEN1 A79V carriers in the family with late-onset ADAD, 4 were female (57%); among those with LOAD, 529 were female (47%). Seven mutation carriers (70%) developed AD dementia, while 3 were yet asymptomatic in their seventh and eighth decades of life. No differences were observed between mutation carriers and individuals with LOAD concerning age at symptom onset (mutation carriers: mean, 75 years [range, 63-77 years] vs those with LOAD: mean, 74 years [range, 60-101 years]; P = .29), presenting symptoms (memory loss in 7 of 7 mutation carriers [100%] vs 958 of 1063 individuals with LOAD [90.1%]; P ≥ .99) and duration (mutation carriers: mean, 9.9 years [range, 2.3-12.8 years] vs those with LOAD: 9 years [range, 1-27 years]; P = .73), and rate of progression of dementia (median annualized change in Clinical Dementia Rating–Sum of Boxes score, mutation carriers: 1.2 [range, 0.1-3.3] vs those with LOAD: 1.9 [range, −3.5 to 11.9]; P = .73). Early emergence of comorbid hallucinations and delusions were observed in 57% of individuals with ADAD (4 of 7) vs 19% of individuals with LOAD (137 of 706) ( P = .03). Three of 12 noncarriers (25%) from the PSEN1 A79V family are potential phenocopies as they also developed AD dementia (median age at onset, 76.0 years). Conclusions and Relevance In this family, the amyloidogenic PSEN1 A79V mutation recapitulates the clinical attributes of LOAD. Previously reported clinical phenotypic differences between individuals with ADAD and LOAD may reflect age- or mutation-dependent effects.

Hemicolectomy in a patient with aortic valve disease: Case report

Patients with valve disease are at a higher risk of perioperative complications in the context of non-cardiac surgery. The active involvement of the anaesthetist from the moment of the pre-anaesthesia assessment to determine the severity of the disease is crucial.The purpose of this report on the management of a clinical case is to highlight the need for a multidisciplinary approach to the patient with heart disease.We present the case of a patient in the eighth decade of life with severe aortic stenosis, and a 46mm infra-renal abdominal aortic aneurysm; chronic obstructive pulmonary disease, controlled arterial hypertension; and a lymphoproliferative process. Following the pre-anaesthesia assessment, valve repair surgery was indicated prior to a surgical procedure for colon cancer resection. Key to the successful management of this patient was pre-operative optimization with cardiac surgery and adjustment of the pharmacological treatment, plus haemodynamic monitoring as a basis for decision-making during the perioperative period using a minimally invasive device (Vigileo®). Spinal analgesia with intrathecal morphine was combined with general anaesthesia. The patient remained stable with CI 2.3–3l/min/m2, SVV 2–7% and ScvO2 74–67%.As a result of the successful anaesthetic and surgical process, we concluded that it is our duty at the present time to know and apply the recommendations contained in the guidelines developed by the anaesthesia and cardiology societies and their regular updates, as they allow clinicians to make decisions in accordance with evidence-based protocols.

Hemicolectomía en un paciente con valvulopatía aórtica: reporte de caso

Patients with valve disease are at a higher risk of perioperative complications in the context of non-cardiac surgery. The active involvement of the anaesthetist from the moment of the pre-anaesthesia assessment to determine the severity of the disease is crucial.The purpose of this report on the management of a clinical case is to highlight the need for a multidisciplinary approach to the patient with heart disease.We present the case of a patient in the eighth decade of life with severe aortic stenosis, and a 46mm infra-renal abdominal aortic aneurysm; chronic obstructive pulmonary disease, controlled arterial hypertension; and a lymphoproliferative process. Following the pre-anaesthesia assessment, valve repair surgery was indicated prior to a surgical procedure for colon cancer resection. Key to the successful management of this patient was pre-operative optimization with cardiac surgery and adjustment of the pharmacological treatment, plus haemodynamic monitoring as a basis for decision-making during the perioperative period using a minimally invasive device (Vigileo®). Spinal analgesia with intrathecal morphine was combined with general anaesthesia. The patient remained stable with CI 2.3 - 3 l/min/m2, SVV 2 - 7% and ScvO2 74- 67%.As a result of the successful anaesthetic and surgical process, we concluded that it is our duty at the present time to know and apply the recommendations contained in the guidelines developed by the anaesthesia and cardiology societies and their regular updates, as they allow clinicians to make decisions in accordance with evidence-based protocols.

PD34-03 THE INCIDENCE AND TREATMENT OF HYPOGONADISM IN PATIENTS WITH TESTICULAR CANCER

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease I1 Apr 2016PD34-03 THE INCIDENCE AND TREATMENT OF HYPOGONADISM IN PATIENTS WITH TESTICULAR CANCER Jamal Nabhani, Diana Jin, and Siamak Daneshmand Jamal NabhaniJamal Nabhani More articles by this author , Diana JinDiana Jin More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.988AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Though the diagnosis of testicular cancer (TC) has been associated with hypogonadism, the mechanistic and clinical interrelation remains unclear. The fraction of men with TC who are on androgen replacement therapy (ART) has not been previously quantified. We investigate the pattern of diagnosis and treatment of hypogonadism in men with TC. METHODS Using Humana administrative claims data from 2007-2013, men with and without a diagnosis of TC were identified. Testosterone laboratory and prescription data were analyzed between the cohorts and by decade of life in order to adjust for differences in the rates of hypogonadism with age. RESULTS 2,647 men with and 6,337,475 without TC were identified, yielding a rate of 4.2 cases of TC per 100,000 men, peaking at 11.6 per 100,000 men in the fourth decade of life. 428 men with testis cancer (16.2%) had a serum testosterone checked. The odds ratio (OR) of having a serum testosterone level measured in patients with TC was 4.5 95% CI [4.0,5.0]. This increased with age, peaking with an 8.2 fold increase in the ninth decade of life. 211 of the 428 men with TC who had a serum testosterone measured (8.0% of all men with testis cancer) were found to have a low serum testosterone. The OR of having a low testosterone was 4.0 95% CI [3.5,4.6] in men with TC compared to controls, peaking at 6.1 in the eighth decade of life. The diagnosis of low serum testosterone predated TC diagnosis by > 30 days in 144 men (5.4% of all TC cases). In terms of ART 225 men (8.5%) with TC were prescribed testosterone. The OR of receiving a prescription was 4.5 95% CI [4.2,5.5] times higher than in men without TC and disproportionately high in younger men, with an 8.1 fold increase in the third decade of life. CONCLUSIONS Men with a diagnosis of TC are four times more likely to have a serum testosterone checked, be diagnosed with hypogonadism, and receive ART. Serum testosterone is measured and more frequently found to be low in elderly patients with a history of TC compared to age-matched controls. Additionally, hypogonadism often predates the diagnosis of testis cancer. Finally, despite higher detection in elderly patients, ART is prescribed more often to young men with TC. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e839-e840 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Jamal Nabhani More articles by this author Diana Jin More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Vascular risk factors and progression of white matter hyperintensities in the Lothian Birth Cohort 1936

We aimed to determine associations between multiple vascular risk factors (VRF) at ∼73 years and progression of white matter hyperintensities (WMH) from ∼73 years to ∼76 years. We calculated correlations and generalized estimating equation models of a comprehensive range of VRF at 73 years and change in WMH volume from 73 years to 76 years. Higher systolic (rho = 0.126, p = 0.009) and diastolic (rho = 0.120, p = 0.013) blood pressure at 73 years were significant predictors for greater WMH volume at 76 years in a simple correlation model. However, neither measured blood pressure nor self-reported hypertension at 73 years was significant predictors of WMH volume change in a fully adjusted model which accounted for initial WMH volume at 73 years. Lower high-density lipoprotein cholesterol (beta = −0.15 % intracranial, −1.80 mL; p < 0.05) and current smoking (beta = 0.43 % intracranial, 5.49 mL; p < 0.05) were the only significant VRF predictors of WMH volume change from 73 years to 76 years. A focus on smoking cessation and lipid lowering, not just antihypertensives, may lead to a reduction in WMH growth in the eighth decade of life.

Results of surgical aortic valve replacement and transapical transcatheter aortic valve replacement in patients with previous coronary artery bypass grafting.

To evaluate the results of aortic valve replacement through sternotomic approach in redo scenarios (RAVR) vs transapical transcatheter aortic valve replacement (TAVR), in patients in the eighth decade of life or older already undergone previous coronary artery bypass grafting (CABG). One hundred and twenty-six patients undergoing RAVR were compared with 113 patients undergoing TaTAVR in terms of 30-day mortality and Valve Academic Research Consortium-2 outcomes. The two groups were also analysed after propensity-matching. TaTAVR patients demonstrated a higher incidence of 30-day mortality (P = 0.03), stroke (P = 0.04), major bleeding (P = 0.03), worse 'early safety' (P = 0.04) and lower permanent pacemaker implantation (P = 0.03). TaTAVR had higher follow-up hazard in all-cause mortality [hazard ratio (HR) 3.15, 95% confidence interval (CI) 1.28-6.62; P < 0.01] and cardiovascular mortality (HR 1.66, 95% CI 1.02-4.88; P = 0.04). Propensity-matched patients showed comparable 30-day outcome in terms of survival, major morbidity and early safety, with only a lower incidence of transfusions after TaTAVR (10.7% vs RAVR: 57.1%; P < 0.01). A trend towards lower Acute Kidney Injury Network Classification 2/3 (3.6% vs RAVR 21.4%; P = 0.05) and towards a lower freedom from all-cause mortality at follow-up (TaTAVR: 44.3 ± 21.3% vs RAVR: 86.6 ± 9.3%; P = .08) was demonstrated after TaTAVR, although cardiovascular mortality was comparable (TaTAVR: 86.5 ± 9.7% vs RAVR: 95.2 ± 4.6%; P = 0.52). Follow-up freedom from stroke, acute heart failure, reintervention on AVR and thrombo-embolisms were comparable (P = NS). EuroSCORE II (P = 0.02), perioperative stroke (P = 0.01) and length of hospitalization (P = 0.02) were the determinants of all-cause mortality at follow-up, whereas perioperative stroke (P = 0.03) and length of hospitalization (P = 0.04) impacted cardiovascular mortality at follow-up. Reported differences in mortality and morbidity after TaTAVR and RAVR reflect differences in baseline risk profiles. Given the lower trend for renal complications, patients at higher perioperative renal risk might be better served by TaTAVR.

Squamous cell carcinoma of the oral cavity and oropharynx in young adults.

Head and neck squamous cell carcinoma (SCC) is a disease of older age group predominately in the sixth and eighth decades of life. The incidence of oral SCC (young age <40 years) varies between 0.4% and 3.9%. There has been increasing trend in younger age group worldwide as well as in India as reported by many studies. The aim of the present study was to compare the clinicopathological profile, treatment, and outcomes of SCC of oral cavity and oropharyngeal cancer in the young age group of <40 years old. This retrospective observational study was done by retriving data of selected cohort from 2013 to 2015. Patients were divided into 2 groups: Group 1 (10-30 years) and Group 2 (31-40 years) for comparison. SPSS Version 16 software was used for statistical analysis. Cohort of 217 patients was analyzed. The male:female ratio was 11:1. The most frequent site of primary tumor was tongue > buccal mucosa. The primary site of cancer as oropharynx was present in 3 (5.17%) and 22 (13.83%) patients, respectively, in two groups. Mean overall survival (OS) in two groups was 22.53 and 25.14 months, respectively (P = 0.119). The median disease-free survival (DFS) in two groups was 7 and 8 months, respectively. The present study showed that the incidence of oropharyngeal cancer increases with age, but the behavior is more aggressive in a younger age group in spite of aggressive treatment, the DFS and OS were not improved in under 30 years group.

Primary Osteogenic Sarcoma in Patients over than Forty Years

Objectives: Osteogenic sarcoma has a well recognized double peak of incidence, beside being the most common childhood malignancy of bone, there is a significant second peak in the seventh and eighth decades of life. We sought to review the clinical and hisopathological features also chemotherapy regimens in this particular group of patients and to determine possible prognostic factors. Materials and Methods: We reviewed 287 patients of osteosarcoma treated between 1986 and 2010.Patients were considered eligible for the present study if they fulfilled the following criteria: primary OS, typical histological and radiographic features of OS, no prior history of cancer or treatments elsewhere, and no prior history of pre-existing bone abnormalities. Results: The Kaplan-Meier survival curve for the entire group including 95% confidence limits at two and five years. The overall two- and five-year survival rates were 76.2% and 72.8%, respectively. Surgical margin was a significant factor affecting survival. Also pathological fracture was a significant factor affecting the survival. Discussion: The decreasing incidence of OS over the age of 40 years and the expectation that these elderly patients may not tolerate aggressive modern chemotherapy means that the patients with OS over the age of 40 years may must often excluded from current trials of treatment. Osteogenic sarcoma remains a challenging disease to treat. A multidisciplinary approach is the best method for treating OS in patients older than 40 years. The poor clinical outcome in elderly patients with primary OS reported previously is difficult to understand. Level of Evidence: Level 3 Keyword: Osteogenic Sarcoma, Elderly Patients DOI: 10.3944/AOTT.2016.16.0035 This abstract belongs to the un-edited version of the article and is only for informative purposes. Published version may differ from the current version.

Microsurgeons do better--tactile training might prevent the age-dependent decline of the sensibility of the hand.

Recent data demonstrate that the normal sensibility of the hand seems to be age-dependent with the best values in the third decade and a consecutive deterioration afterwards. However, it is not clear if long-term tactile training might prevent this age-dependent decline. We evaluated sensibility of the hand in 125 surgeons aged between 26 and 75 years who perform microsurgical operations, thereby undergoing regular tactile training. We examined sensibility of the radial digital nerve of the index finger (N3) and the ulnar digital nerve of the small finger (N10) using static and moving two-point discrimination (2PD) tests and compared the results to 154 age-matched individuals without specific long-term tactile training. We found significantly lower static and moving 2PD values for the sixth, seventh, and eighth decade of life in the microsurgery group compared to the control group (p < 0.05). This study demonstrates that long-term tactile training might prevent the known age-dependent decline of the sensibility of the hand.

Heritability of Health and Aging Limitations on Personally Desired Activities.

The aim of this study is to estimate heritability of incident limitations on personally desired activities within the eighth decade of life. We measured self-rated ability to perform ten personally desired activities in 1606 male veteran twin pairs at baseline and four years later. At follow-up, 33% of the cohort reported more limitations in desired activities. Among twins who completed both assessments, there were no statistically significant differences in incidence rates of limitations as a function of zygosity. Sensitivity tests showed the same for change scores; and that, if cognitive impairment or death are deemed to belong among limitations of desired activities, zygosity contributed 10% to new limitations at follow-up. Maintaining personally desired activities over four years in the eighth decade is not subject to substantial genetic influence. However, if death and cognitive impairment are added to incident limitations, then genetics plays a modest role. In all cases, unique environment is the predominant influence.

Brain volumetric changes and cognitive ageing during the eighth decade of life.

Later‐life changes in brain tissue volumes—decreases in the volume of healthy grey and white matter and increases in the volume of white matter hyperintensities (WMH)—are strong candidates to explain some of the variation in ageing‐related cognitive decline. We assessed fluid intelligence, memory, processing speed, and brain volumes (from structural MRI) at mean age 73 years, and at mean age 76 in a narrow‐age sample of older individuals (n = 657 with brain volumetric data at the initial wave, n = 465 at follow‐up). We used latent variable modeling to extract error‐free cognitive levels and slopes. Initial levels of cognitive ability were predictive of subsequent brain tissue volume changes. Initial brain volumes were not predictive of subsequent cognitive changes. Brain volume changes, especially increases in WMH, were associated with declines in each of the cognitive abilities. All statistically significant results were modest in size (absolute r‐values ranged from 0.114 to 0.334). These results build a comprehensive picture of macrostructural brain volume changes and declines in important cognitive faculties during the eighth decade of life. Hum Brain Mapp 36:4910–4925, 2015. © 2015 The Authors. Human Brain Mapping Published by Wiley Periodicals, Inc

P12.16 Older patients attending sexually transmitted infections clinics

Background Many older patients remain sexually active well into their eighth decade of life. Surveillance data suggest that rates of sexually transmitted infections (STIs) in this age group may be increasing. We sought to compare demographics, risk behaviours and predictors of acute infections in patients 50 years and older versus younger patients attending STI clinics in Baltimore, Maryland. Methods Retrospective study from a large electronic database of all visits to two urban STI clinics between 2005 and 2010. Proportions were compared using the c2 test. Logistic regression was used to assess predictors of acute STIs in older versus younger groups. Results 4461 first visits for patients over 50 and 4893 visits for patients under 50 were included in the analysis. Patients over 50 frequently reported high-risk behaviours [35.4% (CI 0.34–0.37) vs. 52.7% (CI 0.51–0.54) in those Conclusion Older patients who seek care at STI clinics engage in significant risk behaviours. Race, a factor strongly predictive of acute STIs in young men and women is not a significant predictor of STIs in older persons. Disclosure of interest statement No sources of funding or conflicts of interest to disclose.

Coupled changes in brain white matter microstructure and fluid intelligence in later life.

Understanding aging-related cognitive decline is of growing importance in aging societies, but relatively little is known about its neural substrates. Measures of white matter microstructure are known to correlate cross-sectionally with cognitive ability measures, but only a few small studies have tested for longitudinal relations among these variables. We tested whether there were coupled changes in brain white matter microstructure indexed by fractional anisotropy (FA) and three broad cognitive domains (fluid intelligence, processing speed, and memory) in a large cohort of human participants with longitudinal diffusion tensor MRI and detailed cognitive data taken at ages 73 years (n = 731) and 76 years (n = 488). Longitudinal changes in white matter microstructure were coupled with changes in fluid intelligence, but not with processing speed or memory. Individuals with higher baseline white matter FA showed less subsequent decline in processing speed. Our results provide evidence for a longitudinal link between changes in white matter microstructure and aging-related cognitive decline during the eighth decade of life. They are consistent with theoretical perspectives positing that a corticocortical "disconnection" partly explains cognitive aging.

Sublingual varices in relation to smoking, cardiovascular diseases, denture wearing, and consuming vitamin rich foods.

Objectives:To identify potential risk factors such as smoking, cardiovascular diseases (CVD), denture wearing, and consuming vitamin rich foods, and its relation to the development of sublingual varices (SLV).Methods:This cross-sectional observational study was conducted on patients who attended the Department of Dentistry at The University of Jordan Hospital, Amman, Jordan between February and May 2013. Clinical examinations and inspections of 391 patients (203 males and 188 females), 13-74 years of age were conducted to determine the presence of SLV. Sublingual varices were classified into 2 categories: grade 0 (few or none visible), and grade one (moderate or severe). Frequency distributions of both SLV and risk factors were obtained. Multiple logistic regression analysis and Chi-square test were used to analyze the influence of individual risk factors on the incidence of SLV.Results:There were 88 subjects (22.5%) who had SLV. In the multivariate logistic regression model, SLV were significantly associated with age (odds ratio [OR]: 2.27, p=0.008) with highest occurrences in the eighth decade of life, gender (OR: 2.74, p=0.001), smoking (OR: 2.93, p=0.002), denture wearing (OR: 2.03, p=0.044), and CVD (OR: 4.01, p=0.00).Conclusion:The presence of SLV could be indicative of some potential risk factors including old age, female gender, and denture wearing, and may alert the dental clinician to recognize underlying systemic conditions, particularly CVD.

Assessment of the Results of Surgical Treatment of Zenker'S Diverticulum in Own Material.

Zenker diverticulum (ZD) is the most common type of diverticula of the esophagus. Most often refers to men with a peak incidence in the seventh and eighth decade of life. In the majority diverticula remains asymptomatic and in patients with symptomatic course of the disease symptoms are often nonspecific. Aim of the study was to present the authors' own experience in surgical treatment of Zenker diverticulum. In this paper we present an analysis of 31 patients with confirmed ZD treated surgically at the Clinic in 2004-2014. Patients were analyzed in terms of age, gender, clinical symptoms, diverticulum size, type of surgery, the time to return to the oral intake, hospital stay and perioperative complications. 22 men and 9 women were enrolled it this study. The mean age of the patients was 64.8 (SD, 10.7; in the range of 28 to 82 years). 29 patients (93.5%) underwent resection of the diverticulum, while diverticulopexy was performed in two patients. In 25 (80.6%) cases stapler device was used, while in 4 (12.9%) resection was performed manually. The average size of resected diverticulum was 4.9 cm (SD, 1.5). Following the surgery in four patients (12.9%) complications were present. The average operating time was 118.7 minutes (SD, 42.2, in the range of 50 to 240 minutes). The mean length of hospital stay was 9.3 (SD, 3.3). Surgical treatment of ZD is associated with high effectiveness and low recurrence rate. Despite the advantages of endoscopic techniques, surgical treatment is characterized by one- stage procedure. The use of mechanical suture (stapler) significantly improves the operation, although on the basis of our own analysis there was no superiority revealed over hand sewn. Unquestionable adventage of classical technique is the opportunity to histopathological evaluation of resected diverticulum what is impossible to achieve in endoscopic techniques.

Sinonasal Verrucous Carcinoma

ABSTRACT Verrucous carcinoma is a low grade malignancy and is a variant of squamous cell carcinoma. It is a rare tumor of the sinonasal tract. The neoplasm occurs in older people usually in the seventh or eighth decade of life. Our cases were both of sinonasal origin and of younger age group. How to cite this article Qazi SM, Iqbal I, Mirza A, Ali I, Kumari S. Sinonasal Verrucous Carcinoma. Int J Head Neck Surg 2015;6(1):8-9.