Healthy Middle-aged People Research Articles

Recurrent transient topographical amnesia: a patient with frequent episodes

Topographical disorientation is a condition in which a subject becomes disoriented in familiar surroundings [1]. The selective deficit of topographical disorientation is relatively rare and has been attributed to cerebrovascular disease, Alzheimer’s disease, and frontotemporal dementia [1–3]. Recently, cases of transient topographical amnesia (TTA) have been published [4–7]. These cases are characterized by a sudden onset and short-lasting disturbance in orientation without any loss of consciousness or episodic memory. The patients soon recover completely, and their prognosis seems good without progression to dementia or physical disability. We report a patient who had recurrent episodes of TTA, which gradually worsened over 16 years. The patient was a 61-year-old right-handed man, with 9 years of formal education. His birth and development were normal, and there was no history of neurological disease in his family. His first episode of topographical disorientation occurred at 45 years of age, when he was driving his car along familiar roads. The episode lasted for only several seconds, and immediately following he was reorientated. These episodes first occurred once a year, but gradually increased in frequency with time. The attacks also occurred while walking and occasionally their duration was close to 1 min. At age 61, he experienced these episodes a few times a month, and then visited our hospital. He described the episodes as follows: ‘‘I was driving my car to go home from the office. I suddenly became insensible even to familiar sights. I could not recognize the buildings and bridges for pedestrians while I should know them. Then, they became clear several seconds later.’’ During the episode, he was alert and well-oriented. He was aware of, and memorized his attack, and could describe it later in detail. Neuropsychological evaluation of memory and abstract logical abilities proved normal by means of standardized tests (Table 1). There were no abnormalities in his neurological examination, or in his complete blood count, serum biochemistry including thyroid function and vitamins, Holter electrocardiogram, repeated electroencephalogram (EEG), brain magnetic resonance imaging (MRI) and angiography, with the exception of [I]iodoamphetamine single photon emission computed tomography (SPECT) performed 2 weeks after the last attack, showing hypoperfusion in the inferolateral surface of bilateral occipital lobes (Fig. 1). Repeated EEGs revealed no abnormalities and carbamazepine medication failed to improve his symptoms, although epilepsy was suspected as the pathogenic mechanism. Transient topographical amnesia is a rare symptom, and previous literature reported that some episodes are caused by transient ischemic attack [8], migraine [9], normal pressure hydrocephalus [10], and epilepsy [7, 11]. The etiology of TTA remains unknown. Most patients with TTA are healthy middle-aged or elderly people, and A. Shindo (&) H. Tomimoto Department of Neurology, Mie Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan e-mail: a-shindo@clin.medic.mie-u.ac.jp

The gait disorders diagnostic method with using the laser range finder in patients with cerebellar ataxia syndrome

The aim of the study was assessment of gait parameters with a laser range finder use in patients with cerebellar ataxia syndrome. There are reliable differences in the relative stride length and stride variability coefficient for the patients with ataxia in comparison with the healthy middle aged people was found.

Subchondral Fracture of the Femoral Head in Healthy Adults

Subchondral fracture of the femoral head has been reported to occur as an insufficiency fracture associated with poor bone quality or as a fatigue fracture in young military recruits. Transient osteoporosis of the hip has clinical and imaging findings that resemble those of a subchondral fracture, but it usually occurs in healthy middle-aged people not involved in sports or similar activities. The clinical aspects of five cases of subchondral fracture of the femoral head occurring in four healthy adults without antecedent trauma were evaluated. Of particular interest were whether subchondral fracture of the femoral head could occur without a sudden increase in daily activity and what differences could be detected from the imaging and clinical courses between subchondral fracture of the femoral head and transient osteoporosis of the hip. Three cases of subchondral fracture of the femoral head occurred without an increase in daily activity. The only difference in imaging findings between subchondral fracture of the femoral head and transient osteoporosis of the hip was the existence of a subchondral fracture line seen on magnetic resonance images of a subchondral fracture of the femoral head. The clinical courses of these disorders were similar. These findings suggest transient osteoporosis of the hip and subchondral fracture of the femoral head are subchondral bone injuries of different severity. Level IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Modulation of the withdrawal reflex during hemiplegic gait: Effect of stimulation site and gait phase

Objective The objective of the study was to investigate the sensitivity of the nociceptive withdrawal reflex to stimulation of different locations on the sole of the foot during hemiplegic gait. Methods Reflexes were evoked by cutaneous electrical stimulation of 4 locations on the sole of the foot of 7 hemiplegic and 6 age-matched healthy persons. The stimuli were delivered at heel-contact, during foot-flat, at heel-off, and during mid-swing. Reflexes were recorded from muscles of the stimulated and the contralateral leg. Ankle, knee, and hip joints angles were recorded using goniometers. Results In the hemiplegic persons, the size of tibialis anterior reflexes, and the latency of soleus reflexes were site- and phase-modulated. In both groups, the tibialis anterior reflexes were significantly smaller with stimulation to the fifth metatarsophalangeal joint and the heel compared with the first metatarsophalangeal joint and the arch of the foot. The tibialis anterior reflexes evoked at heel-off and mid-swing were larger in hemiplegic persons than in healthy persons. Reflexes in the proximal and contralateral limb muscles were not site-modulated during hemiplegic gait. The kinematic response at the ankle joint was also different in the two groups during mid-swing. Conclusions Hemiplegic and healthy middle-aged people presented different phase-modulation of the kinematic and muscle nociceptive reflex responses evoked by stimulation delivered on the sole of the foot. Significance The results have potential application in programs to rehabilitate hemiplegic gait.

Relationships between Age, Daily Physical Activity, Antioxidant Capacity and Oxidative Stress among Middle-aged and Elderly People

The effects of age and daily physical activity (PA) on antioxidant capacity and oxidative stress remains unclear, especially among advanced age population. Thus the present study evaluated antioxidant capacity and oxidative stress status, taking into account age and PA in healthy middle-aged and elderly people (45-92 years, n=436; 166 males and 270 females). The advanced age subjects were classified in groups according to their age. Data collected from young male subjects (18-26 years, n=36) were used as a reference. The scavenging activity against superoxide anions (O2 · -) and hydroxyl radicals (HO · ), oxidized/reduced glutathione concentrations ([GSSG] and [GSH]) and thiobarbituric acid reactive substances concentration ([TBARS]) were analyzed using blood samples which were obtained at resting condition. The PA of all subjects was determined using a pedometer. By comparing antioxidant and oxidative stress markers between groups, there were not any marked differences except for the fact that elderly subjects had lower [GSH] and higher [TBARS] than young subjects. As a result of multi-regression analysis using factors such as age, sex, life style related disease and smoking habit as explaining variables, the PA did not associate with either antioxidant capacity or oxidative stress status. These data suggested that age and PA may have little influence on antioxidant capacity and oxidative stress among advanced age people.

Relationship between carotid artery stiffness and retinal arteriolar narrowing in healthy middle-aged persons.

Both carotid atherosclerosis and cerebral arteriolosclerosis are associated with stroke. However, the relationship between carotid atherosclerosis and cerebral arteriolosclerosis is unknown. We examined the association between carotid artery stiffness, a marker of early atherosclerosis, and retinal arteriolar narrowing, a marker of arteriolosclerosis, in healthy middle-aged people. This population-based, cross-sectional study involved 8031 men and women 45 to 64 years of age. Carotid arterial stiffness was estimated from high-resolution ultrasonic echo tracking of the left common carotid artery and was defined as adjusted arterial diameter change (AADC, micro, adjusted for diastolic blood pressure, pulse pressure and pulse pressure squared, and diastolic arterial diameter and height, with smaller AADC reflecting greater arterial stiffness). Generalized retinal arteriolar narrowing was estimated from measurements of diameters of retinal vessels from digitized retinal photographs and summarized as the arteriole-to-venule ratio (AVR, with smaller AVR indicating greater retinal arteriolar narrowing). After controlling for age, sex, ethnicity, hypertension, diabetes, and cigarette smoking, decreasing AADC was associated with decreasing AVR. The mean AADCs, comparing the lowest and highest quartiles of AVR, were 394 (SE, 4) and 409 (SE, 4) micro, respectively (P<0.01). The pattern of the graded association between carotid arterial stiffness and generalized retinal arteriolar narrowing was similar among persons with and without hypertension. Greater stiffness of the carotid arteries is related to generalized narrowing of the retinal arterioles independent of blood pressure and other vascular factors. This supports a relationship between macrovascular and microvascular disease processes important in stroke pathogenesis.

Retinal microvascular changes and MRI signs of cerebral atrophy in healthy, middle-aged people

Cerebral magnetic resonance imaging (MRI) scans often reveal sulcal widening and ventricular enlargement in elderly people. These imaging characteristics are believed to reflect atrophy of the brain, as part of the spectrum of cerebral changes associated with aging. However, sulcal widening and ventricular enlargement have also been independently linked with cardiovascular risk factors such as hypertension, diabetes, and cigarette smoking and with a prior history of stroke, suggesting that vascular mechanisms may also contribute to the pathogenesis of these cerebral characteristics. Because the retinal vessels are accessible to direct noninvasive evaluation and share common anatomic, embryologic, and physiologic characteristics with the cerebral microcirculation, these vessels offer a unique opportunity to investigate the role of the microcirculation in cerebrovascular diseases. Abnormalities of the retinal arterioles (for example, microaneurysms, retinal hemorrhages, and arteriolar narrowing) may be markers of concomitant cerebral small vessel diseases. In the Atherosclerosis Risk in Communities (ARIC) Study, a large community-based study of cardiovascular health in middle-aged people, the authors previously showed that retinal microvascular abnormalities, as documented from retinal photographs, are independently associated with incident stroke, cognitive impairment, and cerebral white matter lesions detected on MRI. The objective of this study was to examine the relation of retinal microvascular abnormalities and MRI signs of cerebral atrophy in healthy middle-aged people. A population-based, cross-sectional study involved 1,684 persons aged 51 to 72 years who had cerebral MRI and retinal photography in 1993 to 1995. Sulcal and ventricular size were quantified from the MRI scans and coded as grades 0 to 9, with sulcal widening and ventricular enlargement defined as grades 3 or higher. The presence or absence of retinopathy, microaneurysms, hemorrhages, and other characteristics were defined from retinal photographs using a standardized protocol. Generalized arteriolar narrowing was defined from a computer-assisted measurement of arteriolar diameters from digitized photographs. Persons with retinopathy had higher sulcal (P = .001) and ventricular (P = .03) grades than persons without retinopathy. After adjusting for age, gender, race, mean arterial blood pressure, diabetes, cigarette smoking, common carotid artery intima\Nmedia thickness, and other vascular risk factors, retinopathy was significantly associated with sulcal widening (odds ratio OR, 1.9; 95% confidence intervals CI, 1.2, 3.0) and ventricular enlargement (OR, 1.5; 95% CI, 1.0, 2.3). These associations persisted even in people without diabetes or hypertension (OR 1.9, 95% CI, 0.8, 4.4 for sulcal widening; OR 2.7, 95% CI, 1.2, 6.5 for ventricular enlargement). Other retinal arteriolar characteristics (arteriovenous nicking, focal and generalized arteriolar narrowing) were not related to sulcal or ventricular grade. The authors conclude that in healthy, middle-aged people, retinopathy is independently associated with sulcal and ventricular enlargement on MRI. This finding is compatible with the hypothesis that microvascular characteristics may influence the development of cerebral atrophic changes. Valerie Biousse

Flicker sensitivity and cardiovascular function in healthy middle-aged people.

To establish normative relations between measures of visual function and cardiovascular variables that are important for age-related disease, including various forms of glaucoma. Foveal flicker sensitivities, resting blood pressures and heart rates, and intraocular pressures were measured in 18 individuals aged 40 to 68 years. All subjects had 20/20 or better visual acuity in the test eye and no evidence of eye disease or glaucoma suspicion on clinical evaluation and medical history. No subjects were using medication to lower blood pressure. Flicker sensitivity was measured by increasing the illuminance of a fully modulated 20-Hz test stimulus until flicker was perceived. Two test-background stimulus combinations were used: a 570-nm ("yellow") test on a predominantly long-wavelength ("magenta") background and a 580-nm ("yellow") test on a 580-nm ("yellow") background. The illuminance of the yellow background was dimmer than that typically used for short-wavelength automated perimetry, whereas the illuminance of the magenta background was greater. The 2 flicker sensitivity measures were distinguished by the strong dependence of the magenta background measure on the ratio of mean arterial blood pressure to heart rate. Log flicker sensitivity on this background generally could be modeled as a linear combination of age, intraocular pressure, and ratio of mean arterial blood pressure to heart rate. The optimal model accounted for 84% of the variance (R = 0.92) from all but 2 outlying individuals. After age and intraocular pressure effects were partialed out, an increasing ratio of mean arterial blood pressure to heart rate was strongly associated with decreasing flicker sensitivity. Reduced cardiovascular function impacts the ability of the normal visual system to adapt and regulate flicker sensitivity. Elevated intraocular pressure and increased age reduce flicker sensitivity relatively uniformly across a range of stimulus conditions. Because the ratio of mean arterial blood pressure to heart rate equals total peripheral vascular resistance multiplied by cardiac stroke volume, and because total peripheral resistance is determined largely at the arterioles, it is likely that even modest changes in arteriolar function are associated with measurable alterations of visual function. Arch Ophthalmol. 2000;118:1049-1055

Influence of gender, age and sampling time on plasma fibrinolytic variables and fibrinogen: A population study

Reference data are provided for tissue plasminogen activator (t-PA) activity, t-PA antigen levels, plasminogen activator inhibitor type 1 (PAI-1) activity and fibrinogen levels in plasma. The data are from a population-based sample of 1288 healthy 25 to 64-year-old men and women who were not taking any medication. Time of sampling influenced the measurements in that, from 07:00 to 14:00 t-PA activity rose, t-PA antigen levels and PAI-1 activity declined, whereas plasma fibrinogen levels remained unchanged. Age had little influence on t-PA activity or PAI-1 activity, although t-PA antigen levels correlated with increasing age (r=0.26 and 0.34, in men and women, respectively). Fibrinogen levels also correlated with age (r=0.29 in both sexes). In the 45 to 54-year age group, t-PA activity was significantly lower (p<0.001) and PAI-1 activity significantly greater (p<0.01) in men than in women; otherwise there were no gender differences in t-PA and PAI-1 activities. t-PA antigen levels were consistently greater in men up to the age of 55. Fibrinogen levels were greater in women in the youngest and oldest age group. The strongest interrelations between the fibrinolytic variables were observed between t-PA and PAI-1 activities (r= −0.73 in men, −0.59 in women, p<0.001) and between PAI-1 activity and t-PA antigen levels (r=0.40 in men, 0.37 in women, p<0.001). This first population-based description of fibrinolytic parameters, including t-PA activity, in healthy middle-aged people shows that timing of blood sampling should be standardized and that reference data must be age- and sex-specific. In the assessment of fibrinolytic function, measurements of t-PA antigen levels seem to add little to determinations of t-PA and PAI-1 activities.