Younger-onset Group Research Articles

P262 Differences in the Management and Demographics of Adult Inflammatory Bowel Disease in Older-Onset and Younger-Onset

Abstract Background The goal of this study was to investigate differences in the management and demographic characteristics of older-onset and younger-onset adult patients with Ulcerative Colitis (UC) and Crohn’s Disease (CD). Methods We retrospectively compared the management and distinguishing characteristics of UC and CD patients who were older-onset (≥60 years) and younger-onset (18-60 years) between June 1993 and October 2023. Results A total of 1245 patients with 56 (4.5%) older-onset adults (Male 41, 73%) and 1189 (95.5%) younger-onset adults (Male 725, 58%) were admitted to the study. The median follow-up time was 11 years (Older-onset 6 and younger-onset 11 years) for both groups. Prevalence of UC 39 (69.6%) in the older-onset group was more common than that of younger-onset group 579 (48.7%), (p=0.002). There were no significant differences between the two disease onset groups in terms of UC extension, CD location, behavior, and perianal involvement. In younger-onset, active smokers 277 (23%) was more frequent than older-onsets 6 (10%) (p= 0.003). A family history of IBD in older onsets 2 (4%) was less common than younger-onsets 155 (13%) (p= 0.037). Prior major abdominal surgery was detected similar (Older-onset 20, 35.7% and younger-onset 464, 39%). At least one extraintestinal manifestation exist was less common in older-onsets 18 (32.1%) than younger-onsets 606 (51%) (p= 0.006). Baseline partial MAYO score 7 and CDAI 302 in older-onsets, and 297 in younger-onsets were similar in both groups. Thiopurine usage 391 (32.9%) in younger-onsets was the most frequent than in older-onsets 9 (16.1%) (p=0.008). There was no difference in both groups in terms of other conventional medications. At least one biological experience was less common in older-onsets 15 (26.8%) than the younger-onsets group 586 (49.3%) (p=0.001). The two biological therapies that were used the most frequently were adalimumab (Older-onset; 6, 10.7% and younger-onset; 384, 32.8%) (p=0.001) and infliximab (Older-onset; 15, 26.8% and younger-onset; 586, 49.3%) (p=0.02). Conclusion Our study showed that the prevalence of UC in older-onsets was more common than younger-onsets. A family history, extraintestinal manifestation, thiopurine, and biological usage in older-onsets were less common than in younger-onsets. Major abdominal surgery was similar in both groups. Older-onset patients demonstrated significant differences in medication utilization, including less thiopurine and biological therapy compared with younger-onset groups, these utilization patterns may have long-term effects on disease outcomes. Further investigation is needed to optimize care pathways in the older-onset population.

Clinical characteristics and outcome of elderly onset adult-onset Still's disease: A 10-year retrospective study

ObjectiveOur objective was to retrospectively analyze the clinical characteristics and outcome of adult-onset Still's disease (AOSD) patients with elderly onset. MethodsRetrospective data of patients diagnosed with AOSD in our institute during 2013–2021 were analyzed. The diagnoses were based on the Yamaguchi criteria for AOSD. All long-term follow-up data were collected from medical records and phone calls. ResultsIn total, 281 AOSD patients were enrolled in this study, with the median follow-up interval of 47 months. Thirty-two (11.4%, ≥65 years) AOSD patients were classified into the elderly onset groups. Compared to the younger onset group, the percentage of patients with skin rash (p = 0.047), sore throat (p = 0.001), myalgia (p = 0.001), splenomegaly (p = 0.039), hepatosplenomegaly (p = 0.002) and the Pouchot's score (p = 0.002) were significantly lower in the elderly onset group. The death rate (p = 0.014) of elderly onset group is higher than younger onset group, and the independent risk factors of mortality in all AOSD patients were age at onset (HR: 1.115, p = 0.044), disseminated intravascular coagulation (HR: 391.576, p = 0.001) and pleuritis (HR: 23.162, p = 0.033). The probability of relapse was significantly increased in the patients with macrophage activation syndrome (MAS) compared with the patients without MAS (p < 0.001), though the different age groups of AOSD patients with MAS showed no difference in the probability of relapse (p = 0.737). ConclusionElderly onset AOSD patients were distinguished by several distinct clinical features compared to younger onset AOSD patients. The frequency of relapse and complications were similar to that of AOSD patients with elderly or younger onset. A higher mortality rate was observed in elderly onset AOSD patients, and the mortality of AOSD patients was related to age at onset, DIC and pleuritis.

Clinical Profile And Risk Factors Of Stroke: A Comparative Analytical Study Between Young And Old Onset

Background: With ever-increasing incidence, young-onset stroke is responsible for significant psychosocial and economic burden, primarily due to post-stroke disability in the productive population. Objective: The aim of our study is to assess the profile and risk factors in young-onset stroke compared to those in older patients. Methods: This was a retrospective cross-sectional study. We included all patients with acute stroke, or transient ischemic attack (TIA) treated at Siloam Lippo Village Hospital between October 2021 and February 2022. An independent t-test was conducted for continuous variables with normal distribution and a Mann-Whitney U test for ordinal or continuous variables with non-normal distribution. Pearson's chi-square test was performed for categorical variables. Results: 153 patients with acute stroke and TIA were included. On univariate analysis comparing young and old-onset strokes, significant differences were found in diagnosis (p=0.039), Bamford classification (p=0.022), NIHSS (p=0.014), history of smoking (p=0.012), previous stroke (p=0.045), history of coronary artery disease (p=0.026), and routine antiplatelet use (p=0.018). Conclusion: We found a predominance of hemorrhagic stroke and TIA in the young-onset group, with more common involvement of the anterior circulation. Older onset was associated with a higher NIHSS score. Modifiable risk factors are more common in young-onset stroke, while non-modifiable risk factors are more common in the older population. However, hypertension remains an equally important risk factor in both groups. Our study provides an overview of the profile and risk factors for young-onset stroke. The information obtained can be useful as educational material for the community to prevent young-onset stroke.

Retinal Thickness Associates with Cognition Dysfunction in Young Adult with Type 1 Diabetes in Taiwan.

Background Several factors could affect the cognitive dysfunction in patients with type 1 diabetes (T1D). Objectives To report the characteristic of cognitive dysfunction in T1D and find its association with the retinal thickness. Subjects We recruited one hundred and seven patients with T1D in our study. Methods Detailed clinical and demographic factors and Cambridge Automated Neuropsychological Test Battery (CANTAB) were performed in all participants. The age at onset>5 years old and ≤5 years old groups was defined as old- and young-onset groups. The levels of the average values of 5-year glycated hemoglobin (HbA1c_5) before study were collected. Ophthalmic study and central retinal thickness (CRT) were performed. Results The median age of T1D was 24.9 years old and 57 participants were women. The median age at onset was 7.4 years old, and mean disease duration was 17.2 years. After adjusting off multiple covariates by the regression analyses, the young-onset group had significantly a longer latency in sustained attention than old-onset group (P = 0.02). The HbA1c_5 showed a significantly negative association with the sustained attention (P = 0.03). The average values of CRT showed significantly negative correlations with the reaction time in sustained attention and visual searching (P = 0.04 and P < 0.01, respectively). Conclusions Our results suggest that age at onset and glycemic control had significant impacts on different cognitive domains in T1D. The CRT had a significant correlation with sustained attention, which could be a surrogate markers of brain structural changes in T1D.

Clinical characteristics and treatment of elderly onset adult-onset Still\u2019s disease

Adult-onset Still’s disease (AOSD)—a systemic inflammatory disease—often occurs at a young age. Recently, elderly onset patient proportion has been increasing; however, data are limited. To evaluate the characteristics of elderly patients with AOSD in a multicenter cohort, we retrospectively analyzed 62 patients with AOSD at five hospitals during April 2008–December 2020. Patients were divided into two groups according to age at disease onset: younger-onset (≤ 64 years) and elderly onset (≥ 65 years). Clinical symptoms, complications, laboratory findings, treatment, and outcomes were compared. Twenty-six (41.9%) patients developed AOSD at age ≥ 65 years. The elderly onset group had a lower frequency of sore throat (53.8% vs. 86.1%), higher frequency of pleuritis (46.2% vs. 16.7%), and higher complication rates of disseminated intravascular coagulation (30.8% vs. 8.3%) and macrophage activation syndrome (19.2% vs. 2.8%) than the younger onset group. Cytomegalovirus infections were frequent in elderly onset patients (38.5% vs. 13.9%) but decreased with early glucocorticoid dose reduction and increased immunosuppressant and tocilizumab use. Elderly AOSD is not uncommon; these patients have different characteristics than younger-onset patients. Devising a way to control disease activity quickly while managing infections may be an important goal in elderly AOSD.

Clinical and demographic features among patients with type 1 diabetes mellitus in Henan, China

BackgroundThe hallmark of type 1 diabetes (T1D) is an absolute lack of insulin. However, many studies showed a tendency to heterogeneity in TID. We aimed to investigate the demographic and clinical characteristics in T1D and the differences in young-onset and adult-onset patients.MethodsThis retrospective study was conducted among 1943 patients with clinically diagnosed T1D. Medical records on patients’ demographics, anthropometric measurements, and clinical manifestation were collected. According to the age at onset, the newly diagnosed patients were divided into the young-onset group (< 18 years, 234 patients, mean age 11 years) and adult-onset group (≥ 18 years, 219 patients, mean age 27 years). Pancreatic β-cell function was assessed by fasting C-peptide (FCP) and 2-h C-peptide (2-h CP).ResultsThe median age of patients at disease onset was 22 years. The median duration of patients was 3 years. The overall median glycated hemoglobin (HbA1c) value was 10.3 % [89(mmol/mol)]. The prevalence of diabetic retinopathy was 25.1 %. The overall rate of DKA at onset in the new-onset patients was 59.6 %. The frequency of overall dyslipidemia was 37.8 %. The most frequent dyslipidemia was low high-density lipoprotein-cholesterol (HDL) (29 %). The proportion of patients with anti-glutamic acid decarboxylase (GADA), insulin antibody (IAA) and islet cell antibody (ICA) were 28.1 %, 6.4 % and 21.6 %, respectively. The mean HbA1c showed a downward trend with age. Increasing or decreasing trends of overweight and obesity in this population during the period 2012 to 2018 was not found.Compared with young-onset T1D, adult-onset patients comprised better islet function (FCP: 0.4 vs. 0.3 ng/ml, P < 0.001; 2-h CP: 0.9 vs. 0.7 ng/ml P < 0.001, respectively) and glycemic control [12.9 % (117mmol/mol) vs. 11.7 % (104mmol/mol), P < 0.001], higher prevalence of diabetes condition in the male gender (64.4 % vs. 51.3 %, P = 0.006), higher proportion of obesity or overweight (24.6 % vs. 9.5 %, P = 0.002), higher frequency of GADA (33.7 % vs. 23.3 %, P = 0.025), and lower frequency of diabetic ketoacidosis at disease onset (64.5 % vs. 43.5 %, P < 0.001).ConclusionsThis population was characterized by poor overall blood glucose control, high prevalence of DKA, dyslipidemia and diabetic retinopathy, and low prevalence of islet-related antibodies, and overweight or obesity. Adult-onset patients with T1D were not uncommon and had better clinical manifestations than young-onset patients. Any findings related to body mass index (BMI) and autoantibodies should be considered strictly exploratory due to excessive missing data.

Patients with late onset psychogenic non-epileptic seizures (PNES): How do they compare to those with younger onset?

ObjectiveTo determine whether patients who experienced their first psychogenic non-epileptic seizure (PNES) at 50 years or older differed from those who developed PNES at a younger age, in terms of demographic, social/clinical as well as psychological measures. BackgroundThe typical age for PNES onset is roughly between 20 and 40 years of age. Only a handful of studies have examined samples with PNES onset at an older age and therefore information about these individuals is limited. MethodsThis is a retrospective study of 75 consecutive individuals who developed (video EEG-confirmed diagnosis) PNES before age 50 years and 55 consecutive individuals who developed PNES at 50 years or more. Patients were examined on demographics (age, education, working and relationship status), clinical (seizure frequency, trauma type: sexual, multiple trauma, and health-related traumatic experiences), and self-report measures(Coping Inventory for Stressful Situations, Toronto Alexithymia Scale, and the Quality of Life Inventory in Epilepsy-31). ResultsPatients who had experienced sexual trauma were likelier to develop PNES at an earlier age. Those who experienced “health problems pre-PNES onset” were likelier to develop PNES at an older age. On psychological measures, it was noted that after adjusting for the covariate effects, those with elevations in Avoidance (CISS) were likelier to develop PNES at an earlier age. and those with elevations in QOLIE31 cognitive complaints were likelier to be in the older cohort. ConclusionsNo matter at what age PNES presented, patients reported markedly high rates of exposure to psychological trauma (single and multiple), similarly elevated unemployment rates and low quality of life. The groups with different age of onset differed in the type of trauma experienced prior to the development of PNES. In addition, the younger onset group demonstrated a significantly higher use of avoidance as a stress-coping strategy.

Clinical Characteristics of Japanese Patients with Elderly-Onset Adult-Onset Still's Disease.

The aim of this study was to compare the characteristics of Japanese patients with elderly-onset Adult-onset Still's disease (AOSD) and those with younger-onset AOSD. Patients were classified into elderly-onset (≥ 65 years, n = 20) and younger-onset (< 65 years, n = 62) groups according to age at AOSD diagnosis. Analyses included the comparison of clinical features, treatments, and Pouchot and modified Pouchot (mPouchot) scores between the two groups. The frequencies of sore throat, lymphadenopathy, and splenomegaly were significantly lower in the elderly-onset group than in the younger-onset group (30.5% vs. 80.6%, p = 0.0004; 15.0% vs. 54.8%, p = 0.0019; 30.0% vs. 61.3%, p = 0.0203; respectively). There were no significant differences in the frequencies of complications, such as macrophage activation syndrome and disseminated intravenous coagulation, between the patients with elderly-onset or younger-onset AOSD. Serum ferritin levels were higher in the elderly-onset group than in the younger-onset group, albeit without statistical significance (median, 9,423 vs. 4,164 ng/mL, p = 0.1727). Pouchot score was lower in the elderly-onset group than in the younger-onset group (median score, 5.5 vs. 4.0, p = 0.0008); however, there was no significant difference in the mPouchot score between the two groups. Our analyses revealed that elderly-onset AOSD was associated with certain characteristics that were distinct from those of younger-onset AOSD and that the disease severity in patients with elderly-onset AOSD, determined by Pouchot score at the time of AOSD diagnosis, was similar to or less than that in patients with younger-onset AOSD.

Clinical features of elderly-onset Adult-onset Still’s disease

Objectives To clarify the characteristics of patients with elderly-onset Adult-onset Still’s disease (AOSD). Methods Patients were classified into elderly-onset (>60 years: 47 patients) and younger-onset (≤60 years: 95 patients) groups according to their age at diagnosis of AOSD. Clinical features, treatments, and prognosis were compared between the elderly-onset and younger-onset groups. Results In the elderly-onset group, compared with the younger-onset group, typical skin rashes were less frequent (21.3% vs 58.9%, respectively; p < .0001), whereas pleuritis (27.7% vs 7.4%, respectively; p = .0011) and disseminated intravascular coagulation (19.1% vs 2.1%, respectively; p = .0004) were more frequent, and serum ferritin levels were higher (median 12,700 ng/ml vs 2526 ng/ml, respectively; p < .0001). Overall survival and AOSD-related survival were reduced (p = .0006 and p = .0023, respectively) and drug-free remission was less frequent (p = .0035) in the elderly-onset group compared with the younger-onset group. Conclusions Our results demonstrated that elderly-onset AOSD patients had several characteristics that differed from younger-onset AOSD patients, including less typical skin lesions, more AOSD-related complications, higher ferritin levels, and poorer prognoses.

Longitudinal evolution of non-motor symptoms according to age at onset in early Parkinson's disease

ObjectiveTo investigate the longitudinal change of non-motor symptoms according to the age at onset in Parkinson's disease (PD). MethodsThis cohort study using the Parkinson's Progression Markers Initiative data included 405 patients with early PD. They were classified into late-onset (age at onset ≥ 70 years, n = 63), middle-onset (50 to 69 years, n = 268), and young-onset (<50 years, n = 74) groups. Non-motor symptoms were assessed with well-validated instruments covering neuropsychiatric, sleep-related, and autonomic symptoms yearly over 5 years of follow-up. Dopamine transporter imaging was also performed at baseline and the 1-, 2-, and 4-year follow-up visits. ResultsThe late-onset group had a mean decrease of 0.35 more points per year in the Montreal Cognitive Assessment (MoCA) scores (p = 0.008) and increases of 0.32 more points in the 15-item Geriatric Depression Scale scores (p = 0.002) and 0.72 more points in the State-Trait Anxiety Inventory-state scores (p = 0.022) compared to the middle-onset group. The young-onset group had a mean decrease of 0.22 fewer points per year in the MoCA scores (p = 0.002) than the middle-onset group. The other non-motor progression did not differ among the groups. No significant differences were found between the late-onset, middle-onset, and young-onset groups in the changes of striatal DAT binding ratios. ConclusionCompared to middle-onset PD, late-onset PD showed a faster progression of cognitive impairment along with depression and anxiety, and young-onset PD showed a slower progression of cognitive impairment in the early phases of the disease. These differences do not appear to be associated with the longitudinal changes in striatal dopaminergic activities.

Maternal vs paternal diabetes: The parental history is different in younger onset versus older onset type 2 diabetes

BackgroundA number of previous studies exploring family history of type 2 diabetes have reported a predominance of maternal diabetes. These studies have not explicitly compared parental history of diabetes across the spectrum of disease onset from youth to later adulthood. MethodsFamily history data from 11,467 patients with type 2 diabetes were extracted from the RPA Diabetes Centre database. Parental histories of diabetes were compared across a range of age of diagnosis strata (15-<30, 30-<40, 40-<50, 50-<60 and 60-<70 years). For the young-onset group (diagnosed between 15 and 30 years of age), associations between parental history of diabetes and the presence of cardio-metabolic risk factors and diabetic complications were also explored. ResultsFor the total cohort and within each age of diagnosis strata, more individuals reported maternal history than paternal history of diabetes. The young-onset group demonstrated the highest prevalence of any parental history of diabetes (60.7%), the highest combined maternal and paternal history (15.8%) and the smallest differential between maternal (25.1%) and paternal (19.7%) history of diabetes. Within the young-onset group, no significant association between parental history and cardio-metabolic risk factors or diabetic complications were identified after a median of 15.0 years of diabetes exposure. ConclusionOverall, our results demonstrate a consistent maternal excess of diabetes which could be consistent with an underlying epigenetic effect. However, the differential between maternal and paternal history is significantly lower in the young-onset group. Earlier emergence of type 2 diabetes may therefore reflect a different interaction and impact of genetic and environmental factors.

Heterogeneous Patterns of Striatal Dopamine Loss in Patients with Young- versus Old-Onset Parkinson's Disease: Impact on Clinical Features.

ObjectiveAmple evidence has suggested that age at onset of Parkinson’s disease (PD) is associated with heterogeneous clinical features in individuals. We hypothesized that this may be attributed to different patterns of nigrostriatal dopamine loss.MethodsA total of 205 consecutive patients with de novo PD who underwent 18F-FP-CIT PET scans (mean follow-up duration, 6.31 years) were divided into three tertile groups according to their age at onset of parkinsonian motor symptoms. Striatal dopamine transporter (DAT) availability was compared between the old- (n = 73) and young-onset (n = 66) groups. In addition, the risk of developing freezing of gait (FOG) and longitudinal requirements for dopaminergic medications were examined.ResultsThe old-onset PD group (mean age at onset, 72.66 years) exhibited more severe parkinsonian motor signs than the young-onset group (52.58 years), despite comparable DAT availability in the posterior putamen; moreover, the old-onset group exhibited more severely decreased DAT availability in the caudate than the young-onset group. A Cox regression model revealed that the old-onset PD group had a higher risk for developing FOG than the young-onset group [hazard ratio 2.523, 95% confidence interval (1.239–5.140)]. The old-onset group required higher doses of dopaminergic medications for symptom control than the young-onset group over time.ConclusionThe present study demonstrated that the old-onset PD group exhibited more severe dopamine loss in the caudate and were more likely to develop gait freezing, suggesting that age at onset may be one of the major determinants of the pattern of striatal dopamine depletion and progression of gait disturbance in PD.

Racial/ethnic differences in the outcomes of patients with metastatic breast cancer: contributions of demographic, socioeconomic, tumor and metastatic characteristics

PurposePopulation-based estimates of racial disparities in metastatic breast cancer are lacking. We quantified the contributions of demographic, socioeconomic, tumor, and metastatic characteristics to racial differences in metastatic breast cancer and characterized the most disproportional subgroup.MethodsPatients diagnosed with metastatic breast cancer between 2010 and 2014 were identified using the Surveillance, Epidemiology, and End Results database. A multivariable Cox proportional hazards model was used to adjust each set of variables. The excess relative risk of cancer-specific and all-cause death in non-Hispanic black (NHB) versus non-Hispanic white women diagnosed with metastatic breast cancer was expressed as a percentage and was stratified by the age at diagnosis.ResultsWe identified 13,066 female patients. NHB women exhibited substantially higher morbidity and mortality than women of other races/ethnicities. The greatest excess mortality risk for NHB women was observed in the young-onset group (18–49 years; hazard ratio: 1.57), followed by the middle-age group (50–64 years; hazard ratio: 1.42); the trend was not significant among the elderly group. Socioeconomic factors stably explained one-half of the excess risk, whereas the contribution of tumor characteristics obviously decreased with age (18–49 years, 40.7%; 50–64 years, 33.9%), and the metastatic pattern accounted for approximately one-tenth of the excess risk. Additionally, the disproportional death burden of NHB women persisted in less aggressive subgroups.ConclusionsBy providing a comprehensive assessment of racial differences in the incidence and outcomes of patients with metastatic breast cancer, we urge the implementation of targeted preventive efforts in both the public health and clinical arenas.

Clinical analysis of late-onset systemic lupus erythematosus in Xinjiang

Objective To assess the clinical characteristics of systemic lupus erythematosus (SLE) in the elderly in Xinjiang. Methods As a retrospective study, clinical date and laboratory test results were collected from 87 elderly SLE patients and 222 non-elderly SLE patients (age <50 years)hospitalized in the People's Hospital of the Xinjiang Uygur Autonomous Region from January 2006 to July 2016. Results The female to maleratio was 5.7∶1.0 in the older-onset SLE group and the female to male ratio was 11.3∶1.0 in the younger-onset SLE group.Of the 13 patients with predisposing factors in the older-onset SLE group(14.9%), 11 had infection (12.6%), whereas the 27 patients with predisposing factors in the younger-onset SLE group (12.2%)had pregnancy, abortion or insolation, in addition to infection.Arthritis(63.2%), weakness(40.2%), malar rashes(36.8%), anorexia(26.4%), and shortness of breath(26.4%) were common clinical manifestations in the older-onset SLE group.The incidence of anorexia in the older-onset SLE group was higher than that in the younger-onset SLE group(P<0.01), while the incidence of trichomadesis was lower in the older-onset SLE group than that in the younger-onset SLE group(P<0.01); Aminotransferase elevation, creatinine elevation and thrombocytopenia were more common in the older-onset SLE group than in the younger SLE group (P<0.05). Lower rates of positive anti-Smanti body and anti-Acl antibody were found in the older-onset SLE group, compared with the younger-onset SLE group (P<0.05); Han older-onset SLE patients showed higher rates of oral ulcers than older-onset SLE patients of Uygur, Kazak or other ethnic minorities (P<0.05). There were no significant differences between Han and Uygur/Kazak patients in laboratory test results. Conclusions The proportion of male SLE patients in the elderly is higher than that in non-elderly SLE patients in Xinjiang.Also, elderly SLE patients are prone to oral ulcers but often do not show typical early clinical symptoms and have low levels of specific antibodies.Therefore, clinicians should pay particular attention to older-onset SLE patients in order to reduce the rates of misdiagnosis and missed diagnosis. Key words: Lupus erythematosus; systemic

Analysis of biochemical and pathological features as well as therapeutic response of autoimmune hepatitis in the elderly-onset patients

Objective To investigate the differences in the biochemical and pathological features and therapeutic response between the elderly-onset autoimmune hepatitis (AIH) and young-onset AIH. Methods From October 2013 to November 2016, a total of 87 consecutive AIH patients diagnosed by liver biopsy were enrolled and divided into elderly-onset group (≥60 years) and the young-onset group (<60 years). The biochemical and pathological features and therapeutic response of the two groups were compared. Mann-Whitney test and chi square test were performed for statistical analysis. Results As AIH diagnosed, the proportion of liver cirrhosis detected by imaging examination of elderly-onset group and the young-onset group were 67.7%(21/31) and 35.7%(20/56), respectively, the former was higher than the latter, and the difference was statistically significant (χ2=8.214, P=0.004). The proportion of patients complicated with extrahepatic autoimmune diseases of the elderly-onset group was 9.7%(3/31), which was lower than that of the young-onset group (28.6%, 16/56), and the difference was statistically significant (χ2=4.173, P=0.041). The median levels of alanine aminotransferase (ALT) and albumin of the elderly-onset group were 50.0 U/L (22.0 U/L, 193.0 U/L) and 34.8 g/L (31.3 g/L, 40.5 g/L), which were lower than those of the young-onset group (146.0 U/L (43.8 U/L, 390.5 U/L), 39.4 g/L (35.8 g/L, 44.6 g/L), and the differences were statistically significant (Z=-2.109, -2.092; both P 0.05). After treatment, among 17 patients of elderly-onset group, seven patients obtained biochemical remission and the median time to remission was 3.2 months; among 37 patients of young-onset group, 18 patients (48.6%) obtained biochemical remission and the median time to remission was 2.3 months. There was no significant difference in the percentage of patients achieved biochemical remission and the median time between the two groups (both P>0.05). Conclusion The percentage of complicated with extrahepatic autoimmune diseases of elderly-onset group is lower than that of young-onset group, which indicates that age-associated immune dysfunction may involve in the genesis and development of elderly-onset AIH. Key words: Hepatitis, autoimmune; Elderly; Biochemistry; Pathology; Prognosis

Inflammatory rheumatic diseases in the elderly

Rapid aging of world's population will translate into more elderly patients in the near future. Diagnosis of inflammatory rheumatic diseases in this age group is complicated by atypical clinical features compared to the younger onset group, nonspecific positivity of serological parameters, and confounding radiological signs. Management of these diseases also presents unique challenges in lieu of altered physiology of elderly, cognitive decline, presence of comorbidities, and altered immune system (inflammaging). Hence, this review attempts to synthesize the existing knowledge of the clinical, diagnostic, and therapeutic idiosyncrasies of inflammatory rheumatic diseases in this subgroup of population.

Appendectomy may delay Parkinson's disease Onset.

Alpha-synuclein (α-Syn) is particularly abundant in the vermiform appendix, which makes this structure an anatomical candidate for the initiation of Parkinson's disease (PD) pathology. We hypothesized that history of appendectomy might affect PD clinical onset. A total of 295 PD patients enrolled in a comprehensive observational study were asked about past history of appendectomy. Cox's regression, with a time-dependent covariate, explored the effects of appendectomy on age at PD onset. Thirty-four patients (11.5%) had appendectomy before PD onset. There was no significant effect of appendectomy on age at PD onset for the entire cohort (P = 0.153). However, among patients with late onset (≥55 years), we found evidence that those with past appendectomy had more years of life without PD symptoms than patients without appendectomy (P = 0.040). No association was found for the young-onset group (P = 0.663). An apparent relationship was observed between appendectomy and PD onset in the late PD cohort.

Results of patient‐reported outcome in Japanese patients with multiple sclerosis: Evaluation of the severity and progression of gait disability

AbstractObjectiveTo evaluate the degree of severity and disability progression in Japanese patients with multiple sclerosis (MS) using descriptive study methods.MethodsPostal questionnaires were sent to patients through three Japanese MS patients' associations. Survey participants were asked to evaluate their disability and MS severity based on two scales: the Patient Determined Disease Steps (PDDS) and the Short Form‐8 Health Survey.ResultsA total of 789 MS patients were surveyed. Approximately 45% of patients had gait disability (PDDS score of 3) or higher. Patients with a higher age of MS onset had rapid progression of disease. The mean duration from first symptom of MS to treatment initiation was 4.5 years. The time to treatment initiation was longer for the younger onset group, ≤29 years‐of‐age, than that of the older onset group, ≥40 years‐of‐age (6.2 years vs 2.2 years, respectively). The PDDS showed two‐stage disability progression: while progression time to a PDDS score of 2 varied, progression time from a PDDS score of 2 to a score of 4 was similar across the participants.ConclusionsBased on the patient‐reported disability progression of MS, we showed that the possibility of severity and MS disease progression between Japanese and Western countries might be similar. The PDDS could be a useful alternative to assess MS disability.

Somatic mutations in young-onset colorectal cancer unrelated to hereditary syndromes: A comparative study using high-depth targeted exome sequencing.

623 Background: Colorectal cancer (CRC) is being increasingly diagnosed among young adults, but known hereditary syndromes do not account for the majority of these cases. Young patients often present with metastatic disease and exhibit aggressive clinical courses. We aimed to elucidate the potentially unique biology of young-onset CRC. Methods: Patients diagnosed with metastatic CRC prior to age 40 without a known predisposing syndrome (young-onset) were compared to similar patients diagnosed after age 60 (later-onset). Primary and/or metastatic tumor tissues from 19 young- and 51 later-onset patients underwent targeted exome sequencing on a panel of 200 genes using Illumina HiSeq2000 performed by the Institute of Personalized Cancer Therapeutics of MD Anderson Cancer Center. Sequencing was to an average depth of 800x; single nucleotide variations (SNVs) were called according to in-house algorithms. Results: The median age of patients with young-onset CRCs was 34 years (interquartile range: 31-37), while that of later-onset CRCs was 66 years (IQR: 62- 72). The primary CRC was in the rectum in 30% of the young- vs. 16% of the later-onset cases. The overall mutational rate as measured by the number of SNVs per patient (median: 7 vs. 9) did not differ significantly between the groups. However, the median allelic frequency of SNVs was higher in the young-onset group (0.34 vs. 0.17%), suggesting differing patterns of tumor heterogeneity. Genes known to be associated with CRC carcinogenesis were mutated at different proportions (Table); SMAD4, mismatch repair genes (MSH6, MLH1, MSH2), ARID1A, IGF1R and KITappear to be more frequently mutated among the young. Conclusions: This exploratory study suggests that the somatic mutation profiles are distinct between young- vs. later-onset CRCs. More in-depth analysis of the genomic landscape of young-onset CRCs may reveal distinct and novel therapeutic avenues. [Table: see text]

Comparing clinical features of young onset, middle onset and late onset Parkinson's disease

BackgroundParkinson's disease (PD) affects 1–2% of the population over 65 years. There is evidence that the clinical features differ with age at symptom onset, but published information is scarce. MethodsWe reviewed the charts of 593 PD patients and divided them into young onset (≤49 years), middle onset (50–69 years) and late onset (≥70 years) groups. Data collected included age at symptom onset, year of onset, family history of Parkinson's disease in first and second degree relatives, predominant first symptom, first anti parkinsonian medication prescribed, frequency of levodopa-induced dyskinesia, therapy related dystonia, therapy related gastrointestinal side effects, hallucination, dementia, depression and apathy. ResultsThe middle onset was the largest group (51%), followed by the late onset (39%) and the young onset (10%) groups. Young onset patients had a more frequent family history of Parkinson's disease and a longer survival. Symptoms other than tremor were more frequent as the initial symptom of the young onset group, and the frequency of tremor as the first symptom increased with advancing age at onset. Depression was more frequent in the young onset group. The frequency of treatment related dyskinesia or dystonia decreased with advancing age at onset. ConclusionWe have identified specific clinical differences in Parkinson's disease related to the patient's age at onset and added to the existing knowledge of the variability of disease presentation. We suggest an age of onset of 49 years or less for the definition of young onset PD.