Left fascicular hemiblocks in the elderly.

A three-year follow-up study was made of 45 elderly subjects with left anterior hemiblock, either alone or associated with right bundle-branch block. In the LAH + RBBB group, there was a higher mortality rate and frequent evolution toward complete A-V block. The prognostic significance of left fascicular hemiblocks is discussed.

Idebenone in senile dementia of Alzheimer type: a multicentre study.

Idebenone is a new cerebro-active drug, effective in dementia disorders, particularly indicated in primary degenerative dementias, i.e. Alzheimer's disease. This new molecule acts as an electron trapper and a free radical scavenger protecting mitochondrial membranes from lipid peroxidation. A multicentric, double-blind trial of idebenone (45 mg twice daily orally) vs. placebo was carried out on 102 elderly patients affected by Alzheimer-type dementia of mild or moderate severity. Idebenone was administered for 4 consecutive months, 45 mg twice daily. Clinical evaluations were performed at the time of enrollment (t0) and monthly thereafter (t30, t60, t90 and t120) and at follow-up (t150 ). Tolerability to idebenone treatment was good and was associated with a statistically significant improvement of memory, attention and behaviour. It is worthwhile noting that these cognitive and behavioral findings were observed after the first month of treatment with enhancement evident in the following period.

Randomized, double-blind, placebo controlled, multicentre study of idebenone in patients suffering from multi-infarct dementia.

In this randomized double-blind, placebo controlled, multicentre study on 108 elderly patients with mild to moderate mental deterioration of vascular origin, idebenone - a benzoquinone derivative with a hydroxyalkyl side chain - proved to be therapeutically effective in the treatment of multi-infarct dementia. The oral administration of idebenone 45 mg/day b.i.d. for 120 days significantly improved the scores of the following test in comparison with placebo: Mini Mental State, Randt Memory Test, Gottfries Rating Scale, Token Test, Toulouse Piéron Test, indicating improvements in memory attention and cognitivity. The drug was well tolerated and effective in patients with multi-infarct dementia. No changes in laboratory parameters were observed either before or after treatment.

[Hemochemical data in the function study of the senile kidney]. / Considerazione di alcuni dati ematochimici per l'inquadramento funzionale del rene senile.

A survey was made of 2426 serum creatinine (SC) values in subjects over 60 and free from kidney diseases or other conditions capable of influencing the renal function. SC values were higher in males than in females and showed a tendency to increase with advancing age. The study of the correlation between endogenous creatinine clearance and both urea and SC showed that the latter represents a more reliable index of glomerular filtration rate than the former.

[Arrhythmias in the elderly]. / Le aritmie nell'anziano.

A survey was made on a population of 6059 subjects aged more than 60 years with the aim to assess 1. the prevalence of heart arrhythmias and 2. the relationships between arrhythmias and some other ecg alterations. Arrhythmias resulted present in 29.0% of the whole population with a significantly higher prevalence among males (30.7% vs 28.1%, P less than 0.05) and among subjects over 75 years of age (33.2% vs 23.9%, P less than 0.001). Supraventricular extrasystoles (SE, 11.55%), atrial fibrillation (AF, 10.44%) and ventricular extrasystoles (VE, 8.91%) were the most frequent arrhythmias, followed by sinus bradycardia (SB, 2.04%), sinus arrhythmia (SA, 1.35%), atrial flutter (AFL, 1.09%) and junctional rhythms (JR, 0.20%). AF and AFL resulted significantly more frequent among females, whilst SE, VE and SB were more frequent among males. All the above arrhythmias, with the exception of AFL and JR resulted significantly more frequent among subjects over 75. A significantly higher prevalence of ecg signs of left ventricular hypertrophy, ischemia, previous myocardial infarction (MI) and of the so-called "minor" T-wave changes (MTC) was found among the subjects with arrhythmia as compared with those free from rhythm disturbances. Ecg signs of MI and MTC were significantly more frequent among males and MTC were more frequent among females and among subjects over 75. It is concluded that in an old person the presence of an arrhythmia should lead to a careful evaluation of the general and cardiological clinical situation in order to avoid 1. to prescribe an unnecessary and potentially dangerous antiarrhythmic treatment, and 2. to misdiagnose an underlying clinical condition liable to a decisive improvement under adequate treatment.

Ketanserin in the treatment of mild hypertension in elderly patients: preliminary results of a controlled double-blind trial.

Thirty elderly patients (mean age 77.5 years) with mild hypertension were considered for a double-blind trial comparing the effects of ketanserin and propranolol. After 28 days of placebo, a group of 15 patients was given ketanserin at the daily dose of 20 mg twice daily for 15 days and of 40 mg twice daily for the subsequent 75 days, while the other group of 15 patients was given propranolol for 90 days at the dose of 80 mg twice daily. Blood pressure and pulse rate in the supine and standing positions were evaluated every 15 days. After the beginning of treatment with ketanserin there was a gradual but highly significant decrease of the systolic and diastolic blood pressure values. No relevant side-effects or significant biochemical alterations were observed during treatment with ketanserin.