Relating the MNA Mobility Single Item to Usual Walking Speed in Hospitalized and Community-Dwelling Geriatric Patients.

Usual walking speed (WS) is a relatively easy and reproducible tool for detecting mobility impairment. For some reasons, however, geriatric patients might not be able to perform walking tests. Therefore, a subjective assessment could be an alternative method to screen for mobility impairment. In the present paper, we explore the use of the mobility item from the Mini Nutritional Assessment-short form (MNA-sf) to assess mobility and its congruence with walking speed in hospitalized and ambulatory patients. We analyzed retrospective data from 357 patients and found a highly significant correlation between WS and the MNA-sf mobility item. After dichotomization of the MNA-sf mobility score (mobility impairment ≤1 and no impairment >1), AUC for ROC curves showed that the mobility item derived from the MNA-sf reflects fairly well the mobility of geriatric hospitalized patients (AUC = 0.773), while it performs better in ambulatory patients (AUC = 0.838).

Force-time characteristics during sustained maximal handgrip effort according to age and clinical condition.

BACKGROUND: Muscle fatigue, a prominent symptom in older patients, can be assessed by sustained maximal handgrip testing. The force decline during sustained maximal contraction is described for young adults, but data for elderly persons are scarce. The aim of this study was to investigate force-time characteristics during a sustained maximal handgrip effort according to age and clinical condition. METHODS AND MATERIALS: Force-time data were continuously recorded during sustained maximal grip effort in 91 elderly patients (aged 83±5years), 100 elderly controls (aged 74±5years) and 100 young controls (aged 23±3years). The force-time curve was divided in 4 parts per 25% strength drop observed. Time (representing fatigue resistance (FR)) was measured during which grip strength (GS) dropped to 75% (FR75), 50% (FR50), 25% (FR25) of its maximum and to exhaustion (FRexhaustion). Grip work ((GW), the area under the force-time curve) was measured for the 4 parts as well as for the first 20 and 30s of the fatigue protocol test. Strength decay (GWdecay), defined as the difference between the area under the curve (% GW) and a theoretical maximal area under the curve (assuming there's no strength drop), was also studied. In the elderly participants, relationships (controlling for age and sex) of GS, FR and GW with circulating IL-6 and TNF-α were analyzed. RESULTS: FRexhaustion was similar for all groups, whereas the duration of each of the 4 parts was significantly different between the 3 groups. FR75 was shortest in old patients (p=0.004), FR75-50 was almost twice as long in old community-dwelling compared to old patients and young controls (p<0.001). This contrast was inverted for FR50-25 which was significantly shorter in old community-dwelling compared to the other groups (p=0.013). FR25-exhaustionwas significantly longer in young controls compared to the groups of older participants (p=0.017). Old patients showed lower GW for the first 2 parts compared to old community-dwelling and young controls. Also, GWdecay values during the first 20 and 30s were significantly higher in old patients compared to old community-dwelling and young controls (both p<0.001). IL-6 was significantly related to lower GSmax, FR75, FR50, FR25, FRexhaustion, GW75, GW50 and GW75-50. CONCLUSION: This is the first study reporting differences in strength decay during a sustained maximal handgrip effort according to age and clinical condition. Old patients showed a particularly rapid decline in GW during the first part of sustained handgrip. GW was also significantly related to circulating IL-6. Future studies should confirm whether a shorter FR test protocol (i.e. until FR75) but using a continuous registration of the strength decay could be more informative in a clinical setting compared to the classical FR test (measuring only FR50).

Effects of Physical Exercise on Markers of Cellular Immunosenescence: A Systematic Review.

Aging affects negatively the immune system, defined as immunosenescence, which increases the susceptibility of elderly persons to infection, autoimmune disease, and cancer. There are strong indications that physical exercise in elderly persons may prevent the age-related decline in immune response without significant side effects. Consequently, exercise is being considered as a safe mode of intervention to reduce immunosenescence. The aim of this review was to appraise the existing evidence regarding the impact of exercise on surface markers of cellular immunosenescence in either young and old humans or animals. PubMed and Web of Science were systematically screened, and 28 relevant articles in humans or animals were retrieved. Most of the intervention studies demonstrated that an acute bout of exercise induced increases in senescent, naïve, memory CD4+ and CD8+ T-lymphocytes and significantly elevated apoptotic lymphocytes in peripheral blood. As regards long-term effects, exercise induced increased levels of T-lymphocytes expressing CD28+ in both young and elderly subjects. Few studies found an increase in natural killer cell activity following a period of training. We can conclude that exercise has considerable effects on markers of cellular aspects of the immune system. However, very few studies have been conducted so far to investigate the effects of exercise on markers of cellular immunosenescence in elderly persons. Implications for immunosenescence need further investigation.

Discriminative power of the advanced activities of daily living (a-ADL) tool in the diagnosis of mild cognitive impairment in an older population.

BACKGROUND: Mild cognitive impairment (MCI) is characterized by subjective and objective memory impairments in the absence of manifest functional decline. Mild changes in activities of daily living (ADL) can be present and probably predict conversion to dementia. A new advanced (a)-ADL tool was developed, evaluating high-level activities and, taking each participant as their own reference, distinguishing a global Disability Index (a-ADL-DI), a Cognitive Disability Index (a-ADL-CDI), and a Physical Disability Index (a-ADL-PDI), based on the number of activities performed and the severity and causes of the functional problem. This study evaluates the discriminative validity of the a-ADL in MCI. METHOD: Based upon clinical evaluation and a set of global, cognitive, mood, and functional assessments, 150 community-dwelling participants (average age 80.3 years (SD 5; 66-91)) were included and diagnosed as (1) cognitively healthy participants (n = 50); (2) patients with a-MCI (n = 48), or (3) mild to moderate AD (n = 52). The a-ADL tool was not a part of the clinical evaluation. RESULTS: The a-ADL-DI and the a-ADL-CDI showed a sensitivity and specificity ranging from 70% to 94.2%, Positive Predictive Value ranging from 70% till 93.8%, and Negative Predictive Value from 64.4% and 93.8%, an area under the curve (AUC) ranging from 0.791 to 0.960. Functional decline related to physical deficits, as assessed by the a-ADL-PDI, did not discriminate between the different groups. CONCLUSION: The a-ADL tool has a good ability to distinguish normal and pathological cognitive aging. Its discriminative power for underlying causes of limitations may be an advantage.

Shortcomings in the application of multicolour flow cytometry in lymphocyte subsets enumeration.

The lymphoid system is composed of numerous phenotypically distinct subsets of cells, each of which has a unique role in the effectiveness of an immune response. To distinguish specifically between these subsets, it is mandatory to detect simultaneously different cell surface antigens. This became feasible by the development of multicolour flow cytometric technologies. With these techniques, researchers now have the opportunity to study individual cells in far greater detail than previously possible. However, proper data analysis, interpretation and presentation of results will require a high level of understanding of the intricacies of the technology and the inherent limitations of the acquired data. The present report is intended to contribute to the better understanding of how the flow cytometer operates. This report may help new and inexperienced users to work appropriately with the flow cytometer.

Recovery of muscular performance after surgical stress in elderly patients.

INTRODUCTION: Inflammation is related to muscle wasting in elderly persons. Since surgery is accompanied by an important inflammatory response, the degree of muscle wasting and related symptoms such as weakness and tiredness might exacerbate very rapidly in elderly surgery patients. METHODS: PubMed and Web of Science were systematically screened for articles reporting the influence of surgery-induced inflammation on muscle performance and/or fatigue in elderly patients. Studies reporting surgery-induced inflammation and changes in muscle performance and/or fatigue, but without analyzing their association were excluded. Although 5 relevant articles were identified including older patients (highest ages reported were 71-92 years), none focused exclusively on elderly patients. Only 2 studies assessed muscle performance, and in none muscle mass was evaluated. Overall, we found evidence that in elderly patients higher surgery-induced inflammation was significantly related to worse muscle performance and fatigue in the first postoperative days as well as after more than one month (especially for fatigue) following the intervention. Pre-operative anti-inflammatory treatment using steroids or glucocorticoids can reduce the surgery-induced inflammatory response and improve the recovery of muscle performance and postoperative fatigue in elderly elective abdominal surgery or arthroplasty patients. CONCLUSION: We can conclude that to date, only few studies have investigated the association between surgery-induced inflammation and changes in postoperative muscle performance and fatigue in elderly patients. More research is warranted focusing on both the short -and long-term effects of surgical stress on muscle performance in elderly patients as well as the on risks and benefits of peri-operative anti-inflammatory treatment.

The advanced activities of daily living: a tool allowing the evaluation of subtle functional decline in mild cognitive impairment.

OBJECTIVES: Assessment of advanced activities of daily living (a-ADL) can be of interest in establishing the diagnosis of Alzheimer's disease (AD) in an earlier stage, since these activities demand high cognitive functioning and are more responsive to subtle changes. In this study we tested a new a-ADL tool, developed according to the International Classification of Functioning, Disability and Health (ICF). The a-ADL tool is based on the total number of activities performed (TNA) by a person and takes each subject as his own reference. It distinguishes a total disability index (a-ADL-DI), a cognitive disability index (a-ADL-CDI), and a physical disability index (a-ADL-PDI), with lower score representing more independency. We explored whether these indices allow distinction between cognitively healthy persons, patients with Mild Cognitive Impairment (MCI) and patients with mild AD. METHODS: Participants were on average 80 years old (SD 4.6; 66-90), were community dwelling, and were diagnosed as (1) cognitively healthy subjects (n=26); (2) patients with MCI (n = 17), or (3) mild AD (n = 25), based upon extensive clinical evaluation and a set of global, cognitive, mood and functional assessments. The a-ADL-tool was not part of the clinical evaluation. RESULTS: The a-ADL-CDI was significantly different between the three groups (p<.01). The a-ADL-DI was significantly different between MCI and AD (p<.001). The tool had good psychometrical properties (inter-rater reliability; agreement between patient and proxy; correlations with cognitive tests). Although the sample size was relatively small, ROC curves were computed for the a-ADL-DI and a-ADL-CDI with satisfactory and promising results. CONCLUSION: The a-ADL-CDI and a-ADL-DI might offer a useful contribution to the identification and follow up of patients with mild cognitive disorders in an older population.

Inflammation-related muscle weakness and fatigue in geriatric patients.

Inflammation in older persons is associated with muscle wasting, leading to frailty and functional decline. Most studies have focused on IL-6 and TNF-α. In order to further elucidate the underlying mechanisms of muscle wasting and reduced muscle mass and strength we investigated a large panel of cytokines and chemokines, as well as cytoprotective heat shock proteins (Hsp), and measured lean body mass (LBM) and grip strength (GS), fatigue resistance (FR), and grip work (GW) in 33 geriatric patients (median age 84 years) admitted with acute infection-induced inflammation. Higher expression of Hsp27 without heat challenge (WHC) in circulating monocytes and lymphocytes correlated with better FR (r=0.363, p<0.05 and r=0.602, p<0.001 respectively) suggesting a protective effect, as Hsp27 is abundant in muscle. On the other hand, higher serum levels of the inflammatory chemokines CCL11/Eotaxin and CCL2/MCP-1 were related to lower GS and lower LBM (r=-0.393, p<0.05; r=-0.431, p<0.05) respectively. Our results point to a complex pattern of pro-and anti-inflammatory substances that interact with skeletal muscle performance during acute inflammation.

Conversion of the Mini-Mental State Examination to the International Classification of Functioning, Disability and Health terminology and scoring system.

BACKGROUND: In older patients, evaluation of the cognitive status is crucial. The Mini-Mental State Examination (MMSE) is widely used for screening of cognition, providing fairly high sensitivity, specificity and reproducibility. Recently, a consensus emerged on the necessity of an international and transparent language, as provided by the WHO's International Classification of Functioning, Disability and Health (ICF). Most assessment tools however are not in accordance with the ICF. OBJECTIVE: To reformulate the MMSE according to the ICF, both for the individual items and for the scoring system. METHOD: MMSE data (scores varying from 3 to 30/30) of (1) 217 cognitively healthy elderly, (2) 60 persons with mild cognitive impairment, (3) 60 patients with mild Alzheimer's disease (AD), and (4) 60 patients with moderate/severe AD were obtained from studies at a university hospital setting. Subjects were aged 65 years or more and recruited either through advertisement (group 1), from the geriatric day hospital (groups 2 and 3), or the geriatric ward (group 4). The allocation to the groups was done after multidisciplinary evaluation. The conversion of the MMSE to ICF-MMSE was done by content comparison and by subsequent translation of the scoring system using automatic algorithms. RESULTS: All MMSE items were converted to the corresponding ICF categories. Three ICF domains were addressed: global and specific mental functions, general tasks and demands, divided over 6 ICF categories (orientation time/place, sustaining attention, memory functions, mental functions of language, undertaking a simple task). Scores on individual items were transformed according to their relative weight on the original MMSE scale, and a total ICF-MMSE score from 0 (no problem) to 100 (complete problem) was generated. Translation was satisfying, as illustrated by a good correlation between MMSE and ICF-MMSE. The diagnostic groups were distributed over the ICF-MMSE scores as expected. For each ICF domain, ICF-MMSE subscores were higher with increasing severity in cognitive decline. There was a higher dispersion, in accordance with the more detailed scoring possibilities of the ICF-MMSE. CONCLUSIONS: It is possible to adapt the MMSE to the ICF concept. This adaptation enhances interdisciplinary communication since it provides more clarity in assessment, with better visibility of the areas covered by the instrument.

The use of acetyl cholinesterase inhibitors and memantine in nursing home residents.

AIM: Although a high proportion of elderly nursing home residents suffer from Alzheimer's disease (AD), data from the literature indicate that they are only rarely treated with Acetyl Cholinesterase Inhibitors (ChEls) or memantine. The aim of this study was to describe the use of ChEls or memantine by elderly residents in nursing homes, suffering from AD and to document who might qualify for pharmacological treatment according to the Belgian reimbursement rules. METHOD: Descriptive data was collected from 11 nursing homes through a standardized questionnaire consisting of a general section for nurses and a specific medical section for general practitioners (GP). All residents (N = 1032) from these institutions were eligible for inclusion in the study; 718 (69.6%) questionnaires were completed by the nurses of which 533 (51.6%) were also completed by the GP's. RESULTS: AD was diagnosed in 29.4% (n = 211) of the residents of whom 56.4% (n = 119) did not receive an anti-AD treatment, although nearly all of these patients fulfilled the Belgian requirements for reimbursement of ChEls or memantine. The mental status of the residents was often incompletely documented, but it can be estimated that at least an additional 30.1% (n = 216) of all screened residents might possibly qualify for reimbursement of ChEls or memantine. CONCLUSIONS: Less than half of the AD patients in nursing homes receive ChEls or memantine and approximately one third of the residents could possibly qualify for reimbursement. Many residents with cognitive deficits remain undetected and undiagnosed and consequently do not receive appropriate treatment.

Grip work estimation during sustained maximal contraction: validity and relationship with dependency and inflammation in elderly persons.

OBJECTIVES: To validate muscle endurance estimation and to examine relationships with dependency and inflammation in elderly persons. DESIGN: Cross sectional validation and explorative study. SETTING: Hospitalized geriatric patients and community-dwelling controls. PARTICIPANTS: 91 elderly patients (aged 83±5 years), 100 elderly controls (aged 74±5 years) and 100 young controls (aged 23±3 years). MEASUREMENTS: Grip strength (GS) was recorded continuously during sustained maximal contraction until exhaustion. Fatigue resistance (FR) was expressed as the time during which GS drops to 50% of its maximum. Grip work (GW) was estimated as GW=GS*0.75*FR, and compared to the measured GW. In the elderly participants, relationships (controlling for age and physical activity) of GS, FR, GW and GW corrected for body weight (GW/BW) with dependency (Katz-scale) and inflammation (circulating IL-6 and TNF-alpha) were analyzed. RESULTS: Excellent correlation between estimated and measured GW was found (r=0.98, p<0.001). The method error coefficient of variance was 10% for all participants; 7% for all elderly and 8% for young controls. Better GS, FR, GW and GW/BW was significantly related with less dependency (all p<0.05 or p<0.01, except for FR in the male) and with lower circulating IL-6 (all p<0.05 or p<0.01, except for GS in both genders). Higher IL-6 was significantly related to worse dependency (p<0.01). No significant relationships with TNF-alpha were found. CONCLUSION: GW estimation is a valid parameter reflecting muscle endurance in elderly persons presenting diverse clinical conditions. GW is significantly related to both dependency and circulating IL-6, and is a promising outcome parameter in comprehensive geriatric assessment.

Circulating heat shock protein 70 (Hsp70) in elderly members of a rural population from Cameroon: association with infection and nutrition.

Hsp are highly conserved cytoprotective proteins which have been repeatedly portrayed at elevated levels in various infectious diseases, and there are suggestions that the presence of infectious agents may possibly be the root cause of Hsp induction. As organisms age the vulnerability to illnesses such as infection and inflammation increases and late complications due to infectious agents are mostly observed in the older part of the population. Although it is well known that environmental conditions can modulate the susceptibility to infection, and that poor nutritional status can increase the risk of contracting infection when exposed to an infectious agent, the effects of environmental conditions and nutritional status on the heat shock response have not been investigated. Therefore, we studied the heat shock response in a special elderly population living in a remote area in Cameroon, where infection and parasitosis are endemic. Our results indicate a significant increase in Hsp70 serum levels with increasing degree of inflammation. We found negative correlations between Hsp70 levels and micronutrients including vitamin D, vitamin B12, as well as folate, which could be linked to the immune modulating effects of these vitamins.

Surgery-induced inflammation in relation to age, muscle endurance, and self-perceived fatigue.

BACKGROUND: Elective abdominal surgery can be considered as a model for an important acute inflammatory trigger in human participants. The aim of the study was to explore the effect of surgery-induced inflammation on muscle strength, endurance, and self-perceived fatigue and its relation with age. METHODS: Sixty-six elective abdominal surgery patients aged 24-91 years were assessed before and at the second and fourth day after surgical intervention. Outcome parameters were grip strength, muscle endurance, fatigue subscale of the Profile of Mood State and visual analog scale for pain, and the circulating inflammatory mediators C-reactive protein, interleukin (IL)-6, and tumor necrosis factor-alpha (TNF-alpha). RESULTS: All parameters worsened postoperatively (p < .01) and remained significantly (p < .05) worse until the fourth day postsurgery, except for TNF-alpha (no significant change). Older age was related to higher surgery-induced IL-6 levels at the second (p < .05) and fourth postoperative (p < .01) day and to worse self-perceived fatigue and muscle endurance (both p < .05) at the fourth postoperative day. Higher pain levels at the second day following surgery was related to more self-perceived fatigue (p < .05). Worsening muscle endurance following surgery was significantly related to higher IL-6 release following surgery (p < .01) and self-perceived fatigue (p < .05) at the fourth day following the intervention. Age and surgery-induced increase in circulating IL-6 at Day 4 postsurgery was highest in patients showing both worsened muscle endurance and self-perceived fatigue (p < .05). CONCLUSIONS: Surgery-induced inflammation is related to reduced muscle endurance and the sensation of fatigue. Elderly patients suffer from a higher impact of surgery on muscle endurance.

Anaemia in the elderly.

Anaemia is highly prevalent in elderly populations, particularly in long term care facilities and geriatric wards. Even mild anaemia is associated with adverse health outcomes. Although senescence is considered to be a contributing factor, underlying pathology always has to be thoroughly explored. The most frequent etiologies of anaemia in the elderly are anaemia of chronic disease/inflammation; iron, folate and cobalamin deficiency; and myelodysplastic syndrome. Multiple concomitant etiologies are frequently present. The diagnostic workup is straightforward, not very invasive and should be done systematically. Nutrient deficiencies require complete workup and cure. Anaemia of chronic disease/inflammation ideally is taken care of by treating the underlying disease. If this is not possible and if glomerular filtration rate is significantly decreased, treatment with erythropoietin should be considered. Most cases of myelodysplastic syndrome will benefit from supportive care, but a specific subgroup responds particularly well to oral thalidomide analogues. Transfusions should be avoided.

Integrating the International Classification of Functioning, Disability and Health (ICF) in the Geriatric Minimum Data Set-25 (GMDS-25) for intervention studies in older people.

OBJECTIVE: Since the number of older people is rising worldwide, there is an increasing need for a structured and integrated approach for the participation of the older person in clinical research. The introduction of a 'Geriatric Minimum Data Set' (GMDS) will allow a standardized description of the older person participating in clinical research. ICF, a universal tool for the comprehensive description of human functioning, developed by the World Health Organisation, can make a substantial contribution to the development of a GMDS. It can serve as a 'framework', including all the functional characteristics needed in research in Gerontology and Geriatrics. The objective was to integrate ICF terminology in a recently proposed GMDS-25. DESIGN: ICF is explored to determine the most relevant ICF-categories for GMDS-25. RESULTS AND CONCLUSION: Several items of the GMDS-25 can be described in terms of ICF. This description contributes to the optimal standardization of the GMDS-25.

The effect of aging and inflammation on heat shock protein 27 in human monocytes and lymphocytes.

Heat shock proteins (Hsp) are highly conserved proteins and their synthesis is ubiquitous in virtually every species in which they have been sought. In the present study we have investigated the effect of age and inflammation on the induction of Hsp27 in human peripheral blood mononuclear cells, using flow cytometry. Sixty-six healthy control subjects or patients suffering from inflammation participated in the study. In both heat shocked (HS) and non-HS conditions, the percentage of Hsp27 producing lymphocytes as well as the intensity of Hsp27 in lymphocytes and monocytes were negatively influenced by age. The basal levels and also the levels of Hsp27 production after HS were higher for monocytes compared to lymphocytes. In addition, we found that HS resulted in a small but significant increase in the levels of Hsp27 in lymphocytes whereas a significant decrease in Hsp27 was noticed for monocytes. In conclusion, results presented herein provide evidence in support of an age-related decrease in the level of Hsp27, which disappeared in the presence of inflammation. Several relationships between the circulating levels of CRP, IL-6 and TNF-alpha with the various Hsp27 determinations were observed, indicating that cytokines are able to influence the production of Hsp27.

Inflammatory status as an important determinant of heat shock protein 70 serum concentrations during aging.

Heat shock proteins (Hsp) form a large family of proteins that are ubiquitously present in all organisms. In the absence of destabilising stimuli, Hsp are expressed at low levels, but their expression can be highly induced by various noxious conditions such as heat, oxygen stress and infection. Hsp have been reported to interfere with inflammatory processes and their induction is well known to decrease with aging. In the present study we have investigated Hsp 70 serum concentrations using an optimised ELISA in elderly patients, recruited from a geriatric University Hospital ward. Our results portray positive correlations between the serum levels of Hsp 70 and various markers of inflammation (monocyte count, serum concentration of TNF-alpha, plasma concentrations of C-reactive protein, and fibrinogen), explaining the difference in Hsp 70 serum concentrations in these subjects with various degrees of inflammation. We conclude that Hsp 70 is involved in inflammatory diseases and that the serum level of Hsp 70 is directly linked to the inflammatory status of the subject. However, the nature of this relationship remains to be elucidated.

Elevated serum heat-shock protein 70 levels in patients with acute infection: use of an optimized enzyme-linked immunosorbent assay.

Heat-shock proteins (Hsps) are highly conserved throughout evolution and evoke great interest both in basic biology and in medicine. They are expressed in small quantities under normal conditions, and their expression can be strongly induced by several stressors. Although their action is basically intracellular, it is now obvious that these proteins can be released into the extracellular environment from viable cells. In this study, the human Hsp 70 serum concentrations were determined using an optimized, cost-effective enzyme-linked immunosorbent assay (ELISA). The average intra-assay variation was 6%, whereas the average interassay variation was 9%. The sensitivity of the assay was 10 ng/ml, and spiking experiments showed recoveries between 101 and 109%. As an application of the technique, we have investigated the serum levels of human Hsp 70 in patients with infection and in healthy subjects. Our data show significantly higher levels of Hsp 70 (P = 0.003) in patients compared to control subjects. Positive correlations were noticed between the serum levels of Hsp 70 and various markers of inflammation (IL-6; r = 0.579, P = 0.009, TNF-alpha; r = 0.552, P = 0.012, IL-10; r = 0.361, P = 0.002). We conclude that Hsp 70 is involved in inflammation of infectious origin. The interindividual variation in the serum concentration of Hsp 70 precludes the use of serum Hsp 70 levels to distinguish patients from healthy subjects.

Age-related decrease in the inducibility of heat-shock protein 70 in human peripheral blood mononuclear cells.

We have investigated the effect of age and of the presence of proinflammatory cytokines on Hsp 70 production in human peripheral blood mononuclear cells, using flow cytometry. Twenty-seven women and 23 men, all apparently healthy, participated in the study. At 37 degrees C, the percentage of Hsp 70-producing monocytes and lymphocytes, as well as the level of Hsp 70 in monocytes, were negatively influenced by age. After exposure of the cells to 42 degrees C, the increase of Hsp 70 production was more pronounced in monocytes than in lymphocytes; both the intensity of Hsp 70 production and the percentage of Hsp 70-producing cells were negatively influenced by the age of the subjects, as well for monocytes as for lymphocytes. There was a negative correlation between the intensity of Hsp 70 production by monocytes exposed to 42 degrees C and the serum levels of tumor necrosis factor-alpha and interleukin-6. In conclusion, in human monocytes and lymphocytes, heat-induced Hsp 70 production is reduced with increasing age and is negatively influenced in monocytes by proinflammatory cytokines.