Changes of psychical and physical conditions in the elderly after a four-year follow-up.

The elderly show a loss of both the intellectual functions and of motion ability. This happens also without particular pathologies; possible tests to highlight this loss are the Mini Mental State Examination (MMSE), and the Functional Reach (FR)-test. During 2004-2005 winter 50 healthy subjects were analyzed; the subjects were divided into three age-groups: from 55 to 64 years; from 65 to 74 years; over 75 years of age. The test results showed a significant decline of MMSE and FR from the first group to the other two groups, a same behavior of male and female subjects, a greater decline of physical characteristics compared to psychic characteristics. During 2008-2009 winter several subjects (34 of 50) were again analyzed, and a more accurate facility was used to measure the FR. The aim of the new test has been the exam of the cognitive conditions and of the physical performances after the 4 year follow-up. The results of the new tests confirm the previous results, both with regard to the decline of the psychophysical characteristics from the first age-group to the others but the decrease is not as significant as the previous, and with regard to the greater physical decline. What is surprising is that the decline of both the psychic and the physical characteristics concerns only the first age-group, not the other two. Maybe healthy subjects, without particular pathologies reach a stabilization of the above-mentioned characteristics; some hypothesis is given to explain what happens.

Recurrent syncope in elderly patients and tilt test table outcome: the role of comorbidities.

Syncope is a common disorder that can lead to serious consequences in the elderly. Tilt-test is a safe, useful specific tool to investigate recurrent syncope also in the elderly. Comorbidities and medication use, widely present in elderly patients, affecting the hemodynamic response, can influence the tilt-test outcome. The aim of this study was to evaluate the influence of these confounding factors on tilt-test results in elderly patients with recurrent syncope. We included in this study a consecutive group of 87 patients>75 years (82.1+/-4.3 years) with unexplained syncope. They underwent passive upright tilt-test. Heart rate an blood pressure were recorded using non-invasive devices. The patients were classified according to the modified Vasovagal Syncope International Study (VASIS). Comorbidities were measured with the geriatric index of comorbidities (GIC), which is a composite score taking into account both the number of diseases and their severity as measured by Greenfield's IDS. The tilt-test was positive in 22 patients. There were no significant differences in clinical characteristics, and medication use between the tilt-test negative and positive patients, except for the GIC score (1.12+/-0.5 vs. 2.42+/-0.48; p=0.001) and for a reduced number of medications in the former group (5.7+/-3.1 vs. 8.2+/-2.4; p=0.001). This study suggests that comorbidities and the number of medications could influence tilt test outcome.

[Use of sildenafil in the chronic uremic patient]. / L'uso del sildenafil nel paziente uremico.

BACKGROUND: Erectile dysfunction is one of the factors influencing negatively the quality of life of patients in hemodialytic treatment. The international literature shows that erectile dysfunction is present in 30% of patients with chronic renal failure and in 50% of patients undergoing dialytic treatment. Fertility, libido and erectile dysfunction, suffer progressive worsening with time, in spite of hemodialysis. The availability of a drug like Sildenafil can improve the quality of life of the patient and give him a normal sexual activity. METHODS: Twenty patients between 29 and 51 years, were selected; 2 of these had been subjected to renal transplant, with a dialytic treatment time varying from 3 to 13 years. Before the treatment all the patients have been subjected to an andrological screening (testosterone, prolactin, penile color Doppler ultrasound) and proposed the IIEF test. Therapeutic strategy included the assumption of the drug in the days in which the patients were not subjected to dialysis, with an interval from 1 to 3 weeks between assumption and another. The dose was 25-50 mg. At the end of three months of therapy the patients were again subjected to the IIEF test. RESULTS: All patients reported an improvement in sexual activity and sexual desire with very good repercussions on general and psychophysical conditions. CONCLUSIONS: The results demonstrate at least that Sildenafil is also effective in uremic patients in dialytic treatment or after renal transplant and that it can therefore resolve one of the main problems for the normal development of the life of such patients.