APOE polymorphism as a potential determinant of functional fitness in the elderly regardless of nutritional status.

OBJECTIVES: Life expectancy is determined by a combination of genetic predisposition (~25%) and environmental influences (~75%). Nevertheless a stronger genetic influence is anticipated in long-living individuals. Apolipoprotein E (APOE) gene belongs among the most studied candidate genes of longevity. We evaluated the relation of APOE polymorphism and fitness status in the elderly. MATERIAL AND METHODS: We examined a total number of 128 subjects, over 80 years of age. Using a battery of functional tests their fitness status was assessed and the subjects were stratified into 5 functional categories according to Spirduso´s classification. Biochemistry analysis was performed by enzymatic method using automated analyzers. APOE gene polymorphism was analysed performed using PCR-RFLP. RESULTS: APOE4 allele carriers had significantly worse fitness status compared to non-carriers (p=0.025). Multiple logistic regression analysis showed the APOE4 carriers had higher risk (p=0.05) of functional unfitness compared to APOE2/E3 individuals. CONCLUSIONS: APOE gene polymorphism seems be an important genetic contributor to frailty development in the elderly. While APOE2 carriers tend to remain functionally fit till higher age, the functional status of APOE4 carriers deteriorates more rapidly.

History of dementia research in Bohemia and middle Europe.

UNLABELLED: The clinical aspects and histopathology of dementia are best understood when based on knowledge of the historical milestones associated with its development. We studied archive materials and visited some of the psychiatric asylums that were active in Prague during the 19th century. RESULTS: The gradual recognition of dementia and its histological correlates on the territory of the actual Czech Republic from the 1830s are described, together with its links to Austrian, German, and other foreign psychiatry and neurology. A stepwise differentiation between inborn mental incapacity and the acquired forms occurred between 1830 and 1890. This was followed by contributions from Emil Redlich, Arnold Pick, Karel Kuffner, Oskar Fischer and others between 1890 and 1930, elucidating features of senile plaques, and shedding light on behavioral-morphological correlations and on the role of inflammatory tissue changes. These discoveries allowed the distinction between neurodegenerative causes of dementia and other etiological categories. CONCLUSION: One hundred years ago, Prague was one of the cradles from which our modern understanding of neurodegenerative dementia emerged.

Colon resection in elderly patients: comparison of data of a single surgical department with collective data from the Czech Republic.

Colorectal cancer is predominantly a disease of elderly people, since over 70% of cases occur in those aged 65 years or older. Clinicians have to frequently decide whether major surgery is justified in elderly patients with a limited life expectancy. Our retrospective study was aimed to compare outcomes of primary surgery for colorectal cancer in the elderly patient population. The evaluated data were collected from the 1st Department of Surgery, Charles University, and from all over the Czech Republic. Patients were divided into three groups: the young-old (21-59 years), the older-old (60-69 years), and the oldest-old (>69 years) patients. In the collective data the youngest and the oldest groups differ significantly in the rate of early postoperative complications (12.3% versus 17.6%, p<0.001). The number of complications associated with the emergency procedures was twice as high compared to elective surgery in all groups (p<0.001). There was no correlation between age and length of hospital stay in the single surgery department. These data suggest that major oncology procedures may be undertaken in older patients in whom operative risk is reasonable, with acceptable rates of complications.