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Alzheimer's disease (AD) is a complex disorder affecting numerous hormones and nervous system components. It causes memory loss, and also leads to personality and neuromuscular changes, seizures, and sometimes psychosis. It has been estimated that almost half of those over 85 years of age have AD. Medications are now being tested to improve either cognitive function or behavior. The drugs to improve cognition either enhance the function of neurotransmitters or otherwise affect the function of neurons, or they affect the circulatory system. Other drugs under consideration affect other systems. Acetylcholine regulates the messages passing between nerve cells that store and retrieve information in memory. Nootropic drugs increase the activity of neurons, and these may help some patients with AD. Oxiracetam may help mitigate the effects of sedatives, including diazepam, phenobarbital sodium, and scopolamine, but it has recently been withdrawn from trials. Vasodilators (agents that improve blood flow by widening blood vessels) may also reduce the symptoms of AD. Ergot-type drugs and the calcium channel blockers are currently being tested. The role of calcium is not well understood, and low levels in the diet may play a role in the development of AD. Among other types of drugs under consideration are selegiline, a monoamine oxidase (MAO) B inhibitor. MAO inhibitors are often used to treat depression, and selegiline is used to treat Parkinson's disease. Other ''miscellaneous'' drugs have not been successful so far. Among drugs affecting behavior, neuroleptics (sedatives) are the most common, and probably the most overused, especially in nursing homes, despite physician education and guidelines for use. Drugs to control anxiety (benzodiazepines and barbiturates) are commonly prescribed, but should not be used for longer than one week. Carbamazepine, an antirage drug, has been used successfully to treat agitation and violent behavior. (Consumer Summary produced by Reliance Medical Information, Inc.)

Rural America has not been neglected in the national move toward managed health care. Some people may find this surprising since health care in rural America is generally characterized by [...]

Aging in experimental animals and in man is associated with a significant defect of helper/inducer T-lymphocytes. This quantity deficiency is paralleled by a qualitative deficiency of T-lymphocyte number and function. Similar defects have been observed in protein calorie malnutrition and zinc deficiency, and there is evidence that both may exist in the aged ill and perhaps even in aged healthy individuals. Nutritional support improves the immune defect in aged ill patients and it may be of value in improving this deficiency, even when administered to aged healthy subjects.

Some studies have shown a negative association between age and serum albumin. Several of these studies included older people with known disease. Disease may reduce albumin in any age group. Other studies have shown no association between age and albumin. To investigate the association of age and albumin, albumin levels were determined in 241 apparently healthy subjects aged 55 to 101. A small but consistent negative regression slope of about 4% per decade was found for those aged over 70. Because the relationship to age was small, the finding of hypoalbuminemia in an elderly patient generally should be attributed to disease rather than age alone.

There are differing opinions on whether or not to use isoniazid (INH) preventive treatment in older people with significantly reactive (“positive”) tuberculin skin tests and fibrotic changes on chest roentgenogram. To assist the clinician facing this decision, a Decision Analysis was completed. Using available data, it is seen that using INH will not have much impact on five‐year survivorship, but will reduce the number of tuberculosis disease cases, thus having an overall beneficial impact. Where tuberculosis incidence is higher, the benefit of INH preventive treatment is correspondingly higher. J Am Geriatr Soc 34:814–817, 1986

Prescription drugs are not always taken as directed. When there is a discrepancy between the use of a drug and the prescription directions, the drug‐taking behavior is considered “nonadherent.” To determine the extent of prescription nonadherence by old persons and the reasons for nonadherence, an in‐home survey was made of 111 elderly subjects who were taking prescription drugs. Drug‐taking behavior was compared with the behavior implied by the prescription instructions, and reasons for the differences were sought. Of the study sample, 43 per cent showed such differences in use of one or more prescription drugs. The chief type of discrepancy was underuse (90 per cent of nonadherence). No difference was observed in most of the psychosocial variables studied between those who took drugs as directed and those who did not. Hypertensive subjects did not differ from those without hypertension. A large proportion of nonadherence (73 per cent) was intentional. Intentional nonadherence was more likely to occur in subjects who used two or more pharmacies and two or more physicians. Traditional efforts aimed at reducing the incidence of forgetting to take medicines would not seem to be helpful in cases of intentional nonadherence.

A quantitative system, amenable to automation, for determining the presence of group A streptococci in broth culture is described. After separation from the broth, the cells' protein coats are removed by digestion with 0.1% trypsin, and they are then stained with anti-A fluorescent antibody (FA). Excess FA is removed, and bound FA is put into solution by dissociation with demineralized distilled water. The amount of FA bound to the cells is quantitated by fluorometry of the solution. The level of nonspecific staining is measured by staining the cells with fluorescein-conjugated normal rabbit globulin absorbed with group A cells, dissociating, and quantifying, as above. The two quantities are subtracted to measure specific binding of FA to group A cells. A clinical trial showed 92% agreement with microscopists.

Variation in costs of laboratory and drug use was audited among 33 faculty internists caring for a homogeneous population at a university clinic. Variation was more extreme for laboratory (17-fold) than for drug use (fourfold). Laboratory and drug costs per physician were significantly correlated (P<.05). There were no predictive characteristics permitting identification of "high cost" or "low cost" physicians. Distribution of the results of the cost audit was followed by a 29.2% decrease in laboratory (P<.01) and a 6.4% increase in drug expenditures. Decreases in laboratory (P<.01) and drug use were greatest among high-cost physicians. The extreme variation observed in costs of care emphasizes the need to relate costs to quality and efficiency. The cost audit may be an effective means of decreasing the utilization of laboratory tests.

The digital computer is now used in diagnostic centers for the analysis of medical signals. In one location, a health-department clinic, routine electrocardiograms and spirograms are sent daily by telephone to the central computer facility. The computer analysis is returned by teletype to the clinic. In another setting, the computer is used to interpret ECGs obtained in a mass screening project. A third use of the computer involves obtaining ECGs in the patient's home, with transmission individually by telephone. In each situation, the computer allows delegation of a routine task from man to machine.