Colonoscopy in Patients Aged 85 Years or Older: An Observational Study

Objectives: Colonoscopy is the first-line modality to examine the colon even in the very elderly but may have an increased risk of complications. This study aimed to evaluate the efficacy and safety of colonoscopy in the very elderly. Methods: Patients 85y old, who underwent colonoscopy between September 2010 and August 2012 in two tertiary-care hospitals in Japan were enrolled. Main outcome measures were cecal intubation rate, detection rate of adenomas and cancers, treatment, adverse events, and long-term outcomes. Results: A total of 207 colonoscopies were performed in 177 patients (females 72, males 105; maximum age 95 years). Of these, 202 attempted to reach the cecum, with success in 92%. Excluding patients with known colorectal neoplasms, invasive cancers were detected in 12%, including T1 lesions in 2% and T2 or deeper in 9%. No cancers were detected in patients referred for surveillance or mild abdominal symptoms. Cancers were found in 25% of patients with positive fecal immunochemical tests, 22% with altered bowel habits, 21% with anemia, and 18% with hematochezia. Treatment of 29 patients with cancer included surgery in 22, endoscopic resection in two and no treatment (due to comorbidities) in five. There were no complications. During 730 days (mean) of follow up, 27 patients died but only three died from recurrent colorectal cancer. Conclusions: Colonoscopy for patients aged 85 years is safe. A relatively high detection rate of cancers was found, and most were treatable and even curable. (UMIN000018575

Differentiation Between Dementia With Lewy Bodies And Alzheimer’s Disease Using Voxel-Based Morphometry Of Structural MRI:AMulticenter Study

Dementia with Lewy bodies (DLB) is one of the main etiologies of neurodegenerative dementia after Alzheimer’s disease (AD).1 Distinguishing DLB from AD is difficult because of their overlapping clinical and pathological features.2–4 Patients with clinically defined DLB may also have AD-type pathological changes as well as the characteristic Lewy bodies. However, the differential diagnosis is particularly important because DLB respond better to cholinesterase inhibitors but are sensitive to neuroleptics, which cause worsening of clinical status