Normative Data for Elderly Adults: The Maine-Syracuse Study

The primary objective of this study was to provide supplementary normative data on aging and cognition from an ongoing community-based study. This dementia- and stroke-free sample (age range = 70–89; mean = 77.5) consisted of 228 women and 155 men participating in the Maine-Syracuse Longitudinal Study at waves 6 to 7 (2001–2009). The authors employed a battery of 23 widely utilized clinical cognitive tests. In this cross-sectional study, the authors focus on subjects 70 to 79 (n = 248) and 80 to 89 (n = 135) years old, and provide preliminary data for a smaller number of subjects aged 90 to 98 years old (n = 14). More highly educated and younger participants exhibited better performance on cognitive tests. Education was not significantly associated with every cognitive outcome, nor was age cohort membership. The addition of cardiovascular disease (CVD)/health variables to a model including age, education, and gender main effects provided statistically significant increases in R² (range = .021–.084) of performance on some tests. Results are discussed in relation to this study's value with respect to determining cognitive impairment in individuals free from probable dementia or stroke.     

蒙特利尔认知评估量表在健康体检人群中的应用

目的研究蒙特利尔认知评估量表(MoCA)在健康体检人群中的分布特征。方法选择1350例健康体检者,采用北京版MoCA对受试者进行认知功能测评。最终777例进入分析,按年龄分为:<65岁组175例,65⁶9岁组200例,7069岁组200例,70⁷4岁组145例,7574岁组145例,75⁷9岁组124例,≥80岁组133例;按受教育年限分为:≤12年组153例和1379岁组124例,≥80岁组133例;按受教育年限分为:≤12年组153例和13²0年组624例。结果不同年龄组、不同受教育年限组MoCA总分比较,差异有统计学意义(P<0.01)。多元线性回归方程显示,年龄与MoCA总分呈负相关(β=-0.639,P=0.000),受教育年限与MoCA总分呈正相关(β=0.741,P=0.000)。以均数-1.5倍标准差为轻度认知障碍筛查的参考值,筛查值范围分别为:<65岁组≤25分,6520年组624例。结果不同年龄组、不同受教育年限组MoCA总分比较,差异有统计学意义(P<0.01)。多元线性回归方程显示,年龄与MoCA总分呈负相关(β=-0.639,P=0.000),受教育年限与MoCA总分呈正相关(β=0.741,P=0.000)。以均数-1.5倍标准差为轻度认知障碍筛查的参考值,筛查值范围分别为:<65岁组≤25分,65⁶9岁组≤24分,7069岁组≤24分,70⁷4岁组≤24分,7574岁组≤24分,75⁷9岁组≤23分,≥80岁组≤19分;≤12年组≤20分,1379岁组≤23分,≥80岁组≤19分;≤12年组≤20分,13²0年组≤24分。结论在健康体检人群中,用MoCA进行认知功能障碍患者的筛查界值不同,尤其在低文化程度和高龄人群更需注意。     

Six-minute walk performance and quality of life comparisons in North Carolina cardiac rehabilitation programs

OBJECTIVE: The purposes of this study were (1). to determine if six-minute walk (6MW) performance improved after short-term cardiac rehabilitation (CR) across multiple outpatient programs; (2). to examine differences in 6MW performance by patient age, sex, and race; and (3). to determine what relationships existed, if any, between 6MW performance and subscales of the Ferrans and Powers' Quality of Life Index-Cardiac Version III (QOLI). DESIGN: Study design was nonexperimental, prospective, and comparative. SETTING: Study setting included 14 outpatient CR programs from urban and rural settings across North Carolina. PATIENTS: Adults aged 40 to 89 years (N = 630; men = 424 [67%], women = 206 [33%]; mean age, 61 +/- 10.32 years) with medically or surgically treated coronary heart disease enrolled in outpatient CR. Outcome Measures: Study measures included scores on the QOLI and distance walked (feet) on the 6MW test. RESULTS: Six-minute walk tests and QOLI surveys were administered before and immediately after short-term CR participation. Six-minute walk distance increased for all patients in all age categories across programs after CR (P <.0001). As a group, women improved 6MW distance by 15% (1243.9 +/- 301.2 to 1435.3 +/- 298.1; P <.001). Men also improved 6MW distance by 15% (1463.3 +/- 339.5 to 1683.7 +/- 346.9; P <.001) and walked farther than women on both the initial and follow-up 6MW tests (P <.0001). By age, there were no differences in 6MW scores between men and women aged 40 to 49 years (n = 58) and 50 to 59 years (n = 140; P = 0.54). Both of these age groups had greater initial and discharge 6MW scores than those aged 70 to 79 years (n = 183) and 80 to 89 years (n = 22; P <.001). Those aged 60 to 69 years (n = 227) had lower 6MW scores than those aged 40 to 49 years (P = 0.001) and 50 to 59 years (P <.05), and greater scores than those aged 70 to 79 years (P <.05) and 80 to 89 years (P <.05). Those aged 70 to 79 years had greater initial and follow-up 6MW scores than those aged 80 to 89 years(P <.001). Overall improvements in 6MW performance were found in both white subjects (n = 575; P <.001) and African-Americans (n = 54; P <.001). There were no apparent relationships between 6MW performance and overall or Health and Function QOLI scores (r <.21). CONCLUSIONS: Participation in short-term outpatient CR improved 6MW performance in patients aged 40 to 89 years across 14 programs in North Carolina. No relationships were found between 6MW performance and any domain of the QOLI, including the Health and Function domain.     

Prevalence and characteristics of anemia in the elderly: cross-sectional study of three urban Korean population samples

We conducted a prospective study to assess the prevalence and clinical characteristics of anemia and to define the risk factors for anemia in older Koreans. From October 2002 to November 2002, 1,254 subjects over the age of 60 years were selected from a cross-sectional study. All subjects underwent a complete medical history taking and laboratory testing, which included; a complete blood cell count, reticulocyte, liver and renal function tests, lipid profiles, and iron profiles. The median age was 70 years old (range, 60-95 years). The mean levels of hemoglobin (mean +/- SD) were 14.5 +/- 1.4 g/dL in men and 13.0 +/- 1.1 g/dL in women, and the overall prevalence of anemia was 13.6% (171/1,254): 9.9% (27/273) in men and 14.7% (144/981) in women. We found that the prevalence of anemia differed significantly between those of age 60-69 and 70-79 years (P < 0.0001), those of age 60-69 and > or =80 (P < 0.0001), and those of age 70-79 and > or =80 (P = 0.0474). Hemoglobin levels were significantly lower in subjects > or =80 years old. By logistic regression testing, female sex, old age, lower albumin level, higher creatinine level, and lower body mass index were identified as independent risk factors of anemia in elderly Koreans. In conclusion, the overall prevalence of anemia in our study group was 13.6% (171/1,254), and this increased with age.     

Cognitive performance in hypertensive and normotensive older subjects

Longitudinal studies suggest that hypertension in midlife is associated with cognitive impairment in later life. Cross-sectional studies are difficult to interpret because blood pressure can change with onset of dementia and the inclusion of subjects on treatment and with hypertensive end-organ damage can make analysis difficult. We examined cognitive performance in hypertensive and normotensive subjects without dementia or stroke >/=70 years of age. Cognitive performance was determined with the use of a computerized assessment battery in 107 untreated hypertensives (55 women, age 76+/-4 years, blood pressure, 164+/-9/89+/-7; range, 138 to 179/68 to 99 mm Hg) and 116 normotensives (51 female, age 76+/-4 years, 131+/-10/74+/-7; 108 to 149/60 to 89 mm Hg). Older subjects with hypertension were significantly slower in all tests (reaction time, milliseconds; simple, 346+/-100 versus 318+/-56, P<0.05; memory scanning, 867+/-243 versus 789+/-159, P<0.01; immediate word recognition, 947+/-261 versus 886+/-192, P<0.05; and delayed word recognition, 937+/-230 versus 856+/-184, P<0.05; picture recognition, 952+/-184 versus 894+/-137, P<0.01; spatial memory, 1390+/-439 versus 1258+/-394, P<0.01; excepting choice reaction time, 510+/-75 versus 498+/-72, P=0.08). Accuracy was also impaired in tests of number vigilance, 99.2+/-2.5% versus 99.9+/-0.9, P<0.01; delayed word recognition, 83.5+/-16 versus 87.9+/-9.8, P<0.01; and spatial memory 64+/-32 versus 79+/-20, P<0.001. Hypertension in older subjects is associated with impaired cognition in a broad range of areas in the absence of clinically evident target organ damage.     

Psychophysics of reading--X. Effects of age-related changes in vision

This study examined the influence of age-related changes in vision on reading performance. Maximum reading speed was measured in groups of young (n = 16, mean age 21.6 years) and old (n = 14, mean age 68.3 years) subjects, all with acuities of 20/32 or better. A psychophysical procedure was used for measuring reading speed that has proven reliable and sensitive to visual factors in previous research. Data were collected for character sizes ranging from .15 degrees to 12 degrees. Research revealed that old subjects who were free of eye disease read as fast as the young subjects for character sizes ranging from .3 degrees to 1.0 degrees. This is the range in which reading speed is maximum for young subjects. Research also revealed that old subjects showed a deficit when reading text composed of very small or very large characters. Their speeds dropped to about 70% of the young adult speeds. These deficits may be due to age-related losses in visual contrast sensitivity.     

双侧颈动脉内膜中层厚度差异与危险因素的相关性分析

目的探讨老年人双侧颈动脉内膜中层厚度(IMT)的差异及其与相关危险因素的相关性。方法整群抽样法调查山西省吕梁市4个地区常住居民1818例,并进行问卷调查、体格检查和彩色多普勒超声检查。根据年龄分为55⁵9岁组508例,6059岁组508例,60⁶4岁组476例,6564岁组476例,65⁶9岁组370例,7069岁组370例,70⁷4岁组238例,≥75岁组226例。应用多元线性回归法对双侧颈动脉IMT的影响因素进行分析。结果双侧颈动脉IMT随年龄增长而增厚。除6574岁组238例,≥75岁组226例。应用多元线性回归法对双侧颈动脉IMT的影响因素进行分析。结果双侧颈动脉IMT随年龄增长而增厚。除65⁶9岁组外,5569岁组外,55⁵9岁组、6059岁组、60⁶4岁组、7064岁组、70⁷4岁组和≥75岁组左侧颈动脉IMT明显较右侧厚[(0.72±0.11)mmvs(0.70±0.10)mm,(0.77±0.12)mmvs(0.75±0.12)mm;(0.83±0.13)mmvs(0.80±0.12)mm,(0.86±0.13)mmvs(0.82±0.14)mm,P<0.05]。多元线性回归分析表明,年龄、吸烟指数、血压、即刻血糖、TC对左侧颈动脉IMT的影响大,而男性对右侧颈动脉IMT的影响较大。结论年龄在55岁以上人群,左侧颈动脉IMT较右侧厚,且双侧颈动脉IMT受年龄、性别、吸烟指数、血压、即刻血糖、TC影响不同。     

The influence of physical fitness on automatic and effortful memory changes in aging.

A cross-sectional study was carried out in order to determine the influence of cardiovascular fitness on age-related declines in cognitive performance. Forty-eight volunteers were divided into Young (n = 13, 18-27 years), Middle-Aged (n = 22, 60-65 years) and Old (n = 13, 65-88 years) groups and tested on a battery of cardiovascular, pulmonary, hemodynamic, and biochemical tests in order to assess physical fitness. Cognitive performance was evaluated by a variety of memory tasks distributed along an automatic-to-effortful processing continuum. Memory for location and frequency of occurrence were selected as representative of automatic processing, whereas, an auditory free-recall task was selected as representative of effortful processing. Age-related performance declines were observed for the free-recall task, but no such age-dependent association was observed for frequency and location memory. With regard to the influence of physical fitness; the Middle-Aged and Older participants were divided into High and Low Fitness groups and significant differences were observed between these groups for the effortful but not the automatic memory tasks. These data suggest that the relationship between physical fitness and cognitive performance in old age is task dependent. Furthermore, the apparent prophylactic effects of physical fitness on effortful memory, do not appear to extend to cognitive tasks requiring less effortful processing.     

The use of psychoactive medications and cognitive function in older adults

This study examined the relationship between cognitive function and psychotropic medication use in a population sample (n = 743) of elderly persons. Approximately one third of subjects received such agents, which consisted primarily of anxiolytics, hypnotics, and antidepressants. Subjects received a battery of cognitive tests at three time points: when they were 70, 75, and 79 years of age. Data on medication use revealed that the use of psychoactive agents increased with age, and was greater for females. A cross-sectional analysis showed that those using psychoactive medicines had lower cognitive test scores compared with those who did not receive such drugs. Repeated measures analysis of variance demonstrated that psychotropics had a negative and cumulative effect on cognition, with the function of subjects who received psychoactive agents consistently poorer than those who did not. The magnitude of this effect is relatively small and for several cognitive tests subjects who received these drugs averaged only a few points lower than individuals not using psychoactive medicines.     

Cognitive performance and age: norms from the Maine-Syracuse Study

The primary objective of this study was to provide contemporary normative data on aging and cognition from an ongoing community-based study. This dementia and stroke-free sample (age range = 20-79; mean = 53) consisted of 623 women and 322 men participating in the Maine-Syracuse Longitudinal Study at waves 4 to 6 (1993 to 2003). We employed a battery of 22 widely utilized cognitive tests. A 5 (age) x 3 (education) x 2 (gender) analysis of variance indicated that, in general, higher educated and younger participants exhibited better performance on cognitive tests. We found education group to be the strongest, and gender to be the weakest, predictor of cognitive performance. However, education cohort was not significantly associated with every cognitive outcome, nor was age cohort membership. The addition of cardiovascular disease health variables to a model including age, education, and gender groupings provided statistically significant, but modest, increases in prediction of performance on some tests. Results are discussed in relation to findings for previous studies presenting normative data on cognitive ability as a function of age, education, and gender.     

The association between low diastolic blood pressure in middle age and cognitive function in old age. A population-based study

BACKGROUND: previous longitudinal studies have shown an inverse relation between blood pressure and cognitive function. OBJECTIVE: to determine the association between mid-life blood pressure and performance in different areas of cognitive function in late life. SUBJECTS AND METHODS: we recruited 502 men, aged 69-74 years, from a population-based cohort in Uppsala, Sweden. Blood pressure had been measured at age 50 and we examined performance in 13 psychometric tests about 20 years later. RESULTS: after the 39 men with a previous stroke had been excluded, there was an inverse relation between diastolic blood pressure at age 50 and performance 20 years later in the digit span test, the trail-making tests and in verbal fluency. The relationships were significant, independently of age, education and previous occupational level. Men within the lowest category of diastolic blood pressure (< or = 70 mmHg, n = 59) showed the best results. Baseline blood pressure levels were not linked to performance in tasks on vocabulary, verbal learning and memory or figure copying. CONCLUSIONS: low blood pressure in mid-life indicates a low long-term cerebrovascular risk and is associated with higher late-life performance in cognitive tests that mainly assess subcortico-frontal cognitive functions.     

Development of a short form of Mini-Mental State Examination for the screening of dementia in older adults with a memory complaint: a case control study

Background

Structural changes occur in the pancreas as a part of the natural aging process. With aging, also the incidence of maldigestive symptoms and malnutrition increases, raising the possibility that these might be caused at least in part by inadequate pancreatic enzyme secretion due to degenerative processes and damage of the gland. Fecal elastase-1 is a good marker of pancreatic exocrine secretion. The aim of this study was to investigate the fecal elastase-1 levels among over 60 years old Finnish and Polish healthy individuals without any special diet, known gastrointestinal disease, surgery or diabetes mellitus.

Methods

A total of 159 patients participated in this cross-sectional study. 106 older individuals (aged 60-92 years) were recruited from outpatient clinics and elderly homes. They were divided to three age groups: 60-69 years old (n = 31); 70-79 years old (n = 38) and over 80 years old (n = 37). 53 young subjects (20-28 years old) were investigated as controls. Inclusion criteria were age over 60 years, normal status and competence. Exclusion criteria were any special diet, diabetes mellitus, any known gastrointestinal disease or prior gastrointestinal surgery. Fecal elastase-1 concentration was measured from stool samples with an ELISA that uses two monoclonal antibodies against different epitopes of human elastase-1.

Results

Fecal elastase-1 concentrations correlated negatively with age (Pearson r = -0,3531, P < 0.001) and were significantly lower among subjects over 70 years old compared to controls (controls vs. 70-79 years old and controls vs. over 80 years old, both P < 0.001). Among the over 60 years old subjects, the fecal elastase-1 concentrations were below the cut off level of 200 μg/g in 23 of 106 (21.7%) individuals [mean 112 (86-138) μg/g] indicating pancreatic exocrine insufficiency. Of those, 9 subjects had fecal elastase-1 level below 100 μg/g as a marker of severe pancreatic insufficiency.

Conclusion

In our study one fifth of healthy older individuals without any gastrointestinal disorder, surgery or diabetes mellitus suffer from pancreatic exocrine insufficiency and might benefit from enzyme supplementation therapy.     

成功老龄认知功能及相关因素研究

目的通过对成功老龄认知功能及相关因素研究,以完善理解老龄人群的认知功能状况。方法采用横断面研究对293例>60岁符合成功老龄标准的军队离退休干部,分60～69岁(1组)、70～79岁(2组)、80～89岁(3组)、90～99岁(4组)4个年龄组,应用神经心理学检测试验进行认知功能分析,并对文化程度、婚姻、居住方式、饮食、饮酒、吸烟、锻炼、睡眠及疾病情况等相关因素进行分析。结果这293例老龄人均保持较好的认知功能、躯体活动功能及良好的心态和身心健康,但认知功能随年龄增长有下降趋势。结论不同年龄段在视空间技能、执行功能、认知加工速度,记忆力、注意力虽有显著差异,但保持认知功能水平还是较好的。     

Memory self-assessment and performance in aged diabetics and non-diabetics

Non-insulin dependent diabetes in older adults is associated with elevated depression and a greater decline in certain aspects of cognitive functioning than is found with normal aging. This study sought to determine whether diabetics report more memory complaints in carrying out their daily activities, and if memory self-assessments are reflective of performance on laboratory tasks. Middle-aged (55-64 years) and old (65-74 years) diabetics and non-diabetic control subjects were studied. Results showed that both diabetes and increased age were associated with poorer performance on some cognitive tests as well as with more self-reported memory problems. When depression levels were statistically controlled, the diabetes variable was no longer a significant predictor of memory complaints. The usefulness of self-assessments as an adjunct to more objective cognitive test measures was discussed.     

Memory performance of young and old subjects related to their erythrocyte characteristics.

Several papers reported in recent years on a change in the age population distribution of the circulating erythrocytes in old mice, rats, rabbits, and humans. The results indicate the presence of a chronologically younger cell population in old animals and humans. The cells are typically lower in density and larger. In some reports, the cells have higher levels of enzymatic activity. We wanted to know whether changes in the characteristics of the circulating erythrocytes in old people are related to the changes in cognitive performance often observed in the elderly. Twenty young (20-40) and 21 old (70-90) volunteers submitted to memory and blood tests. Density and size distribution, aspartate aminotransferase/glutamic oxalacetic transaminase (AST/GOT) activity, and the level of glycosylated hemoglobin (HbA1) of erythrocytes were determined. The Wechsler Memory Scale--Revised (Wechsler, 1987) was used to determine general memory and delayed recall scores for each subject. We have confirmed that old subjects have larger and less dense cells. Erythrocyte volume was the only blood parameter examined that revealed statistically significant correlations with memory performance. The old subjects with no age-related memory impairment had significantly smaller cells than the other old subjects.     

Long-term remission following withdrawal of dopamine agonist therapy in subjects with microprolactinomas

OBJECTIVE: Reports suggest that up to 70% of patients with microprolactinomas treated with dopamine agonist therapy may achieve long-term normoprolactinaemic remission following drug withdrawal. Yet, there is no consensus on the duration of therapy nor is therapeutic interruption universally practised. We have assessed remission rates in a large cohort of treatment-naive subjects with microprolactinomas. Subjects received dopamine agonist (DA) therapy with either cabergoline or bromocriptine for a period of 2 to 3 years in the majority of cases, followed by a trial of treatment withdrawal. DESIGN: Retrospective analysis of clinic records of 89 patients (mean age 32.7 +/- 8.4 years, 84 women and 5 men) who had received either cabergoline (n = 67) (0.5-3 mg weekly) or bromocriptine (n = 22) (2.5-10 mg daily) for a mean duration of 3.1 years. RESULTS: Following withdrawal of therapy, 57 subjects developed recurrence (64%) and the mean time to recurrence was 9.6 months (range 1-44 months), while 32 subjects (36%) remained in remission beyond 1 year (mean 3.6 years, range 1-7 years). There was no difference in remission rates between subjects treated with cabergoline (n = 21) and bromocriptine (n = 11), but a direct relationship between pretreatment prolactin concentration and risk of recurrent symptomatic hyperprolactinaemia was observed. No subjects developed clinical features to suggest tumour expansion following therapeutic discontinuation. CONCLUSIONS: This study confirms that abrupt withdrawal of chronic dopamine agonist therapy, following 2 to 3 years of treatment is safe and associated with long-term remission in 30-40% of subjects with microprolactinomas. This therapeutic strategy is convenient and applicable in clinical practice.     

Randomized trial of the effects of simvastatin on cognitive functioning in hypercholesterolemic adults

PURPOSE: In our initial study of the potential effects of cholesterol-lowering interventions on cognitive functioning, treatment with lovastatin as compared with placebo caused performance decrements on several neuropsychological tests, whereas scores on other tests were unaffected. The current study was designed to confirm and extend those findings. METHODS: The study comprised 308 hypercholesterolemic adults between 35 and 70 years of age. Employing a randomized double-blind design, we assigned participants to daily treatment with placebo, 10 mg of simvastatin, or 40 mg of simvastatin for 6 months. A neuropsychological test battery was administered to assess cognitive functioning at baseline and at the end of the treatment period. RESULTS: A total of 283 subjects completed the study: 94 subjects on placebo, 96 taking 10 mg of simvastatin, and 93 taking 40 mg of simvastatin. Compared with placebo, decremental effects of simvastatin treatment were found on tests previously observed to be sensitive to statins (P = 0.008; difference in summary z scores = 0.18; 95% confidence interval [CI]: 0.07 to 0.29) and on tests not previously administered (P = 0.04; difference in summary z scores = 0.17; 95% CI: 0.05 to 0.29), but not on tests previously observed to be insensitive to statins (P = 0.84; difference in summary z scores = 0.02; 95% CI: -0.07 to 0.10). For the three tests specifically affected by simvastatin, effects on cognitive performance were small, manifest only as failure to improve during the 6 months of treatment (compared with placebo), and were confounded by baseline differences on one test. CONCLUSION: This study provides partial support for minor decrements in cognitive functioning with statins. Whether such effects have any long-term sequelae or occur with other cholesterol-lowering interventions is not known.     

Physical activity and risk of cognitive impairment among older persons living in the community

BACKGROUND AND AIMS: Despite growing interest in the physical and environmental factors associated with the risk of cognitive decline, there is still a lack of information explaining whether they are related to each other. The aim of the present study was to evaluate the relationship of lifetime physical activity with cognitive performance in older persons aged 80 years or older. METHODS: Data are from the baseline evaluation of the ilSIRENTE Study (n=364). Cognitive performance was assessed using a 6-item, 7-category scale [Cognitive Performance Scale (CPS)]. The questionnaire in the ilSIRENTE study form contained one item asking respondents about the frequency of light and high physical activity. Analysis of covariance (ANCOVA) was used to examine the effect of different levels of physical activity on cognitive performance, after adjustment for potential confounding variables. RESULTS: The mean age of 364 subjects participating in the study was 85.9 (standard deviation [SD] 4.9) years, and 244 (67.0%) were women. Of the total sample, 158 subjects (43%) had a history of high intensity physical activity during young age; the rate of high intensity physical activity was lower during adult age and old age (125 and 67 subjects, respectively). After adjustment for potential confounders, individuals with a history of high intensity physical activity had a significantly lower CPS score (indicating better performance) than other participants, independently of the age period considered. CONCLUSIONS: The present study suggests that, among old-old subjects living in the community, a history of high physical activity is associated with better cognitive performance.     

Is age a risk factor for major pancreatic surgery? An analysis of 300 resections.

BACKGROUND/AIMS: The aim of this study was to analyze if age alone is a risk factor in major pancreatic surgery. METHODOLOGY: From September 1, 1985 to December 31, 1997, 806 patients underwent surgery for malignant and benign diseases of the pancreas in a prospective case control study performed at the Department of Surgery, Johannes Gutenberg University Hospital Mainz. In 228 patients (men: n = 139; women: n = 89; mean age: 61 years; range: 23-83 years) we performed partial (n = 178) or total (n = 50) pancreaticoduodenectomy, which was combined with portal vein resection in 16 cases. Left pancreatic resection was carried out in 72 patients (men: n = 40; women: n = 32; mean age: 65 years; range: 28-86 years). RESULTS: Surgical complications after pancreaticoduodenectomy occurred in 22.1% of patients < or = 70 years and in 30.2% of patients > 70 years, however, less than half of them had severe complications ranging below 50%. General complications developed in 16.1% of patients < or = 70 years and in 27.9% of patients > 70 years (p < 0.001). The mortality rates 30 and 90 days after surgery were 3.2% (< or = 70 years) and 2.3% (> 70 years), and 6.0% (< 70 years) and 6.9% (> 70 years), respectively. Regression analysis showed the following factors to exert an independent influence on mortality: Pre-operative serum bilirubin, the diameter of the pancreatic duct, intra-operative blood loss and the occurrence of surgical and nonsurgical complications. Age did not exert an independent influence on the prognosis of either morbidity or mortality. However, general complications developed significantly more often in elderly patients. After left pancreatic resection surgical complications developed in 29.3% (< or = 70 years) and 21.4% (> 70 years) of patients, however the rate of severe complications was below 10%. General complications occurred in 10.3% (< or = 70 years) and 28.6% (> 70 years) (p < 0.001). Mortality rates 30 and 90 days after operation were 1.7% (< or = 70 years) and 14.2% (> 70 years), and 3.4% (< or = 70 years) and 14.2% (> 70 years) (p = n.s.), respectively. Regression analysis showed the intra-operative blood loss to exert an independent influence on post-operative morbidity and mortality. Age had no independent influence on either morbidity or mortality. CONCLUSIONS: Results obtained by this study show that, although general complications develop significantly more often in elderly patients, age is not an independent risk factor for post-operative mortality after major pancreatic resection. Factors of importance in improving the outcome of this operation include the experience of the surgeon in selecting patients eligible to undergo the procedure, his operative skills in performing major pancreatic resections, as well as better anticipation and management of post-operative complications.