Student-led exercise sessions yield significant fitness gains for Alzheimer's patients

At a time when they are losing skills in virtually all arenas of life, persons with Alzheimer's disease can experience significant, esteem-building achievements in physical fitness and mood through supervised participation in an exercise program. The effects of physical exercise plus cognitive and social stimulation on persons with early stage Alzheimer's disease were assessed in a longitudinal study. Twenty-four such individuals, aged 54 to 88 at program entry, participated in 16 to 20 exercise sessions and 10 community activity sessions per semester for two to eight semesters. Half of the weekly exercise sessions included memory and language stimulation activities. Students, supplemented by family caregivers, supervised the sessions. Exercise sessions consisted of flexibility, balance, aerobic, and weight resistance activities. Preparticipation and semiannual post-testing of aerobic fitness and duration and upper and lower body strength was done. Highly significant fitness gains (p < .001) were achieved in the six-minute walk test, upper and lower body strength, and duration of aerobic exercise. Five participants, aged 86 to 91, completed six to eight semesters and were doing 27 to 45 minutes of aerobics per session at program's end. Five participants scored within the normal range for age-matched healthy active adults on the six-minute walk test at baseline. Nine others achieved and three exceeded the normal range during treatment. Cognitive decline was slowed and mood improved. First-year cognitive outcomes have been published elsewhere. An article reporting final cognitive outcomes is in preparation; Outcome data is summarized on the project website: www.u.arizona.edu/ ~sarkin/elderrehab.html. The benefits of physical exercise can be made available at nominal cost to Alzheimer's patients and other elderly persons by using students to provide transportation, supervision, and the motivational support that is key to exercise adherence. Further research is needed to determine the relative contributions of each program component to the positive outcomes.     

Where pulmonary arterial catheters go: intrathoracic distribution.

Recent experimental evidence indicates that the position of a pulmonary arterial catheter within the thorax is important because vertical height gradients from catheter tip to main pulmonary artery and left atrium may alter the validity of the pressure measured. The authors therefore examined the intrathoracic distribution of 314 pulmonary arterial catheters which at insertion were advanced to the most proximal position from which pulmonary wedge pressure could be obtained. Five catheters (1.8 per cent) were 6 cm or more cephalad to the carina, and 16 (5.1 per cent) were 9 cm or more lateral to the midline. With peripheral catheters recordings of pulmonary arterial and wedge pressures may be erroneous because future patient position, initiation of positive end-expiratory pressure, and occurrence of low pulmonary arterial and left atrial pressures may convert the region of lung in which the catheter tip lies to a Zone 1 of the lung.     

Haematologic manifestations of the human immune deficiency virus (HIV)

A variety of haematologic abnormalities are associated with infection by HIV, the human retrovirus that is the primary aetiologic agent of the acquired immunodeficiency syndrome (AIDS). We have reviewed the haematologic findings in well-characterized cohorts of patients with AIDS, AIDS-related complex (ARC) and asymptomatic homosexual men at risk for this retrovirus. Anaemia, granulocytopenia and thrombocytopenia were found in increasing prevalence according to the severity of clinical disease associated with retroviral infection. Bone marrow aspirations and biopsies revealed frequent hypercellularity, dysplasia, plasmacytosis and lymphoid infiltrates. These marrow morphologic findings were strongly associated with anaemia and granulocytopenia. Review of transfusion records of patients with HIV antibodies revealed a 21% prevalence of a positive direct antiglobulin test. The pathophysiology of the observed haematologic abnormalities may involve direct retroviral infection of bone marrow progenitors, abnormal regulation of haematopoiesis and/or autoimmune phenomena.