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P OSTER
A BSTRACTS
and its sum of boxes. DLB patients without Capgras were able to tolerate
and continue taking cholinesterase inhibitors (p=0.03) without
other significant differences in medication management.
Conclusions
We found that DLB-C patients had more visual hallucinations,
and that caregivers of DLB-C patients endorse greater caregiver burden.
We were unable to discern specific patient characteristics or psychometric
performance data to help us predict who may be at greater
risk of developing Capgras syndrome. Future research is needed to
evaluate management and treatment options for the clinically challenging
behavioral sequelae of DLB and Capgras syndrome.
A140
Computational Modeling of Aging in Cardiac Myocytes.
P. Dalal, E. Sobie. Pharmacology and Systems Therapeutics, Mt. Sinai
School of Medicine, New York, NY.
Supported By: This research is supported by the Medical Student
Training in Aging Research (MSTAR) at Mount Sinai School of
Medicine.
BACKGROUND: The risk of susceptibility to more serious
forms of cardiac arrhythmia rises significantly with normal aging.
These forms of arrhythmia can manifest as palpitations, fibrillation,
and even sudden death. One indicator of arrhythmia risk is action potential
duration in cardiac myocytes. Specifically, the prolongation of
action potential leads to a larger vulnerability period towards after
depolarization. Such rogue depolarization can result in dangerous,
self-sustaining circular currents. Animal studies in the past have
shown that age associated molecular changes in cardiac myocytes include:
a 40% reduction in SERCA pump protein, a 20% reduction in
the transient outward current, a 59% increase in the peak L-Type calcium
channel current, and a 142% increase in the inactivation time
constant of the L-Type calcium channel. Additionally, the action potential
is prolonged by 92% in older rats when compared with
younger rats and the calcium transient decay is slower in aged rats
while its amplitude remains the same.
HYPOTHESIS: Implementing the molecular changes in rat myocytes
into the computational models of Hund (2004), et al and Ten
Tusscher (2004), et al will prolong the action potentials and slow the
calcium transient decay of these models, creating a computational
tool to study age associated arrhythmia risk.
RESULTS: After implementing the four major molecular
changes associated with cardiac aging, the action potential was prolonged
by 4% in the Hund (2004) model and by 77% in the Ten Tusscher
(2004) model. The calcium transient decay was slower in both
models while the calcium transient amplitude was only unchanged in
the Ten Tusscher (2004) model. In the Hund (2004) model, the amplitude
was increased.
CONCLUSIONS: It is possible to generate a computational
model that replicates the age associated changes seen in cardiac myocytes.
The Ten Tusscher (2004) model more accurately replicates
these changes than the Hund (2004) model.
A141
Isolated CNS Post-transplant Lymphoproliferative Disorder in a
Kidney Transplant Recipient.
S. Dahiya, W. Ooi, A. Asik. Internal Medicine/Division of Hematology
and Oncology, Baystate Medical Center, Springfield, MA.
Introduction
Post-transplantation lymphoproliferative disorder(PTLD)is a
very well recognized complication of solid organ transplantation. Its
incidence varies, depending on the graft recipient’s age,the type and
intensity of immunosuppression, and the organ type transplanted.
Extranodal involvement is common in PTLD, although the central
nervous system (CNS) is an uncommon site of disease, especially in
isolation. Literature review suggests less than handful of cases in geriatric
population.
Case
65 year old female presented with complaints of intermittent expressive
aphasia. Her medical history was remarkable for polycystic
kidney disease leading to kidney failure and thus requiring transplant.
Her transplant history includes, failed first transplant in 1995
from a deceased donor and subsequent living-related donor transplant
in 2005 from her son with unrelated blood type requiring heavy
immunosuppresion. She was on mycophenolate, tacrolimus and prednisone
for immunosuppressive regimen. Her neurological exam was
significant for word finding difficulty and left eye ptosis. Rest of the
physical exam was within normal limits. A spinal tap showed slight elevation
of proteins to 149mg/dl and decreased glucose to 36mg/dl,
raising a question of ongoing infectious process. An urgent MRI was
obtained which showed multiple discrete enhancing lesions throughout
the supratentorial and infratentorial white matter with leptomeningeal
involvement. An extensive infectious workup looking
for various causes of enhancing lesion in this severely immunosuppressed
patient was negative. A brain biopsy was eventually performed,
which showed monomorphic PTLD, categorized as EBV-associated
diffuse large B-cell lymphoma. Given her kidney disease, she
was started on a rather unconventional regimen with weekly rituximab
for 8 weeks and 4 cycles of monthly intrathecal cytarabine. Her
immunosuppresive regimen was changed to sirolimus only. She has
been in remission since last 1 year, but unfortunately developed allograft
rejection because of reduction in immunosuppressive regimen.
Discussion
Isolated CNS-PTLD following kidney transplant is exceedingly
rare. However, it must be considered as a differential in transplant patients
with CNS symptoms to avoid delay in diagnosis. Advanced age
is considered as a poor prognostic factor, but this elderly patient did
rather well with the unconventional regimen as outlined above.
A142
Deep Vein Thrombosis and Pulmonary Embolism (DVT/PE) with
JAK2 positive Polycythemia Vera (PCV) and mild hematologic
findings.
R. Lands, S. Kelley. Department of Medicine, University of Tennessee,
Knoxville, TN.
An 81-year-old man came to the emergency room after becoming
suddenly short of breath while taking a shower. Any exertion
after that exacerbated his dyspnea but was relieved by lying down. He
did not have chest pain, pleuritic or otherwise. He had no preceding
illness, immobilization or prolonged travel. He was previously
healthy with a history of hypertension and gout, but he was on no
meds at the time of admission. Physical examination showed him to
be in no distress at rest while wearing oxygen. Lungs were without
rales or rhonci and his respiratory effort was normal. There was no
edema of either lower extremity. High sensitivity D-Dimer was
greater than 5000 ng/ml. EKG demonstrated right heart strain. Chest
x-ray demonstrated elevation of the hemidiaphragm. Creatinine was
1.9 mg/dl. Ventilation perfusion scan of the lungs was interpreted as
high probability for left and right lower lobe pulmonary emboli.
Doppler venous studies demonstrated bilateral deep vein thromboses
of the lower extremities.
Hgb was 17 g/dl and Hct 53%. WBC was 32,000 without basophilia
or eosinophilia. Cells containing JAK-2 V617F mutation
were present. BCR/ABL was absent. Erythropoietin was 1 mIU/ml.
No further imaging was performed given his marginal renal function.
Review of his old records demonstrated a very mild leukocytosis and
upper normal hemoglobin levels for several years prior to this admission.
One month after discharge, he followed up in the hematology
clinic where his WBC was 15x103 and his hemoglobin 15.8mg/dL.
Discussion: JAK2 is a gain of function mutation with tyrosine kinase
activity that is present in 90% of patients with PCV. While it is
primarily a diagnostic marker now, there is evidence that it might
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