At the MGH FTD Unit, we understand that every patient we meet has a unique support system and exists within that network, family or friendship. We know that having caregivers who are informed and supported can make all the difference in patient care and have witnessed the power of tenacious advocates. We are consistently awed by the strength, perseverance and love that caregivers share every day. Strong partnerships with the Association for Frontotemporal Degeneration, the Boston-area FTD Support Group and the Alzheimer's Association ensure that we will refer caregivers for support, information, and a new community where they will feel respected and welcomed.
This chapter contains sections titled: Introduction Vascular Dementia Dementia with Parkinsonism Dementia with Lewy Bodies Parkinson's Disease Dementia Progressive Supranuclear Palsy Corticobasal Degeneration Multiple System Atrophy Frontotemporal Lobar Degeneration Depression Human Prion Diseases Huntington's Disease Cerebral Vasculitis Alcohol-Related Dementia Human Immunodeficiency Virus–Associated Dementia Paraneoplastic Limbic Encephalitis Normal Pressure Hydrocephalus Medications Approach to the Diagnosis of Dementia in Older Persons Key References References
Ageing men undergo a gradual and moderate decrease in testicular function. This chapter summarises the available information on the diagnosis and management of patients with hypogonadism, with special focus on elderly men. Both cross-sectional and longitudinal studies demonstrate a gradual decline in serum T concentration starting after age 30. The rate of age-related decline in serum T concentrations varies in different individuals and is affected by chronic disease such as obesity, new illness, serious emotional stress, and medications. Normal spermatogenesis depends on the presence of intratesticular T. The diagnosis of hypogonadism requires the presence of symptoms and signs suggestive of T deficiency. Diagnostic workup should be conducted to establish the cause of hypogonadism. Several different types of T replacement exist, including oral capsules, injections, transdermal systems, pellets, and nasal preparations. T therapy consistently decreases subcutaneous fat mass but does not change visceral fat or hepatic fat content in elderly men.
Ageing causes structural and functional changes in the cardiovascular system, increasing the prevalence of cardiovascular diseases, including heart failure (HF). A number of evidence-based treatments are available for HF; however, older people with multimorbidities are typically underrepresented in the clinical trials. Associated ageing-related changes in other major organ systems in the body affect the pathophysiology, presentation, and treatment choices of HF. The common symptoms of HF are dyspnoea on exertion, orthopnoea, lethargy, and lower limb oedema irrespective of age. In older people, hypertension is the commonest cause, followed by ischaemic heart disease. The primary goals of HF management in older people are to alleviate symptoms and thereby improve quality of life, slow the progression of the condition, and reduce mortality. Despite a therapeutic armamentarium, the prognosis of HF is poor, and involvement of multidisciplinary team and discussions about future care plans, including palliative care, are of paramount importance.
In the elderly population, hip fracture is the most common cause of unplanned admission to an acute orthopaedic ward and the second leading cause of hospital admission in general. Proximal femoral fracture is a turning point for the worse in the life of the elderly person, and it often leads to loss of independence and social decline, marked by admission to an institution. A meta-analysis of observational studies evaluating the timing of surgery for a hip fracture included different studies that reported the adjusted risk of mortality. Peripheral blocks have considerably improved pain management in femoral neck fractures. In the elderly person with hip fracture, electrolyte imbalance is frequent and has various causes, such as renal failure, diabetes, and diuretic medications. Delirium in the elderly person with a proximal femoral fracture is a complication whose prevalence is difficult to determine. Many practitioners consider femoral neck fracture a geriatric rather than an orthopaedic condition.
Ageing is associated with a reduction in appetite and food intake, which has been termed the `anorexia of ageing'. After age 70–75 years average body weight decreases, even in healthy people, disproportionately due to loss of lean tissue. The `physiological' anorexia and weight loss of ageing predispose to pathological weight loss and malnutrition. Marked weight loss is common in the elderly and a major cause of morbidity and increased mortality. The cause(s) of the anorexia of ageing are largely unknown. We have identified several possibilities. Animal and preliminary human studies indicate that ageing is associated with increased satiety factors and a reduced feeding drive. Endogenous opioids stimulate eating. We administered iv infusions of the opioid antagonist naloxone to young and older adults. Overall, the suppression of food intake was not different in the two age groups, but was increased in older women, suggesting reduced stimulation of feeding by endogenous opioids in this group. Plasma concentrations of the satiety hormonecholecystokinin (CCK) increase with ageing. Intravenous CCK-8 infusion produced greater suppression of food intake in older than young subjects (33.5 vs 15.5% P = 0.026),indicating that sensitivity to the satiating effects of CCK is at least maintained and may increase withage. This raises the possibility of using CCK antagonists as stimulants of appetite and food intake in malnourished older people.
Abstract The key to longevity among older adults is the incorporation of preventative practices into their daily lives. These includes being up-to-date with recommended preventative screening tests, vaccinations, a balanced nutrition and supplements, physical activities, and limiting exposure or building resiliency to environmental toxins and stress. Another very common major preventable problem in geriatrics is polypharmacy. This chapter in addition to covering in detail common life style based preventative methods covers recommended resources on identifying high-risk medications and drug-drug/drug-herbs/supplements interactions.
This chapter covers relevant psychological aspects of ageing that practitioners should be cognizant of when caring for this population. It discusses both normal and abnormal changes in mental health and cognitive function in older adulthood as well as interventions that can help with adapting to these changes and maintaining function. Attention to normal personality development also offers insight to those caring for older adults. Psychological Interventions are effective in the elderly with behavioural and mental health disorders, and it appears the older adult population prefers psychotherapy to psychiatric medications. Currently available interventions can be divided into pharmacologic and non-pharmacologic categories. A past literature review suggested that non-pharmacologic interventions for mild cognitive impairment and dementia can essentially be divided into four categories: restorative cognitive training, compensatory cognitive training, lifestyle interventions, and psychotherapeutic interventions.
Disseminated intravascular coagulation (DIC) is a pathophysiological syndrome characterized by clinical manifestations of generalized bleeding together with laboratory features of severe coagulopathy. Thus, DIC is a failure of haemostatic homeostasis. In DIC there is unregulated and uncontrolled activation of the coagulation cascade and platelets resulting in blockage of the microvascular system of critical organs. In addition, there is activation of the fibrinolytic cascade generating plasmin and consequently fibrin and fibrinogen degradation, together with depletion of components of the natural anticoagulant pathway which contribute to the systemic bleeding diathesis. The diagnosis of DIC is made in the presence of a predisposing cause, the clinical manifestations of systemic bleeding and multiorgan dysfunction and from appropriate laboratory investigations. The first principle of management of DIC should be toward resuscitation of the patient to achieve adequate oxygenation, blood pressure, circulation and renal perfusion. Treatment of the underlying cause and other strategies are discussed.
