ABSTR ACT BACKGROUND: Orthostatic hypotension (OH) can be seen in as many as 30% to 50% of the elderly population as well as in dementia. OH is part of the autonomic dysfunction in dementia with Lewy bodies (DLB) and prevalent in the majority of these patients. It is also suggested to be a negative prognostic factor for survival in DLB. A detailed interpretation of the 10-minute orthostatic blood pressure measurement has shown prolonged orthostasis in DLB compared with other dementias. The type of OH (systolic and diastolic) has not been separately investigated in different dementias. OBJECTIV ES: The aims of this study were to analyze the type of orthostatic hypotension, systolic and/or diastolic, in different dementia groups compared with normal controls. PATIENTS AND METHODS: One-hundred fifty-six individuals, 52 with DLB, 50 with Alzheimer’s disease (AD), 54 AD with vascular components (ADvasc), and 62 normal controls, were included. As part of each patient’s routine clinical dementia investigation, systolic and diastolic blood pressure measurements were examined in the supine position, immediately after standing up, and after 1, 3, 5, and 10 minutes of standing. OH was defined as a blood pressure drop of 20 mmHg systolic or 10 mmHg diastolic, and the type of OH— systolic, diastolic or both—was defined. RESULTS: Orthostatic hypotension was severely underdiagnosed before the dementia investigation with only 2% to 4% in the dementia groups, while we found that 69% of DLB, 50% of ADvasc, 38% of AD, and 13% of normal controls had OH. A combination of systolic and diastolic OH was the most common type of OH both in the DLB (67%) and ADvasc (48%) groups, while systolic OH was the most common type in AD (63 %) as well as in normal controls (63%). Mini Mental State Examination scores differed significantly ( P 0.001) between the group with no OH (25.2 ± 4.8) and the group with combined systolic and diastolic OH (22.0 ± 4.8). CONCLUSION: Patients with DLB showed a greater proportion of combined systolic and diastolic hypotension. This might suggest a more complex OH than in patients with AD or elderly controls, possibly exacerbating the clinical picture in DLB. Further investigations of the relevance of these findings and the relation to clinical symptoms are needed.
The value of resistance training (RT) for people with Parkinson disease (PD) is disputed, but recent research shows promising results regarding effects of intensive RT. The main aim of this case report was to develop a combined model consisting of home-based training (HT) and supervised RT as a 1-year follow-up to evaluate changes in functional capacities of a patient with PD. The intervention consisted of 8 weeks of supervised progressive RT, followed by 12 weeks of individual HT. This sequence was then repeated, for a total follow-up of 12 months. Functional capacities were assessed between all training periods with a battery of clinical measures. During the second HT period, functional outcomes and muscle strength were better preserved compared with the first HT period. These results are important regarding how to design and implement efficient exercise regimens for patients with PD and show that progressive RT twice a week for 2 months combined with home training in periods is effective in improving muscular strength and functional capacities.
Loneliness is a significant but neglected circumstance in which many individuals, particularly the elderly, find themselves. This review aims to discuss the various effects that loneliness has on mental and physical health and the potential interventions that may alleviate this problem. This review used the PubMed, ScienceDirect, and WHO IRIS databases to search for relevant studies on the topic, mainly focusing on longitudinal studies due to the difficulty in distinguishing the causality between loneliness and its associated factors. In collating these studies, loneliness can be shown to be a significant independent risk factor for a number of conditions such as poor health behaviors (eg, smoking and alcohol consumption), physical health problems (eg, hypertension and motor decline), and psychiatric conditions (eg, depression and cognitive impairment). The interventions discussed, both low tech and high tech, have the potential to benefit patients at both an individual level and a population-wide level.
Palliative care, and more specifically end-of-life (EOL) care, serves to address the physical, practical, psychosocial, and spiritual needs of dying patients and their families. The quality of this care is critical to reduce the burden of illness and moderate escalating health-care costs. Accordingly, assessing the quality of EOL care is a priority of many governments. This article is an overview of the three main types of data sources that can be used to indicate the quality of EOL care: population-based administrative data, clinical data, and patient-reported outcomes. Existing administrative data are relatively inexpensive to use and provide a whole picture of the health-care system. Clinical data are useful for benchmarking care provided against best practices. Patient-reported outcome measures capture quality as defined by the patient and directly represent impact of care. Understanding the capabilities of these data types is the basis for developing feasible quality assessments to inform program and policy development.
Normally, aging adults experience a wide range of changes in sensory abilities, cognition, and language. Pragmatic language ability, or social use of language, declines primarily as a result of the aging of the right cerebral hemisphere of the brain. This commentary will describe the consequences of pragmatic language decline in older adults and how it can damage communication with conversation partners. Aspects of both production and comprehension of pragmatic language can be impaired, including facial expressions, gestures, and figurative language, among others. Older adults also tend to have vital relationships with health care providers to manage increases in illness and other health issues. Essential communication between patients and providers can become more difficult as a result of decline in older patients’ pragmatic language ability, potentially resulting in health information being misunderstood. With the number of adults aged >60 years in the world projected to double by 2050, pragmatic language deficits in older adults will continue to affect the patient–provider relationship and quality of care.
