Gender and Polypharmacotherapy in the Elderly: A Clinical Challenge

Idiopathic normal pressure hydrocephalus (iNPH) is the most common cause of hydrocephalus in adults. The diagnosis may be challenging, requiring collaborative efforts between different specialists. According to the International Society for Hydrocephalus and Cerebrospinal Fluid Disorders, iNPH should be considered in the differential of any unexplained gait failure with insidious onset. Recognizing iNPH can be even more difficult in the presence of comorbid neurologic disorders. Among these, idiopathic Parkinson’s disease (PD) is one of the major neurologic causes of gait dysfunction in the elderly. Both conditions have their peak prevalence between the 6th and the 7th decade. Importantly, postural instability and gait dysfunction are core clinical features in both iNPH and PD. Therefore, diagnosing iNPH where diagnostic criteria of PD have been met represents an additional clinical challenge. Here, we report a patient with parkinsonism initially consistent with PD who subsequently displayed rapidly progressive postural instability and gait dysfunction leading to the diagnosis of concomitant iNPH. In the following sections, we will review the clinical features of iNPH, as well as the overlapping and discriminating features when degenerative parkinsonism is in the differential diagnosis. Understanding and recognizing the potential for concomitant disease are critical when treating both conditions.

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Depressive disorders in the elderly and dementia: An update

Dementia & Neuropsychologia ◽

10.1590/1980-57642020dn14-010001 ◽

2020 ◽

Vol 14 (1) ◽

pp. 1-6

Author(s):

Natália S. Dias ◽

Izabela G. Barbosa ◽

Weihong Kuang ◽

Antonio L. Teixeira

Keyword(s):

Depressive Disorders ◽

Antidepressant Treatment ◽

The Elderly ◽

Elderly Subjects ◽

Clinical Challenge ◽

Csf Levels ◽

Inflammatory Molecules ◽

The Relationship ◽

Circulating Levels

ABSTRACT The relationship between depressive disorders in the elderly and dementia, particularly Alzheimer’s disease (AD), is highly complex. While the nature of this relationship is still a matter of debate, differential diagnosis and treatment remain a great clinical challenge. We review recent findings on the conundrum of depressive disorders in the elderly and AD. There is a biological continuum between depressive disorders in the elderly – or at least a subgroup of them – and AD. While elderly subjects with depression and patients with AD exhibit higher circulating levels of pro-inflammatory molecules and lower BDNF than matched controls, CSF levels of Aβ42 can discriminate AD from depressive disorders in the elderly. The role of antidepressant treatment as a strategy to minimize the risk of AD remains to be established.

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Cell surface changes during aging of human bladder epithelium examined by lectin probes and SEM

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100162429 ◽

1990 ◽

Vol 48 (3) ◽

pp. 966-967

Author(s):

J. Jacob ◽

M.F.M. Ismail

Keyword(s):

The Elderly ◽

Ultrastructural Changes ◽

Pokeweed Mitogen ◽

Asymmetric Structure ◽

Luminal Surface ◽

Bladder Epithelium ◽

Aldehyde Groups ◽

Cell Surface Changes ◽

Phosphate Buffered Saline ◽

Surface Changes

Ultrastructural changes have been shown to occur in the urinary bladder epithelium (urothelium) during the life span of humans. With increasing age, the luminal surface becomes more flexible and develops simple microvilli-like processes. Furthermore, the specialised asymmetric structure of the luminal plasma membrane is relatively more prominent in the young than in the elderly. The nature of the changes at the luminal surface is now explored by lectin-mediated adsorption visualised by scanning electron microscopy (SEM).Samples of young adult (21-31 y old) and elderly (58-82 y old) urothelia were fixed in buffered 2% glutaraldehyde for 10 m and washed with phosphate buffered saline (PBS) containing Ca++ and Mg++ at room temperature. They were incubated overnight at 4°C in 0.1 M ammonium chloride in PBS to block any remaining aldehyde groups. The samples were then allowed to stand in PBS at 37°C for 2 h before incubation at 37°C for 30 m with lectins. The lectins used were concanavalin A (Con A), wheat germ agglutinin (WGA), phytohaemagglutinin (PHA) and pokeweed mitogen (PWM) at a concentration of 500 mg/ml in PBS at pH 7.A.

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The effect of dental geriatric curricula on attitudes toward the elderly

Journal of Dental Education ◽

10.1002/j.0022-0337.1988.52.9.tb02232.x ◽

1988 ◽

Vol 52 (9) ◽

pp. 516-518 ◽

Cited By ~ 2

Author(s):

J Mann ◽

TJ Bomberg ◽

JM Holtzman ◽

DB Berkey

Keyword(s):

The Elderly

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Speech-Language Pathologists' Attitudes Toward Aging and the Elderly

Contemporary Issues in Communication Science and Disorders ◽

10.1044/cicsd_30_f_146 ◽

2003 ◽

Vol 30 (Fall) ◽

pp. 146-155 ◽

Cited By ~ 5

Author(s):

Jeff Searl ◽

Rodney M. Gabel

Keyword(s):

The Elderly ◽

Speech Language Pathologists ◽

Attitudes Toward Aging

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Pharmacology Issues Related to Dementia Syndrome of Depression in Elderly Residents of Long-Term Care Settings

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld25.2.61 ◽

2015 ◽

Vol 25 (2) ◽

pp. 61-69

Author(s):

Angel L. Ball ◽

Adina S. Gray

Keyword(s):

Depressive Symptoms ◽

The Elderly ◽

Environmental Communication ◽

Pharmacological Intervention ◽

Team Approach ◽

Discussion Paper ◽

Term Care ◽

Anticholinergic Medications ◽

Inappropriate Treatment ◽

Dementia Syndrome

Pharmacological intervention for depressive symptoms in institutionalized elderly is higher than the population average. Among the patients on such medications are those with a puzzling mix of symptoms, diagnosed as “dementia syndrome of depression,” formerly termed “pseudodementia”. Cognitive-communicative changes, potentially due to medications, complicate the diagnosis even further. This discussion paper reviews the history of the terminology of “pseudodementia,” and examines the pharmacology given as treatment for depressive symptoms in the elderly population that can affect cognition and communication. Clinicians can reduce the risk of misdiagnosis or inappropriate treatment by having an awareness of potential side effects, including decreased attention, memory, and reasoning capacities, particularly due to some anticholinergic medications. A team approach to care should include a cohesive effort directed at caution against over-medication, informed management of polypharmacology, enhancement of environmental/communication supports and quality of life, and recognizing the typical nature of some depressive signs in elderly institutionalized individuals.

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