Retirement and Beyond

Fisher’s retirement and his life, activities, and accomplishments during retirement are discussed in this chapter. He received many awards, including entrance into the Canadian Medical Hall of Fame. During his last years, his wife developed a dementing illness and died, and he had a myocardial infarction and became nearly blind due to glaucoma. His 90s were spent in assisted living and nursing home facilities in Albany, New York, near his youngest son. He died at age 98 years. He witnessed remarkable changes during his near century of life. Much of the change in the care of patients with stroke and cerebrovascular disease could be directly attributable to his research, writings, and teachings and to the physicians he had mentored lovingly during his long and fruitful career.

Neuroinflammation in Alzheimer’s Disease: Microglia, Molecular Participants and Therapeutic Choices

Alzheimer’s disease is the world’s most common dementing illness. It is pathologically characterized by β-amyloid accumulation, extracellular senile plaques and intracellular neurofibrillary tangles formation, and neuronal necrosis and apoptosis. Neuroinflammation has been widely recognized as a crucial process that participates in AD pathogenesis. In this review, we briefly summarized the involvement of microglia in the neuroinflammatory process of Alzheimer’s disease. Its roles in the AD onset and progression are also discussed. Numerous molecules, including interleukins, tumor necrosis factor alpha, chemokines, inflammasomes, participate in the complex process of AD-related neuroinflammation and they are selectively discussed in this review. In the end of this paper from an inflammation- related perspective, we discussed some potential therapeutic choices.

Palliative care and quality of life for people with dementia: medical and psychosocial interventions

ABSTRACTBackground:Despite mounting evidence that principles of palliative care are appropriate in care for individuals with dementia they are often not applied. As a result, patients with dementia are often exposed to burdensome interventions that have little or no benefit and are not provided with psychosocial treatments.Methods:Recommendations for applying palliative care principles in caring for people with dementia are provided, based on the WHO definition of palliative care, our clinical experience and some key literature reports.Results:People with a diagnosis of an irreversible dementia such as Alzheimer's disease (AD) and their families are rarely informed that this is a terminal disease and palliative care principles are not discussed with them. They are applicable early in the course of illness when the person can still make end-of-life decisions. Palliative care can be used in conjunction with other therapies and services, such as hospice care that provide relief from pain and other distressing symptoms. The care should include keeping people with dementia involved in meaningful activities which decrease or eliminate behavioral symptoms of dementia.Conclusions:Educating families and professionals about palliative care is important as many professionals and non-professionals believe that this approach intends to hasten death, instead of affirming life and regarding dying as a normal process. Living, not just existing, with a dementing illness involves encouraging the person to continue to be involved in meaningful activities. Medical interventions should be compatible with goals of care and balance benefits and burdens for each intervention taking into consideration severity of dementia.

Assessment of mental disorder in older patients

The assessment of older people is not fundamentally different from that of younger patients. The principles of taking history and mental-state examination are the same at any age. But if the goals are common, the routes taken to reach them are not necessarily so. For example, an assessment adequate enough to begin treatment of a 30-year-old woman presenting to an outpatient clinic with a depressive illness might take about an hour and involve speaking only to the patient and perhaps briefly to her partner, whereas the equivalent assessment of an 81-year-old woman in whom uncertainty exists as to whether the diagnosis is that of a depressive or a dementing illness may require more than one interview and necessitate enquiry from several informants. This section will not repeat what can be found in Chapter 1.8.1, but cover only those points which are specific to or need to be emphasized for older patients.