Geriatric medicine: achievements and prospects

The article is a lecture on the history of development and the current state of geriatric medicine. The purpose of the lecture is to consider the stages of the formation of geriatrics as a scientific and clinical discipline and to substantiate its significance. The lecture defines concepts such as holistic approach, complex geriatric assessment, geriatric syndrome. The role of the founders of international and domestic geriatrics, such as M. Warren, B. Isaac, D. Sheldon, I.I. Mechnikov, V.N. Anisimov, E.S. Pushkova, is described. Various directions of geriatric medicine are considered and the necessity of their study is justified. The results of scientific research in geriatrics are analyzed. The basic principles of the ortho-geriatric approach, which becomes crucial for the successful treatment of elderly patients with fractures, as well as the features of geriatric rehabilitation, geriatric cardiology, are described. In conclusion, the author offers several models for the development of geriatric medicine.

Prevalence of Dementia in an Urban Indian Population

This article reports the findings of a 3-year epidemiological survey for dementia in an urban community-resident population in Mumbai (Bombay), India, wherein the prevalence of all types of dementia was determined. Method: The study was conducted in three stages. Stage 1: From a potential pool of 30,000 subjects aged 40 years or more, 24,488 (male = 11,875; female = 12,613) persons completed self-report or interviewer-rated protocols based on the Sandoz Clinical Assessment Geriatric Scale, but 5,512 (18.37%) persons refused to participate. Scores on the protocol had a possible range from 0 through 34. Stage 2: Persons with a score +2SD above the mean were selected in this stage where the persons were screened for cognitive functioning using a modified and translated version of the Mini-Mental State Examination. Individuals who scored below the 5th percentile were included in Stage 3 and underwent a detailed neurological, psychiatric, and neuropsychological evaluation as well as hematological, radiological, electrocardiographic, and electroencephalographic investigations. Diagnoses were made jointly by a neurologist, psychiatrist, and psychologist using the DSM-IV diagnostic criteria. Subjects were also rated on the Clinical Dementia Rating (CDR) scale and assessed for activities of daily living. Results: One hundred five subjects with dementia (CDR ≥ 0.5) were identified in this population of 24,488 persons. The prevalence rate for dementia in those aged 40 years and more was 0.43% and for persons aged 65 and above was 2.44%. Seventy-eight individuals had a CDR of ≥ 1 yielding an overall prevalence rate of 0.32%, and a prevalence rate of 1.81% for those aged 65 years and older. The overall prevalence rate for Alzheimer's disease (AD) in the population was 0.25%, and 1.5% for those aged 65 years and above. AD (n = 62;65%) was the most common cause of dementia followed by vascular dementia (n = 23;22%). There were more women (n = 38) than men (n = 24) in the AD group. Increasing age was associated with a higher prevalence of the dementia syndrome in general as well as AD specifically. Conclusion: In the population surveyed, the prevalence of AD and other dementias is less than that reported from developed countries but similar to results of other studies in India. Prevalence of the dementia syndrome increased with age and was not related to gender. AD was the most common dementia and the prevalence was higher in women than in men. Results are discussed with respect to shorter life expectancy, relocation of affected persons, and differences in the risk factors as compared to developed countries.

Ergoloids and Ischaemic Strokes; Efficacy and Mechanism of Action

In this double-blind, randomized study the efficacy of the ergoloid compounds, co-dergocrine mesylate and nicergoline, in the rehabilitation of patients with ischaemic stroke was investigated. A group of 30 patients was treated daily with 60 mg nicergoline, orally, and a second group of 27 patients was given 1.8 – 6 mg co-dergocrine mesylate, orally or intramuscularly, daily (depending on the time since the initial ischaemic insult) for 6 months. Outcome measures included: motoricity index (limb function); Sandoz Clinical Assessment Geriatric (SCAG) scale; psychometric tests to assess functions such as attention, psychomotor performance, perception and sensory and short-term memory; conventional and computerized electroencephalography; and P300 and reaction time measures. The results showed improvements in some aspects such as limb function ( P < 0.05), SCAG score ( P < 0.01) and some electrophysiological parameters ( P < 0.01) after treatment with both drugs. Though statistically significant most of the changes were not large. The efficacy of both drugs was qualitatively similar. The quantitative difference in some aspects in favour of nicergoline could be attributed to differences in the mechanisms of action of the two drugs, although it is also possible that the difference may reflect the dosages used. Nootropic drugs may induce a condition that facilitates the effects of cognitive training.

Vitamin C Status of Elderly Patients on Admission into an Assessment Geriatric Ward

A study of the plasma vitamin C concentration in patients in an assessment geriatric ward was carried out for 1 year. The incidence of vitamin C deficiency, as reflected by the plasma vitamin C level was 40.1%. There was almost no difference in its prevalence amongst the sexes or various age groups, but the incidence of vitamin C deficiency was highest in patients admitted from institutions. Furthermore, this study also revealed that patients with certain illnesses were more vulnerable to vitamin C deficiency than other patients and the standard hospital diet alone was not sufficient to improve the vitamin C status of these patients in the short-term.

Nimodipine in the Treatment of Headache in Chronic Cerebral Ischemia

The aim of this study was to evaluate the influence of nimodipine on non-migrainous vascular headache in patients with chronic cerebral ischemia. Eighty-six patients were examined in a double-blind trial for 16 weeks (12 weeks of nimodipine or placebo, followed by a 4-week placebo period). Fifty-six patients were studied in an open trial for 12 months. In the total material of the double-blind study there was no difference as far as improvement of headache was concerned when comparing the patients treated with nimodipine with those receiving placebo. However, in a group of 38 patients with a higher degree of headache intensity, selected in accordance with the Sandoz Clinical Assessment Geriatric scale, a statistically significant difference was found in favor of nimodipine. The results obtained in the long-term open trial seem to confirm the effect of nimodipine on headache. The underlying mechanisms of the beneficial effect of the drug have been discussed.

Clinical Ratings: Relationship to Objective Psychometric Assessment in Individuals with Dementia

The efficacy of drugs for the treatment of memory impairment in elderly patients with dementia is frequently established by a combination of subjective and objective psychological assessments. Often these assessments produce conflicting results. To throw some light on the relation between subjective and objective assessments, we examined the correlations of subjective ratings on the Sandoz Clinical Assessment—Geriatric (SCAG) and scores on objective cognitive tests of demented patients (9 men and 14 women) being screened for participation in an experimental drug trial. Our results showed agreement between some SCAG scores and performance on tests assessing orientation and information and global measures of memory and cognitive function. Subjective and objective assessments were not redundant, however; both should be included when evaluating the efficacy of pharmacological treatments for dementia.