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May 8, 2014

Dr.Michael Gordon Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

Abstract
Diabetes Mellitus is very prevalent in the older population. It is one of the important causes of vascular problems which may play a role in the development of dementia, especially of the mixed variety. There has been much progress in the potential medications that can help promote successful glucose control and address the other metabolic correlates of Type 2 diabetes mellitus. Sulfonylureas should be used rarely and very carefully in older especially frail individuals because of their inherent risks. Getting physicians to change their prescribing practices in this frail elderly diabetic population is an important challenge to educators and drug program administrators.
Key Words: diabetes mellitus, sulfonylureas, diabetic management, treatment.

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

August 28, 2012

Stanley A. Yap,1 Shabbir M.H. Alibhai,2,3Antonio Finelli,1
1Division of Urologic Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada. 2Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada. 3Department of Medicine, University of Toronto, Toronto, ON, Canada.


Abstract
The incidence of small renal masses (SRMs) has risen steadily over time, and SRMs now represent the majority of newly diagnosed renal lesions. Approximately 80% of newly diagnosed SRMs will be malignant. However, identifying a benign versus malignant lesion non-invasively can be difficult since no distinct imaging characteristics or growth patterns exist between the two. We have witnessed concurrent improvements in treatment strategies for small, localized tumors and have gained a better understanding of their natural history. Along with these changes there has been a shift in the manner in which we diagnose and treat SRMs. Although surgery remains the standard of care, we can now offer a variety of therapies individualized to the patient.
Keywords: kidney cancer, small renal mass, diagnosis, treatment.

Stanley A. Yap,1 Shabbir M.H. Alibhai,2,3Antonio Finelli,1
1Division of Urologic Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada. 2Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada. 3Department of Medicine, University of Toronto, Toronto, ON, Canada.

July 19, 2012

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Granuloma annulare (GA) is a benign and usually self-limited cutaneous condition that classically presents as arciform to annular plaques in a symmetrical and acral distribution. The exact etiology of GA is unknown. Two-thirds of patients with GA are less than 30 years old. GA is recognized based on its characteristic appearance and no specific investigation is necessary. Reassurance and clinical observation may be the treatment of choice for localized and asymptomatic disease. Spontaneous resolution occurs within 2 years in 50% of cases. Persistent lesions may be treated with very potent topical corticosteroids, intralesional corticosteroid injections, or cryotherapy. Use of more toxic treatments are controversial in recalcitrant cases.
Keywords: Granuloma annulare, Overview, Paraneoplastic, Self-limiting, Treatment.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

February 1, 2011

John D. Markman, M.D., Director, Translational Pain Research, Department of Neurosurgery, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA.
Maria E. Frazer, B.S., Health Project Coordinator, Translational Pain Research, Department of Neurosurgery, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA.
Pierre S. Girgis, M.D., Assistant Professor, Department of Neurosurgery, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA.
Kevin R. McCormick, M.D., Ph.D, Associate Professor, Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA.

Lumbar spinal stenosis (LSS) is the leading cause of spinal surgery among older Americans, yet more than one-third do not gain significant relief from surgical treatment. The distinct pattern of lower back and leg pain induced by standing and walking associated with LSS is known as neurogenic intermittent claudication (NIC). Various treatment options for NIC include surgical interventions as well as pharmacological, biomechanical and conservative therapy (i.e., physical therapy). No specific treatment is associated with guaranteed outcome, which underscores the need to further evaluate the diagnosis and symptoms associated with LSS.
Key words: lumbar spinal stenosis, neuropathic pain, treatment, treadmill testing, epidural steroid injection.

John D. Markman, M.D., Director, Translational Pain Research, Department of Neurosurgery, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA.
Maria E. Frazer, B.S., Health Project Coordinator, Translational Pain Research, Department of Neurosurgery, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA.

September 1, 2009

Erin Dahlke, MD, Dermatology Resident, University of Toronto, Toronto, ON.
Christian A. Murray, MD, FRCPC, Assistant Professor of Medicine and Dermatology, University of Toronto; Co-director of Dermatologic Surgery, Women’s College Hospital, Toronto, ON.

Basal cell carcinoma (BCC) is a common, slow-growing malignant skin tumour that only very rarely metastasizes. The main subtypes of BCC are nodular, superficial, and sclerosing. The most important risk factors for the development of BCC include fair skin, extensive sun exposure as a child, past personal history of skin cancer, and advanced age. Basal cell carcinoma is the most common human malignancy, and its incidence is increasing worldwide. There are a number of different treatm ent modalities for BCC including topical therapies, cryotherapy, electrodesiccation and curettage, surgical excision, radiotherapy, and Mohs’ micrographic surgery. Treatment should be tailored to the individual situation, and advanced age does not typically alter the management choice or reduce the expectation of an excellent outcome, including cure.
Key words: basal cell carcinoma, nonmelanoma skin cancer, risk factors, epidemiology, treatment.

Erin Dahlke, MD, Dermatology Resident, University of Toronto, Toronto, ON.
Christian A. Murray, MD, FRCPC, Assistant Professor of Medicine and Dermatology, University of Toronto; Co-director of Dermatologic Surgery, Women’s College Hospital, Toronto, ON.

March 1, 2009


George A. Heckman, MD, MSc, FRCPC, Assistant Professor of Medicine, Department of Medicine, McMaster University, Hamilton, ON.
Robert S. McKelvie, MD, PhD, FRCPC, Professor of Medicine, Department of Medicine, McMaster University Hamilton, ON.

Heart failure (HF) is usually associated with reduced left ventricular ejection fraction, but approximately 50% of all patients with HF have a preserved ejection fraction. The mortality and morbidity associated with this condition, which may be the most common form of HF in older persons, is substantial and is on the rise. Currently, there are few evidence-based therapies demonstrated to be beneficial for this condition. The usual therapeutic recommendations consist of the aggressive management of the comorbidities and fluid balance associated with this form of HF. Disease management programs may improve outcomes among older persons with HF and preserved ejection fraction.
Key words: heart failure, diastolic dysfunction, preserved ejection fraction, treatment, clinical outcome.


George A. Heckman, MD, MSc, FRCPC, Assistant Professor of Medicine, Department of Medicine, McMaster University, Hamilton, ON.
Robert S. McKelvie, MD, PhD, FRCPC, Professor of Medicine, Department of Medicine, McMaster University Hamilton, ON.

March 1, 2009


Jiska Cohen-Mansfield, PhD, ABPP, Department of Health Promotion, School of Public Health and Herczeg Center on Aging, Tel-Aviv University, Tel-Aviv, Israel, and Department of Health Care Sciences and of Prevention and Community Health, George Washington University Medical Center, Washington, DC, USA.

Approximately 20% of older people with dementia manifest visual or auditory hallucinations. In order to effectively diagnose and treat these individuals, the etiology of hallucinations must be addressed; however, there has been very limited research in this area. There is an association between vision loss and hallucinations, and analyses of case studies suggest other potential etiologies. Accordingly, hallucinations can occur when the person with dementia either misinterprets reality, experiences sensory deprivation, is exposed to inappropriate sensory stimulation, has delirium/medical problems, or when his/her behaviour is misinterpreted due to cultural differences with caregivers. Understanding the etiology of hallucinations will assist in developing an appropriate nonpharmacological treatment, which may improve quality of life.
Key words: hallucinations, dementia, etiology, nonpharmacological, treatment.


Jiska Cohen-Mansfield, PhD, ABPP, Department of Health Promotion, School of Public Health and Herczeg Center on Aging, Tel-Aviv University, Tel-Aviv, Israel, and Department of Health Care Sciences and of Prevention and Community Health, George Washington University Medical Center, Washington, DC, USA.

February 1, 2009

Susan B. Jaglal, PhD, Toronto Rehabilitation Institute Chair, Associate Professor, Faculty of Medicine, Department of Physical Therapy, University of Toronto, Toronto, ON.

A wrist fracture is associated with an increased risk of another fracture and should prompt investigation for osteoporosis in both men and women. If the fracture was caused by low trauma (a fall from a standing height or less), a bone density test should be ordered. If the T score is <–1.5, pharmacological treatment with a bisphosphonate and calcium (1,500 mg/d) and vitamin D3 (≥800 IU/d) is recommended. Management should also include balance, posture, and muscle-strengthening exercises and walking, as well as a review of fall-prevention strategies.
Key words: wrist fracture, osteoporosis, diagnosis, treatment, exercise, falls.

Susan B. Jaglal, PhD, Toronto Rehabilitation Institute Chair, Associate Professor, Faculty of Medicine, Department of Physical Therapy, University of Toronto, Toronto, ON.

July 1, 2008


Catherine Agbokou, MD, MSc, Service de Psychiatrie Adulte, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France.
Emmanuel Cognat, MD, Service de Psychiatrie et de Psychologie Médicale, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France.
Florian Ferreri, MD, MSc, Service de Psychiatrie et de Psychologie Médicale, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France.

Differentiating between Parkinson’s disease dementia (PDD) and dementia with Lewy bodies (DLB) is a difficult issue for many clinicians. To date, these diseases share most of their clinical, neuropathological, and management features. Therefore, PDD and DLB are considered by some authors to be the two extremities of a single spectrum disease named Lewy body diseases. Nevertheless, specific diagnostic criteria now exist for each disease and specific diagnosis remains of interest in clinical practice. In this article, we summarize features and diagnostic criteria of both PDD and DLB, compare them, and examine their treatment options.
Key words: Parkinson’s disease dementia, dementia with Lewy bodies, Lewy body disease, movement disorders, dementia, treatment.


Catherine Agbokou, MD, MSc, Service de Psychiatrie Adulte, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France.
Emmanuel Cognat, MD, Service de Psychiatrie et de Psychologie Médicale, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France.
Florian Ferreri, MD, MSc, Service de Psychiatrie et de Psychologie Médicale, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France.

June 1, 2008

Zena Moore, RGN, MSc, FFNMRCSI, Health Research Board of Ireland, Clinical Nursing and Midwifery Research Fellow, Royal College of Surgeons in Ireland, Dublin, Ireland.
Seamus Cowman, PhD, MSc, FFNMRCSI, P.G Cert Ed (Adults), Dip N (London), RNT, RGN, RPN, Professor and Head of Department, Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.

Pressure ulcers are common, costly, and adversely affect quality of life. Nutritional status is one risk factor that predisposes individuals to the development of a pressure ulcer. The impact of nutritional supplementation is reflected in the reduced incidence of pressure ulcers; however, the evidence is limited. The precise role of nutritional supplementation in pressure ulcer healing is less clear, yet a trend towards healing has been suggested. Patients should have their nutritional status monitored carefully. If difficulties arise, these should be detected early, and if it is not possible to increase the intake of normal food and fluids, then advice should be sought from the dietitian.
Key words: pressure ulcers, risk, prevention, treatment, nutrition.

Zena Moore, RGN, MSc, FFNMRCSI, Health Research Board of Ireland, Clinical Nursing and Midwifery Research Fellow, Royal College of Surgeons in Ireland, Dublin, Ireland.
Seamus Cowman, PhD, MSc, FFNMRCSI, P.G Cert Ed (Adults), Dip N (London), RNT, RGN, RPN, Professor and Head of Department, Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.

May 1, 2008

Shen-Yang Lim, MBBS, FRACP, Movement Disorder Centre, University of Toronto, Toronto Western Hospital, Toronto, ON.
Susan H. Fox, MRCP (UK), PhD, Movement Disorder Centre, University of Toronto, Toronto Western Hospital, Toronto, ON.

Parkinson’s disease (PD) is characterized by the presence of bradykinesia, rigidity, and rest tremor. Nonmotor symptoms are also very common in PD and may result in significant disability. Many approaches are available to reduce symptoms. In this article we provide an update on the management of PD. We also discuss the limitations of current treatments.
Key words: Parkinson’s disease, treatment, motor response complications, nonmotor, nondopaminergic.

Shen-Yang Lim, MBBS, FRACP, Movement Disorder Centre, University of Toronto, Toronto Western Hospital, Toronto, ON.
Susan H. Fox, MRCP (UK), PhD, Movement Disorder Centre, University of Toronto, Toronto Western Hospital, Toronto, ON.

February 1, 2008

Ali Ahmed, MD, MPH, FACC, FAHA, FESC, associate professor, Division of Gerontology, Geriatric Medicine, and Palliative Care, Department of Medicine, School of Medicine and Department of Epidemiology, School of Public Health, University of Alabama at Birmingham; director, Geriatric Heart Failure Clinics, Veterans Affairs Medical Center, Birmingham, AB, USA.

Heart failure (HF) is the leading cause of hospitalization among older adults. Digoxin has been shown to reduce hospitalization due to worsening HF. However, at the commonly prescribed dose of 0.25 mg/day, digoxin does not reduce mortality. New data suggest that at low doses (0.125 mg/day or lower) digoxin not only reduces hospitalization due to HF, but may also reduce mortality. Further, at lower doses, it also reduces the risk of digoxin toxicity and obviates the need for routine serum digoxin level testing. Digoxin in low doses should be prescribed to older adults with symptomatic HF.
Key words: chronic heart failure, older adults, treatment, digoxin, update.

Ali Ahmed, MD, MPH, FACC, FAHA, FESC, associate professor, Division of Gerontology, Geriatric Medicine, and Palliative Care, Department of Medicine, School of Medicine and Department of Epidemiology, School of Public Health, University of Alabama at Birmingham; director, Geriatric Heart Failure Clinics, Veterans Affairs Medical Center, Birmingham, AB, USA.

February 1, 2008

Bhaskar Ghosh, MD, DNB, DM, MNAMS, Movement Disorders Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB.
Oksana Suchowersky, MD, FRCPC, FCCMG, Movement Disorders Program, Department of Clinical Neurosciences; Department of Medical Genetics, Faculty of Medicine, University of Calgary, Calgary, AB.

Chorea is a hyperkinetic movement disorder characterized by nonsustained, rapid, and random contractions that may affect all body parts. Chorea is hypothesized to be due to an imbalance between the direct and indirect pathways in the basal ganglia circuitry. Important causes of chorea among older adults include medications, stroke, and toxic-metabolic, infective, immune-mediated, and genetic causes. The history and clinical examination guide appropriate investigations and help determine an accurate diagnosis. In secondary causes, removal of the precipitating cause is the mainstay of treatment. If the chorea is persistent or progressive, drug therapy may be instituted. Genetic counselling is important in hereditary chorea.
Key words: movement disorders, chorea, older adults, diagnosis, treatment.

Bhaskar Ghosh, MD, DNB, DM, MNAMS, Movement Disorders Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB.
Oksana Suchowersky, MD, FRCPC, FCCMG, Movement Disorders Program, Department of Clinical Neurosciences; Department of Medical Genetics, Faculty of Medicine, University of Calgary, Calgary, AB.

September 1, 2007


Guido Falcone, MD, Department of Neurology, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina.
Ji Y. Chong, MD, Assistant Professor of Neurology, Columbia University, New York, NY, U.S.A.

Stroke is a common disease in the older population. Many gender differences are seen in the epidemiology, outcomes, and treatment of geriatric stroke. Although these differences are not fully understood, recognition of gender differences may help with appropriate treatment and improve outcomes.
Key words: stroke, gender, outcomes, prevention, treatment.


Guido Falcone, MD, Department of Neurology, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina.
Ji Y. Chong, MD, Assistant Professor of Neurology, Columbia University, New York, NY, U.S.A.

September 1, 2007

Elizabeth A. Johnson, RN, PhD(c), Board Certified Geriatric Clinical Nurse Specialist, Doctoral Candidate, Indiana University School of Nursing; Department of Adult Health, Indiana University School of Nursing, Indianapolis, IN, USA.
Tamilyn Bakas, RN, DNS, FAHA, Associate Professor, Department of Adult Health, Indiana University School of Nursing, Indianapolis, IN, USA.
Linda S. Williams, MD, Chief of Neurology, Roudebush Veterans Administration Medical Center; Research Coordinator, VA Stroke QUERI; Associate Professor of Neurology, Indiana University School of Medicine; Research Scientist, Regenstrief Institute, Indianapolis, IN, USA.

Depression, the most frequent neuropsychological problem after stroke, is greatly influenced by the complex relationships between the neurobiological and psychological changes that occur after stroke. Post-stroke depression leads to negative rehabilitation outcomes including less participation in therapy, extended recovery time, significantly decreased quality of life, and increased utilization of health care resources. Because of the high prevalence of post-stroke depression, all stroke survivors should be screened early in the rehabilitation process. Use of a biopsychosocial framework acknowledges the multifactorial etiology of post-stroke depression and contributes to effective, evidence-based treatment. Attention to the needs of the family caregivers further promotes successful post-stroke rehabilitation.
Key words: stroke, depression, risk factors, recovery, treatment.

Elizabeth A. Johnson, RN, PhD(c), Board Certified Geriatric Clinical Nurse Specialist, Doctoral Candidate, Indiana University School of Nursing; Department of Adult Health, Indiana University School of Nursing, Indianapolis, IN, USA.
Tamilyn Bakas, RN, DNS, FAHA, Associate Professor, Department of Adult Health, Indiana University School of Nursing, Indianapolis, IN, USA.

August 1, 2007

Lana S. Rothenburg, BSc(Hons), Neuropsychopharmacology Research Program, Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON.
Nathan Herrmann, MD FRCP(C), Neuropsychopharmacology Research Program; Department of Psychiatry, Sunnybrook Health Sciences Centre; Department of Psychiatry, University of Toronto, Toronto, ON.
Krista L. Lanctôt, PhD, Neuropsychopharmacology Research Program; Department of Psychiatry, Sunnybrook Health Sciences Centre; Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON.

Depression is a common sequela of stroke, occurring in approximately 33% of all patients. Post-stroke depression (PSD) is associated with greater cognitive and functional impairments, excess mortality, and increased health care costs, although symptoms are often mild. Diagnosis of PSD can be made using standard clinical criteria, despite the potential overlap with the somatic and vegetative symptoms of stroke. Post-stroke depression responds to standard antidepressant pharmacotherapies, but use of tricyclic antidepressants may result in increased cardiac adverse events. Given the high prevalence and major negative impact of PSD, active screening of all stroke patients for depression and aggressive treatment is recommended.
Key words: stroke, depression, diagnosis, risk factors, treatment.

Lana S. Rothenburg, BSc(Hons), Neuropsychopharmacology Research Program, Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON.
Nathan Herrmann, MD FRCP(C), Neuropsychopharmacology Research Program; Department of Psychiatry, Sunnybrook Health Sciences Centre; Department of Psychiatry, University of Toronto, Toronto, ON.

June 1, 2007

Børge Sivertsen, PhD, Department of Clinical Psychology, University of Bergen, Bergen, Norway.

Chronic primary insomnia is a sleep disorder with no known secondary etiology, and the prevalence increases with advancing age. Insomnia is associated with a range of adverse consequences, both on an individual and societal level. While pharmacotherapy is still the most common form of treatment of late-life insomnia, it is associated with a number of side effects, and recent evidence shows cognitive-behavioural therapy (CBT) to be more effective in managing chronic primary insomnia. This article will discuss the development, consequences, assessment and treatment of chronic primary insomnia among older adults.
Key words: sleep initiation and maintenance disorders, aged, morbidity, treatment, insomnia.

Børge Sivertsen, PhD, Department of Clinical Psychology, University of Bergen, Bergen, Norway.

May 1, 2007

Christopher Frank, MD, CCFP, Department of Medicine, Division of Geriatrics, Queen’s University, Kingston, ON.

Skin ulcers are common among older adults, especially those in hospital or in long-term care facilities. Prevention of ulcers is important in all clinical settings. Clarifying the cause(s) and exacerbating factors is the first step in management. Pressure and venous insufficiency are the most common causes among older adults. Poor nutrition, edema, arterial insufficiency, and anemia may impair wound healing. Adequate debridement and cleaning is important to decrease infection risk and to promote healing. The choice of dressings depends on the needs of the individual wound but should emphasize the provision of a moist wound environment. Options for dressings are summarized.
Key words: skin ulcers, treatment, wound healing, older adults, pressure ulcers.

Christopher Frank, MD, CCFP, Department of Medicine, Division of Geriatrics, Queen’s University, Kingston, ON.

December 1, 2006


Sudeep S. Gill, MD, MSc, FRCPC, Assistant Professor, Division of Geriatric Medicine, Queen’s University, Kingston, ON.

Delirium is common among hospitalized older adults and is associated with significant morbidity and excess mortality. Despite its prevalence and consequences, delirium is often underrecognized and undertreated. Antipsychotic drugs are commonly used to manage symptoms of delirium, but few controlled trials exist to support their efficacy and safety in this setting. Several recent studies have focussed on preventing delirium in high-risk populations. Clinical trials have demonstrated benefits with multifaceted nonpharmacological interventions, but widespread implementation of these interventions has not yet occurred. Two recent drug trials evaluated an antipsychotic and a cholinesterase inhibitor to prevent delirium, but neither trial demonstrated a reduction in incident delirium. At present, the most promising approach involves targeted, multifactorial interventions that focus on preventing delirium in high-risk patient groups. More work is needed to facilitate the implementation of these evidence-based strategies.
Key words: delirium, prevention, treatment, antipsychotic drugs, cholinesterase inhibitors.


Sudeep S. Gill, MD, MSc, FRCPC, Assistant Professor, Division of Geriatric Medicine, Queen’s University, Kingston, ON.

April 1, 2006


Andrew R. Frank, MD, Alzheimer’s Disease Center, Mayo Clinic College of Medicine, Rochester, MN, U.S.A.
Ronald C. Petersen, MD, PhD, Alzheimer’s Disease Center, Mayo Clinic College of Medicine, Rochester, MN, U.S.A.

Mild Cognitive Impairment (MCI) describes a state of abnormal cognitive functioning that is insufficient to warrant a diagnosis of dementia. While dementia requires that activities of daily functioning be compromised due to cognitive symptomology, the diagnosis of MCI can be made earlier, in the absence of such functional impairment. In MCI, the patient must present with cognitive complaints (or someone who knows the patient well must present them on the patient's behalf), and these complaints must be corroborated by abnormalities on standardized cognitive testing. The diagnosis of MCI alerts the clinician to a higher risk of future development of dementia and provides an ideal target population that may benefit the most from “disease-modifying” cognitive therapies currently in development.
Key words: mild cognitive impairment, MCI, Alzheimer’s disease, dementia, early diagnosis, treatment.


Andrew R. Frank, MD, Alzheimer’s Disease Center, Mayo Clinic College of Medicine, Rochester, MN, U.S.A.
Ronald C. Petersen, MD, PhD, Alzheimer’s Disease Center, Mayo Clinic College of Medicine, Rochester, MN, U.S.A.

April 1, 2006


Patricia Hall, MD, Department of Psychiatry, University of Western Ontario, London, ON.
Verinder Sharma, MB, BS, FRCPC, Professor, Faculty of Medicine and Dentistry, University of Western Ontario, London, ON.

Bipolar disorder is less common in the older adult population. However, the quality of life for older adults with bipolar disorder is significantly impacted. Older patients with bipolar disorder have more cognitive and functional impairment than younger patients. Studies show that older adults with bipolar disorder also have an increased risk of suicide, dementia, and medical illness, as well as a higher mortality rate. This article provides a review of the epidemiology, clinical features, suicide risk, comorbidities (including dementia), and management of bipolar disorder in older adults.
Key words: bipolar disorder, mania, bipolar depression, treatment.


Patricia Hall, MD, Department of Psychiatry, University of Western Ontario, London, ON.
Verinder Sharma, MB, BS, FRCPC, Professor, Faculty of Medicine and Dentistry, University of Western Ontario, London, ON.

April 1, 2006

Felix Geser, MD, PhD, Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
Gregor K. Wenning, MD, PhD, Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.

Multiple system atrophy (MSA) is a sporadic neurodegenerative disorder characterized clinically by various combinations of parkinsonian, autonomic, cerebellar, or pyramidal signs and pathologically by cell loss, gliosis, and a-synuclein-positive glial cytoplasmic inclusions in several brain and spinal cord structures. The clinical recognition of MSA has improved, and the recent consensus diagnostic criteria have been widely established in the research community as well as in movement disorders clinics. Although the diagnosis of this condition is largely based on clinical expertise, several investigations have been proposed in the last decade to assist in early differential diagnosis. Symptomatic therapeutic strategies are still limited.
Key words: multiple system atrophy, clinical presentation, diagnosis, treatment.

Felix Geser, MD, PhD, Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
Gregor K. Wenning, MD, PhD, Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.

January 1, 2006

AM Johnson, PhD, Assistant Professor, School of Communication Sciences and Disorders, the University of Western Ontario, London, ON.
SG Adams, PhD, Associate Professor, School of Communication Sciences and Disorders, the University of Western Ontario, London, ON.

In addition to its widely recognized effects on gait, posture, balance, and upper limb coordination, Parkinson’s disease (PD) can have a profound effect on speech and voice, within a cluster of speech characteristics termed hypokinetic dysarthria. Although dopaminergic therapy produces significant benefits in the early stages of PD, speech symptoms may show selective resistance to pharmaceutical therapy in patients with a disease history of more than 10 years. This article discusses the pathophysiology of PD as it relates to speech disorders and considers nonpharmaceutical therapeutic options for hypokinetic dysarthria.
Key words: Parkinson’s disease, speech pathology, dysarthria, treatment.

AM Johnson, PhD, Assistant Professor, School of Communication Sciences and Disorders, the University of Western Ontario, London, ON.
SG Adams, PhD, Associate Professor, School of Communication Sciences and Disorders, the University of Western Ontario, London, ON.

December 1, 2005


Steven E. Lo, MD, The Neurological Institute, Columbia University Medical Center, New York, NY, USA.
Steven J. Frucht, MD, The Neurological Institute, Columbia University Medical Center, New York, NY, USA.

Parkinson’s disease (PD) is a neurodegenerative disorder that can significantly impact older patients’ quality of life. Although there are many pharmacologic options to treat PD, the clinician needs to know the indications and potential adverse effects of new medications in the older patient population. Carbidopa/levodopa remains the gold standard for treatment, and new formulations and levodopa-extenders fill specific niches. This article reviews the pros and cons of these medications in older PD patients, and demonstrates therapeutic strategies through case presentations.
Key words: Parkinson’s disease, treatment, levodopa, COMT inhibitor, aging.


Steven E. Lo, MD, The Neurological Institute, Columbia University Medical Center, New York, NY, USA.
Steven J. Frucht, MD, The Neurological Institute, Columbia University Medical Center, New York, NY, USA.