Clinics in geriatric medicine
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The term parkinsonian syndromes refers to a group of disorders whose clinical features overlap those of idiopathic Parkinson's disease. The four major entities include three important neurodegenerations, multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration, and a lacunar cerebrovascular disorder, vascular parkinsonism. This article reviews the epidemiology, pathology, clinical features, diagnosis, and management of these disorders.
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Normal pressure hydrocephalus (NPH) is a reversible disorder characterized by gait impairment, subcortical dementia, and urinary urgency and incontinence associated with impaired cerebrospinal fluid circulation and ventriculomegaly. Treatment with shunt surgery is most likely to increase mobility, and may also improve dementia and urinary symptoms. An international, independent study group recently published guidelines for the diagnosis and management of idiopathic NPH. This article helps geriatricians identify patients who might have NPH, and care for these patients after shunt placement.
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The management of advancing Parkinson's disease (PD) is a daunting task, complicated by dynamic medication responses, side effects, and treatment-refractory symptoms in an aging patient population. The motor and nonmotor complications of advancing PD are reviewed, and practical treatment strategies are provided. Careful assessment in the context of the known natural history of advancing PD and rational treatment choices can create significant improvement in the lives of patients who have advancing PD.
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Clin. Geriatr. Med. · Aug 2006
Review Historical ArticleHip and knee arthroplasty in the geriatric population.
Osteoarthritis is the leading cause of hip and knee pathology in the geriatric population. Hip and knee arthroplasty are the definitive interventions to alleviate pain and restore physical functioning. Complications related to these procedures do occur: the most com-mon of these are infection, thromboembolism, dislocations, and periprosthetic fractures. New improvements related to minimally invasive and computer-assisted navigation surgery techniques are promising and already have shown excellent outcomes in patients exposed to joint arthroplasty.
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Clin. Geriatr. Med. · Aug 2006
ReviewCardiac surgery in the elderly: indications and management options to optimize outcomes.
The elderly have increasingly benefited from the advances in cardiac surgical techniques and perioperative care. Compared to the same procedures in younger patients their operations can be more technically demanding and their level of reserve leaves less margin should complications occur. The importance of using realistic indications for operations with a focus on improving the quality of their lives and of optimal preoperative preparation of patients is emphasized.