Geriatrics
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Parkinson's disease is a progressive neurodegenerative condition of unknown cause and with no known cure. The diagnosis is based on clinical findings of rest tremor, muscle rigidity, bradykinesia, and gait instability. Over 40% of patients develop a dementia syndrome that is largely distinct from Alzheimer's disease. ⋯ Anticholinergics and other agents may also be useful. Pharmacologic treatment must be carefully titrated to control symptoms and to avoid side effects. In advanced disease, dose-related dyskinesias, end-of-dose wearing-off effect, and unpredictable sudden motor fluctuations become very disabling and difficult to manage.
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Adrenal diseases are uncommon in older patients but can present insidiously. Adrenal masses are often discovered incidentally on abdominal CT scans and are usually benign, but they should be assessed for hormone production. ⋯ Adrenal insufficiency can be caused by hemorrhage, tuberculosis, or metastatic cancer. Maintaining a high index of suspicion of hidden adrenal disease, the primary care physician should apply an efficient approach to the diagnosis and initial management of adrenal diseases in older patients.
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Delirium is more common in older adults because of normal physiologic changes, increased incidence of medical illnesses, and increased medication use in this population. Older dementing patients are particularly predisposed to delirium because of associated neurologic abnormalities. ⋯ The delirium will usually resolve if the underlying cause is properly treated. Treatment also requires maintaining a comfortable environment for the patient and, when necessary, administering a high-potency neuroleptic.