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Gerontology/Geriatrics - Disease Topic Overview

Gerontology is the science of human aging¹, its implications and its involvement in the broadest sense. Its purpose is to study the modalities and the causes of the changes that age imparts to the functioning of living beings, on all levels (biological, psychological and social) and at all levels of complexity (molecule, cell, organ, organism and population). It is a meeting point of multiple disciplines.

Geriatrics is the branch of medicine that specialises in the care of older people.¹ A number of disorders occur almost exclusively in these patients. Osteoporosis is a prevalent disease, affecting mainly postmenopausal women and is characterised by bone loss.¹ Complications, such as fractures occurring from minor trauma (jarring movement, small falls) can lead to a degradation of quality of life, sometimes transitory but often definitive.²
Other disorders that affect people of all ages may cause different symptoms or complications in older people, for example; depression usually causes younger adults to become tearful, withdrawn, and noticeably unhappy.1 In older people, depression sometimes causes confusion, loss of memory, and apathy without a sense of sadness.¹ Polypathology (co-existence of several chronic diseases in the same individual) is also common and therefore an understanding of polypharmacy (chronic consumption of more than four different drugs) is important.³

Geriatric medicine is not specifically defined by the age (of patients cared for), but must deal with the specific disease of the elderly. Most patients are over 65 years, but major challenges within geriatric medicine occur, particularly in terms of those patients who are 80 years and above.

1. Beers M. H. et al. The Merck manual of medical information. Merck research laboratories. Second home edition. 2003 ;, 16-21.
2. van Balen R. et al. Hip fFracture in eElderly pPatients: Outcomes for fFunction, qQuality of lLife, and Ttype of rResidence. Clinical Orthopaedics & Related Research. September 2001 ; 390 : 232-243.
3. Crome P. What's different about older people ? Toxicology. October 2003 ; 192 (1) : 49-54.

Alzheimer's Disease
Alzheimer's disease(AD) is a progressive, neurodegenerative disease which will affect most of us at one point in time, and it’s prevalence increases with age.

In the early stages in particular, dementia is often difficult to diagnose, since many symptoms are not recognized as such or are trivialized by the patient. 20% of actual dementia cases are reported to be incorrectly diagnosed as a different disease.

In early dementia the symptoms of Alzheimer’s disease include memory loss, disorientation and confusion. These symptoms are caused by the loss of neurons and worsen with continuous neurodegeneration. The pathology of dementia is not solely the result of a cholinergic deficit. It is known that, chronically and pathologically elevated glutamate concentrations play an important role.

In general two main groups of dementia can be distinguished, requiring different types of treatment:
- Cerebro-organic (primary) forms of dementia
- Non-cerebro-organic (secondary) forms of dementia
Depending on the stage of the disease, clinical symptoms of varying intensity dominate. With the progression of AD, treatment is aimed particularly at improving and stabilizing personal everyday functions, so as to keep patients independent for as long as possible.

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Alzheimer's disease (AD) is a progressive, neurodegenerative disease which will affect most of us at one point in time - either directly (as the prevalence is expected to quadruple over the next 50 years) or indirectly through the suffering of a loved one.

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Arthritis
Arthritis is a complex disorder that comprises more than 100 distinct musculoskeletal conditions and can affect people at any stage of life. Arthritis causes joint pain, loss of movement, and inflammation. Common forms of arthritis include osteoarthritis (OA) and rheumatoid arthritis. Both OA and RA are chronic and incurable but respond well to intervention.

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Arthritis is a complex disorder that comprises more than 100 distinct musculoskeletal conditions and can affect people at any stage of life. Arthritis causes joint pain, loss of movement, and inflammation.

Common forms of arthritis include osteoarthritis (OA) and rheumatoid arthritis. Both OA and RA are chronic and incurable but respond well to intervention.Osteoarthritis is the most common type of arthritis.

The prevalence increases with age, and most people over 60 years will have some radiological evidence of it. Osteoarthritis is the result of active, sometimes inflammatory but potentially reparative processes rather than the inevitable result of trauma and ageing.Rheumatoid arthritis is a chronic symmetrical polyarthritis of unexplained cause.

It is a systematic disorder characterized by chronic inflammatory synovitis of mainly peripheral joints. Its course is extremely variable and it is associated with nonarticular features.

To diagnose arthritis, there are a number of guidelines which outline the classification criteria, as well as tools to assess the patients pain.

There are a variety of treatment options available to help manage the pain and inflammation of osteo and rheumatoid arthritis, both pharmacological and non-pharmacological. It is important to balance the potential benefit against the potential side-effects.

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Parkinson's Disease
Parkinson's disease (PD) is a progressive, degenerative disorder of the central nervous system, which causes increasing disability over time. PD predominantly occurs in people over the age of 50 and is the commonest neurodegenerative disorder after Alzheimer's disease that a physician will encounter.

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Parkinson's disease (PD) is a degenerative disorder of the central nervous system characterized by the clinically asymmetric onset of resting tremor, bradykinesia, rigidity and postural instability.^1-3

Parkinson's disease (PD) is the second most common neurodegenerative disorder, after Alzheimer's disease.^{1, 2}

The most recent and comprehensive clinical guidelines for the diagnosis and management of Parkinson's disease (PD) in primary and secondary care have been compiled by the UK National Institute for Health and Clinical Excellence (NICE).⁴

A diagnosis of Parkinson's disease (PD) can be difficult as, in common with other central nervous system degenerative disorders, PD begins insidiously.

The severity of Parkinson's disease (PD) can be assessed using a number of rating scales, assessing patients' motor function, activities of daily living (ADL), mental status, dependency and complications of therapy.

It is important that patients with Parkinson's disease (PD) are treated as soon as a full diagnosis has been made; several studies have shown that patients who receive effective symptomatic treatment earlier in the course of their disease fare significantly better clinically than patients who delay their treatment.^5-7

It is not possible to identify a universal first-choice drug therapy for patients with early PD.⁸ In Established/advanced Parkinson's disease⁹ therapy choices need to be re-evaluated.

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References

1. de Lau, L.M. and M.M. Breteler, Epidemiology of Parkinson's disease. Lancet Neurol, 2006. 5(6): p. 525-35.
2. Schapira, A.H., Science, medicine, and the future: Parkinson's disease. BMJ, 1999. 318(7179): p. 311-4.
3. Guttman, M., S.J. Kish, and Y. Furukawa, Current concepts in the diagnosis and management of Parkinson's disease. CMAJ, 2003. 168(3): p. 293-301.
4. NICE, N.I.f.H.a.C.E., NICE clinical guideline: Parkinson's disease: diagnosis and management in primary and secondary care. 2006.
5. Schapira, A.H. and J. Obeso, Timing of treatment initiation in Parkinson's disease: a need for reappraisal? Ann Neurol, 2006. 59(3): p. 559-62.
6. Poewe, W.H. and G.K. Wenning, The natural history of Parkinson's disease. Neurology, 1996. 47(6 Suppl 3): p. S146-52.
7. Rajput, A.H., Levodopa prolongs life expectancy and is non-toxic to substantia nigra. Parkinsonism Relat Disord, 2001. 8(2): p. 95-100.
8. Horstink, M., et al., Review of the therapeutic management of Parkinson's disease. Report of a joint task force of the European Federation of Neurological Societies and the Movement Disorder Society-European Section. Part I: early (uncomplicated) Parkinson's disease. Eur J Neurol, 2006a. 13(11): p. 1170-85.
9. Horstink, M., et al., Review of the therapeutic management of Parkinson's disease. Report of a joint task force of the European Federation of Neurological Societies (EFNS) and the Movement Disorder Society-European Section (MDS-ES). Part II: late (complicated) Parkinson's disease. Eur J Neurol, 2006b. 13(11): p. 1186-202.

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Ask The Geriatrician - The Physiology of Ageing

Gerontology/Geriatrics Drug Data - A-Z English

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What classical composer is your favourite and why?
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Everything seems like a distant memory right after it happens
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Everything seems like a distant memory right after it happens Sounds like jamais vu which is the opposite of déjà vu. This should ...

What classical composer is your favourite and why?
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... emotionally by composers. They can cause pain and evoke sad memories as music and memory are connected. Bach is subtle but evocative. Rachmaninoff is ...

Latest Clinical Trials

VIDEO: Vitamin D evaluation in osteoarthritis

Does vitamin D help people with knee osteoarthritis?

Conjoint Analysis of Treatment Preferences for Osteoarthritis

The purpose of this study is to develop a conjoint analysis-based questionnaire and decision aid for patients with osteoarthritis of the knee and to compare the responses of two groups of subjects, one receiving only printed information about knee osteoarthritis, the other participating in a computer-based adaptive conjoint analysis program.

Latest Journal Publications

Archives of Gerontology and Geriatrics

The more support elderly people have from their family, the less likely they are to suffer from chronic diseases. The objective of this study is to investigate how family support affects the PA middle-aged and elderly people engage in before and after they suffer from chronic diseases. We interviewed 428 middle-aged and elderly people using a structured questionnaire to measure their aerobic PA. Eighteen percent of middle-aged and elderly people did participate in PA after suffering from chronic diseases. Using multivariate logistic regression models, we found that middle-aged and elderly people who rely on family members when they are sick (OR=1.87, 95%CI=1.08–3.25) and who are accompanied by family members (OR=2.09, 95%CI=1.20–3.62) when they are healthy are more likely to exercise. The more middle-aged and elderly people are supported by their family, the more likely they are to exercise. Strengthening family relationships should help reduce the prevalence of chronic diseases among middle-aged and elderly people.

Archives of Gerontology and Geriatrics

Allergic rhinitis (AR) can be defined as an inflammatory disease of the nose and the paranasal sinuses, characterized by a specific IgE-mediated hypersensitivity reaction. The aim of this study was to evaluate the correlation between the symptoms of AR and the prick test results in geriatric patients presenting with symptoms of AR by comparing these with those of a young control group. Thirty-two geriatric patients (Group 1) were analyzed retrospectively, and 37 patients (Group 2) were selected as the control group. Diagnosis of AR was made based upon the physical examination findings, nasal endoscopic examination findings and the skin prick test results. While the skin prick test positivity was 50% in Group 1, this rate was found as 75.7% in Group 2. The difference was found to be statistically significant (p=0.044). A statistically significant difference was found between the two groups in terms of susceptibility to mugwort pollen and fish (p=0.048, p=0.033). In conclusion, in geriatric patients presenting with AR symptoms, systemic treatment should not be initiated before performing skin prick test, due to the adverse effects of the drugs.

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23^rd February 2012

NX 1207 (Recordati/Nymox) starts Phase III trial for BPH Men's Health, Andrology and Urology Page

Recordati and Nymox Pharmaceutical Corporation announced the start of activities aimed to the preparation of a European Phase III clinical trial for NX-1207, following the successful completion of a Scientific Advice meeting with the European Medicines Agency. NX-1207, is a Phase III investigational drug from Nymox and is currently in clinical development in the United States for the treatment of Benign Prostatic Hyperplasia (BPH). The pivotal controlled clinical trial will assess the efficacy and safety of a single TRUS-guided intraprostatic injection of NX-1207 in patients with lower urinary tract symptoms (LUTS) associated with BPH not adequately controlled by medical therapy.The drug is injected by a urologist in an office setting directly into the zone of the prostate where the enlargement occurs and involves little or no pain or discomfort. NX-1207 has successfully completed a series of blinded controlled multi-center U.S. clinical trials where a single dose of NX-1207 has been found to improve the signs and symptoms of BPH, with improvements about double those reported for currently approved BPH drugs, and without the side effects associated with those drugs, which can include sexual problems and blood pressure changes. Follow-up studies have shown evidence of long lasting benefit with a significant proportion of men reporting maintained improvement in BPH symptoms without other treatments for up to 7½ years.

Zelboraf (Daiichi Sankyo/Roche) is EU approved for BRAFV600 mutation Metastatic Melanoma Page

Plexxikon Inc., a member of Daiichi Sankyo Group,has announced that the European Commission has approved Zelboraf (vemurafenib) for the monotherapy treatment of adult patients with BRAFV600 mutation-positive unresectable or Metastatic Melanoma. The cobas 4800 BRAF V600 Mutation Test, a companion diagnostic used to identify patients with the BRAF mutation, is CE marked and commercially available in Europe. Zelboraf is designed to selectively inhibit the BRAF mutation that occurs in about half of all cases of melanoma. Zelboraf and its companion diagnostic have already been approved in the United States, Switzerland, Israel, Brazil, New Zealand and Canada. In the United States, Zelboraf is being co-promoted by Daiichi Sankyo, Inc. and Genentech, a member of the Roche Group. Roche promotes Zelboraf outside of the United States.

CHMP recommends Pixuvri (CTI Life Sciences) for Non Hodgkin's B-cell Lymphoma Oncology Page

The CHMP has given a conditional recommendation for the approval of Pixuvri (pixantrone dimaleate) from CTI Life Sciences for relapsed or refractory aggressive non-Hodgkin’s B-cell Lymphoma. The drug application at the FDA was withdrawn as additional information was requested. The drug is now scheduled to be considered at the FDA Advisory Comitteee meeting in April 2012.