There are a number of issues that must be considered in geriatric pain assessment. The major issues that merit attention are presence of comorbidities, mental status, depression in late life, limitations in ADLs, medications, and the importance of family and other support systems (see Depression; Social Networks, Support, and Integration). (more…)

The principal reversible dementias are metabolic. Hypothyroidism and exposure to industrial or environmental toxins should be considered; iatrogenic cognitive impairment due to medications is a common example. Depending on the acuteness and intensity of the metabolic disturbance, the clinical presentation may be more similar to delirium than dementia. These dementias are reversible, but often not completely, depending on the length of exposure of the brain to the abnormal metabolic environment. (more…)

Unfortunately, many dementias are partially or completely biologically irreversible. However, as mentioned previously, it is important to recognize that all dementias are treatable. Some of these irreversible dementias are preventable. For example, automobile accidents in civilian populations and projectile wounds in military populations are common causes of brain damage that cause dementia. Some improvements can occur in these conditions for a period of time after the initial insult, but affected individuals are left with varying degrees of impairment and often severe limitations in function. (more…)

It is always important in the treatment of dementia to have clear therapeutic goals established in partnership with the patient and family. Often, the concept of quality of life is an important guide to therapy, as this reflects the values of the individual and his or her family. This section discusses both non-pharmacological and pharmacological treatments of dementia. Remember that non-pharmacological approaches are always appropriate. (more…)

Alzheimer’s disease is a concept in evolution; it is considered by most to be a degenerative brain disease that was first described in 1906 and is the most common cause of dementia. Over the past 100 years, we have learned that many biological and clinical phenomena are included under the rubric of Alzheimer’s disease and that perhaps the term can best be considered a two-word eponym that reveals as much about our ignorance as about our knowledge. (more…)

Aging in human is a combination of two ageing processes: development or maturation, and senescence aging or decline. Development or maturation is the positive aspect of aging; humans typically acquire greater wisdom, experience, and expertise in specific fields as they grow older. Senescence aging, on the other hand, (more…)