By Richard Godwin-Austen MD, FRCP, John Bendall BSc, DM, FRCP (auth.)
Traditional tools within the medical perform of neurology have ruled scientific instructing during this distinctiveness for roughly a hundred years. primarily those equipment contain meticulous consciousness to aspect and the recording of medical evidence. therefore the scientific background has to be recorded chronologically, ideally within the patient's personal phrases, and of the worried sys through a delicately dependent exam tem set out in one of these method as to permit the suitable localisation of the lesion or method concerned. scientific neurology taught and practised during this approach has bred generations of neurologists in the course of the international and raised the factors within the distinctiveness to a degree the place scientific abilities are most likely unexcelled in the other uniqueness. With expanding availability and reliance upon non-invasive imaging ideas, the necessity for those abilities in huge components of neurological perform has lowered. yet possibly extra importantly, the classical scientific equipment in neurology have been constructed whilst the aged inhabitants used to be a lot smaller and while the uniqueness of geriatrics didn't exist. therefore, a lot of the method is inappropriate or unreliable in of geriatrics will often the aged inhabitants and the coed locate himself looking in useless within the textbooks of neurology for assist in assessing an aged sufferer with an odd presentation (for instance disturbance of stability or recurrent confusional episodes) of a few universal neurological disorder.
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Additional resources for The Neurology of the Elderly
Medical treatment without recourse to angiography is usually the appropriate management at this age. Similar considerations apply in cases of intracerebral or subarachnoid haemorrhage; or where aneurysm presents with the classical features of posterior communicating artery aneurysm (latera1ised frontal pain, partial IIIrd nerve palsy, and sensory loss in ophthalmic V). The operative mortality from aneurysm surgery in patients over 60 years old approaches 50%. The procedure of angiography carries a significant morbidity with risk of transient hemiparetic symptoms or other evidence of disturbed cerebral perfusion occurring in 2%-5% of elderly cases.
An awareness of pseudo dementia is very important-it is a potentially treatable state. Early involvement of a psycho geriatrician is advisable for rapid diagnosis and treatment. Careful watch should be kept on the patient's fluid and electrolyte balance and her nutritional state. Failure to do so may lead to superimposed organic confusion which may be diagnostically confusing, and potentially fatal. It may also alter her response to therapeutic measures aimed at the affective disorder. 4 Disturbances of Gait and Balance, and Falls Falls and complaints of postural unsteadiness are commonplace in the elderly.
Although a combination of factors frequently summate to affect balance and walking there is usually one critical abnormality and it is this that must attract the major therapeutic effort. The prospects for independence and mobility depend on this assessment and treatment. Sensory The main sensory inputs for the control of posture are proprioceptive, visual and vestibular. Though gross abnormality of proprioception is not commonly found at examination of the elderly it is likely that the quality of proprioceptive information being relayed to the central processing systems deteriorates with increasing age.
The Neurology of the Elderly by Richard Godwin-Austen MD, FRCP, John Bendall BSc, DM, FRCP (auth.)