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© Borgis - Postępy Nauk Medycznych 6/2010, s. 501-502
In this second volume of „neurogeriatry” we offer you seven new papers. Our job is to highlight you the most important issues of old age neurology that will affect your every day practice. Some of presented diseases such as SLA, Alzheimer's disease are typical for that period of time some of them are different when appeared in senility. Justyna Kubiszewska and Hubert Kwieciński from Neurological Department of WUM emphasize that the average age of ALS is 65 years, 20% cases of the ALS begins over the age of 70 years, which means ALS is also the neurodegenerative disorder of elderly people. The diagnosis of ALS id based on correlation of clinical symptoms, neurophysiologic studies, neuroimaging and some serological tests. The direct cause of ALS is unknown, although there are genetic risk factors of this disease. In ALS there is a special vulnerability of motor neurons to glutaminergic excitotoxicity. Despite, that disease is incurable, many of ALS symptoms can be alleviated, the aim of management should be the improvement of quality of life and supporting the patient's independence as long as possible. Alzheimer disease also incurable in our volume is represented by psychological paper (Mandecka Monika, Florczak Małgorzata) which, presents a summing up of the work from led by authors support group for Alzheimer's caregivers. It describes also stress coping strategies among caregivers witch influence the relationship with patient. Authors try analyze the impact of diagnosis and the changing process of the disease on whole family system. This attitudes toward patients are changing in the course of time and progress of disease. They also present preliminary program of support group for Alzheimer's caregivers and conclusions from first group led by authors. Aging refers to all tissues and organs as well as to the skeletal muscles. The strength and mass of skeletal muscles progressively decrease through years and have negative influence on efficiency of people in an old age. Moreover skeletal muscle cells are unable to regenerate. Additionally, elderly people are much more susceptible to the negative influence of medications. One of the most widely used and prescribed drugs as the prevention of cardiovascular diseases and stroke are statins. It is very controversial how they react and damage muscle cells, however, they may cause muscle pain, weakness, elevated creatine kinase activity as well as life threatened rhabdomyolsis. One of the potential remedies is to encourage old people to regular physical activity, which may significantly improve the quality of life in elderly. There are only a few muscle diseases characteristic for people in an old age, and one of them is inclusion body myositis (Biruta Kierdaszuk, Anna M. Kamińska).
For example Myasthenia Gravis may appear at any age, it has a bimodal peak of age with late-onset peak between ages of 70 and 75 years. Elderly patients tend to have serious comorbidities, drug adverse effects and age-related neuromuscular changes that can interfere with patients' recovery. It is worth to emphasize that myasthenic crisis is more common in MG associated with thymoma, most common anterior mediastinal tumor in old cases according to author of next paper – Marek Leszek Kamiński. Current opinion of origin and natural course of degenerative spine changes is presented by Tadeusz Styczyński. Complications of degenerative spine disease influence clinical picture with dominant pain and symptoms of nervous system's damage. Development of degenerative changes in the disc and facet joints can lead to weakness and destabilisation of the spinal intersegmental connection system. In consequence the vertebral spine column is more sensitive to overloading and microtrauma, becoming a source of pain called mechanical especially by elderly patients. The pain in the lumbar spinal hernias is due to compression and inflammation. The clinician should consider those mentioned above mechanisms of clinical symptoms and existence and degree of neurological complications in therapeutic approach. Tomasz Sobów is an author of paper about very important clinical problem of old age such as polipragmasia. Avoiding polipragmasia, although advisable, seems to be quite unrealistic; rather, we should bear in mind its potentially noxious consequenses stemming from both pharmacodynamic drug properties and their pharmacokinetic interactions. In neurology central anticholinergic and serotoninergic syndromes are particularly dangerous as they may lead to delirium and increased mortality. Patients treated for epilepsy, parkinsonian syndromes and chronic pain are at particularly high risk of dangerous drug-drug interactions. Regarding antiepileptic drugs not only one should remember the rather well-known interactions between these drugs (used in combinations) but also interactions with other drugs that may lead to unwanted side effects as well as to treatment inefficiency. Many clinically important and problematic situation appear when psychiatric co-morbidity is taken to account and psychotropic drugs, especially antidepressants, are needed. Last paper from Katowice (Agnieszka Gorzkowska, Grzegorz Opala) from pioneering clinic of old age neurology is dedicated to rehabilitation extremely important in senility. The prolongation of human life is undoubtedly the success of modern medicine. It is, however, connected with aging-associated diseases, in which rehabilitation is a difficult to replace method of therapy. Rehabilitation measures, which apply diverse and well-adjusted to the age specificity methods, offer the possibility of at least partial reduction of deficits, combating isolation and passivity and, which follows, maintaining the sense of independence and social relevance. Activity in the elderly means also the reduction in anxiety and depression and the increase in immunity to infections. The properly conducted rehabilitation generates in the organism beneficial adaptive mechanisms.
Prof. dr hab. med. Maria Barcikowska
Postępy Nauk Medycznych 6/2010
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