Cognitive Effects of Anticholinergics in the Geriatric Patient Population: Safety and Treatment Considerations
AbstractPurpose of ReviewAnticholinergics are one of the mainstay medications for treatment of overactive bladder syndrome. This review is an assessment of the most current literature describing the cognitive adverse effects related to anticholinergic medication use in the elderly population.Recent FindingsAnticholinergic medications are not without adverse drug effects because of their activity on receptors on multiple sites in the body. Many of these side effects, including constipation, dry mouth, and confusion, have been thought to be self-limited to the duration of medication exposure, but recent studies have shown an association between long-term anticholinergic medication use and an increased risk for irreversible cognitive changes such as dementia.SummaryUrologists should be aware of these recent studies in order to provide counseling about anticholinergic dose minimization, discontinuation of anticholinergics with any signs of cognitive decline, the potential risk of long-term cognitive effects, and balance these with the immediate benefits of decreasing incontinence and improvements in quality of life.
CONCLUSION: Men with rectal prolapse were younger, healthier, and had relatively better anorectal function than women. The Delorme-Thiersch operation in men promoted lower recurrence rates and was advantageous in preserving the fertility of young patients, but the incidence of complications was also higher in men. Adequate counseling and preparation for the possibility of complications are needed. PMID: 31726002 [PubMed]
CONCLUSION: Many surgical techniques have been described for the treatment of anal fistula. The correct choice of surgical technique out of available procedures is the most important factor for proper treatment and reducing the risk of recurrence or incontinence. In the authors' experience, the LIFT technique is simple and easy to learn, and is a good choice for the treatment of simple anal fistula; however, a tailored surgery remains the gold standard for this condition. PMID: 31725998 [PubMed]
Waist circumference is a more accurate indicator of abdominal visceral fat level than body mass index
No MMSE for You! A Case of an "Uncooperative" Patient With Early-Onset Dementia. Prim Care Companion CNS Disord. 2019 Oct 24;21(5): Authors: Tsai PH, Kaur G, Gopalakrishna G Abstract The Banner Alzheimer's Institute Case Conference is a weekly event in which physicians and staff discuss challenging and/or teaching cases of patients seen at the Institute's Stead Family Memory Clinic. These conferences are attended by a multidisciplinary group that includes Banner Alzheimer's Institute dementia specialists, community physicians (internal medicine, family medicine, and radiology), physician assi...
PMID: 31726497 [PubMed - in process]
CONCLUSION: Upon comparing the results with those from the earlier cohort study in Yeoncheon, the incidence of all-cause and AD dementia decreased by approximately 40% over 12 years; it has been mainly driven by the increase in the educational level of older adults. The declining time trends of incidence should be taken into account for estimating the future prevalence of dementia in Korea. PMID: 31726496 [PubMed - in process]
CONCLUSIONS: Bowel symptoms were more frequent in HTLV-1-infected patients than in seronegative controls and the frequency of bowel symptoms correlated with the severity of neurologic disease.
DISCUSSION: CMDs, especially when comorbid, are associated with increased dementia risk; however, leisure activities and social integration mitigate this risk. PMID: 31718906 [PubMed - as supplied by publisher]
As a primary care doctor, I see a lot of women dealing with the inconvenience, discomfort, and embarrassment of urinary incontinence (unintended leaking of urine). Some are comfortable bringing this up right away. Others suffer needlessly because they feel too shy or awkward to mention it. The truth is, an estimated 45% of women experience some form of urinary incontinence at some point in their lives. That’s almost half of all women! It’s a very big deal. Urinary incontinence can negatively affect physical and emotional well-being. For example, women may avoid going out because they’re worried about havi...