Renal Evaluation and Protection
Diabetes and diabetic nephropathy have become more prevalent in the elderly population. Diabetic nephropathy has become increasingly prevalent in the elderly population. The presence of this disease in an age group suffering multiple comorbidities has altered the pathophysiology and leading cause of mortality. Mortality has become linked more often to cardiovascular events rather than progression of end-stage-renal-disease, which explains the recent shift of focus of trials to improving cardiovascular-outcomes in patients with diabetes. In this chapter, we emphasize the difference in treatment modalities and goals of thera...
Source: Clinics in Geriatric Medicine - May 26, 2020 Category: Geriatrics Authors: Rawan Amir, Sara Suhl, Charles M. Alexander Source Type: research

Treating Dyslipidemias in the Primary Prevention of Atherosclerotic Cardiovascular Disease in Older Adults with Diabetes Mellitus
People with diabetes mellitus (DM), especially those who are older, are at higher risk for premature morbidity and mortality related to atherosclerotic cardiovascular disease (ASCVD). Clinical practice guidelines recommend statin therapy for people with DM ages 40 to 75  years. The evidence for those greater than 75 years of age is relatively limited at present. Other health problems should be considered when planning ASCVD primary prevention in adults ages greater than 75 years with DM. Clinicians should discuss the risks and benefits of each plan with these pa tients and their caregivers. (Source: Clinics ...
Source: Clinics in Geriatric Medicine - May 26, 2020 Category: Geriatrics Authors: MengHee Tan, Mark Paul MacEachern Source Type: research

Management of Inpatient Hyperglycemia and Diabetes in Older Adults
Diabetes is one of the world's fastest growing health challenges. Insulin therapy remains a useful regimen for many elderly patients, such as those with moderate to severe hyperglycemia, type 1 diabetes, hyperglycemic emergencies, and those who fail to maintain glucose control on non-insulin agents alone. Recent clinical trials have shown that several non-insulin agents as monotherapy, or in combination with low doses of basal insulin, have comparable efficacy and potential safety advantages to complex insulin therapy regimens. Determining the most appropriate diabetes management plan for older hospitalized patients requir...
Source: Clinics in Geriatric Medicine - May 26, 2020 Category: Geriatrics Authors: Georgia M. Davis, Kristen DeCarlo, Amisha Wallia, Guillermo E. Umpierrez, Francisco J. Pasquel Source Type: research

Artificial Intelligence and Digital Tools
Diabetes mellitus has become a global threat, especially in the emerging economies. In the United States, there are about 24 million people with diabetes mellitus. Diabetes represents a trove of physiologic and sociologic data that are only superficially understood by the health care system. Artificial intelligence can address many problems posed by the prevalence of diabetes mellitus and the impact of diabetes on individual and societal health. We provide a brief overview of artificial intelligence and discuss case studies that illustrate how artificial intelligence can enhance diabetes care. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - May 26, 2020 Category: Geriatrics Authors: Ram D. Sriram, Satti Sethu K. Reddy Source Type: research

Hypoglycemia in Older Patients
Hypoglycemia is a serious problem in older patients with diabetes mellitus. This chapter discusses risk factors associated with hypoglycemia and approaches to mitigation of the risk for hypoglycemia. Specific considerations include selection of glucose lowering agents, comorbid conditions and the implications of declining cognitive dysfunction. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - May 24, 2020 Category: Geriatrics Authors: Byron J. Hoogwerf Source Type: research

Cognitive Dysfunction in Older Adults with Type 2 Diabetes
The prevalence of comorbid diabetes and cognitive dysfunction increases as the population ages. Diabetes increases the risk of progression of cognitive dysfunction through a spectrum of cognitive decline to mild cognitive impairment then to dementia. Cognitive dysfunction, especially impairment in the executive domain, has a negative impact on patients ’ self-care tasks. With further progression of dementia and the development of behavioral problems, the challenge to carers and health care professionals looking after these patients is significant. Therefore, clinical trials are needed to explore the impact of novel h...
Source: Clinics in Geriatric Medicine - May 24, 2020 Category: Geriatrics Authors: Alan Sinclair, Ahmed Abdelhafiz Source Type: research

Diabetes and Heart Failure
This article aims to review the key connections in the epidemiology and etiopathophysiology of type 2 diabetes and heart failure (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - May 24, 2020 Category: Geriatrics Authors: Adi Mehta, Sanjeeb Bhattacharya, Jerry Estep, Charles Faiman Source Type: research

Improving Adherence in Type 2 Diabetes
International Diabetes Federation estimates that there are more than a half-billion adults ages 20 to 79  years worldwide who have diabetes mellitus (DM) and that the global health care expenditure for adults with DM in 2015 was $673 billion. Nonadherence and nonpersistence to prescribed type 2 DM medications are common and remain a barrier to optimal health outcomes. There is a high prevalence of non adherence among older adults. Research has focused on prevalence and predictors of adherence, research methodologies, and development of measures of adherence. Improvements hopefully will result in better disease monitor...
Source: Clinics in Geriatric Medicine - May 24, 2020 Category: Geriatrics Authors: Khine Swe, Satti Sethu Reddy Source Type: research

Nonalcoholic Fatty Liver Disease and Implications for Older Adults with Diabetes
Nonalcoholic fatty liver disease (NAFLD) is common in older patients with type 2 diabetes. In older patients with type 2 diabetes, the presence of NAFLD is associated with a higher risk of hepatic (eg, nonalcoholic steatohepatitis, cirrhosis, and hepatocellular carcinoma) and extrahepatic (eg, cardiovascular disease, sarcopenia, and dementia) complications than that observed in other patient groups. For this reason, appropriate identification and management of NAFLD are clinically relevant particularly in the group of older patients with type 2 diabetes. In this regard, clinicians should consider the peculiar characteristi...
Source: Clinics in Geriatric Medicine - May 24, 2020 Category: Geriatrics Authors: Alessandro Mantovani, Giovanni Targher, Giacomo Zoppini Source Type: research

Preface
The human world is facing an aging phenomenon; in 2015, 901 million people were aged ≥60 years, with most of these individuals living in developed countries. This number is expected to more than double by 2050, reaching 2.1 billion (ie, 20% of the global population). Moreover, the number of people aged>80 years is growing more rapidly than the general older adult population. Approximately 14% of the older adult population (125 million) were ≥80 years in 2015, and this will triple by 2050, reaching 434 million (approximately 20% of the senior population). (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - May 24, 2020 Category: Geriatrics Authors: Satti Sethu Reddy Source Type: research

Diagnosis of Diabetes Mellitus in Older Adults
In the United States, 4 out of 10 adults with diabetes are ≥65 years of age. The older adult with diabetes is very likely to be asymptomatic and also at higher risk of vascular disease. New concerns include new diagnosis of diabetes for older adults admitted to hospital and older adults in long-term care facilities. The pathophysiology for increased inci dence of diabetes in older adults is multifactorial, but dominant features are increased likelihood of metabolic syndrome, dysfunctional insulin secretion, and peripheral insulin resistance. Society in general benefits from more cost-effective care of older adults ...
Source: Clinics in Geriatric Medicine - May 20, 2020 Category: Geriatrics Authors: Satti Sethu K. Reddy Source Type: research

Noninsulin Diabetes Therapies in Older Adults
Diabetes risk increases with age due to changes in β-cell function and increased insulin resistance and is one of the most common chronic medical conditions in the elderly. Diabetes management in this population requires a multidisciplinary, patient-centric approach due to wide heterogeneity in patients’ health and functional capacities. Meticulo us assessment of each patient before formulating a regimen and thorough patient education are keys to success in achieving glycemic goals, which should be individualized. Lifestyle modification is recommended for every patient. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - May 11, 2020 Category: Geriatrics Authors: Zehra Tekin, Robert S. Zimmerman Source Type: research

Delirium in the Elderly
This article discusses the basic epidemiology of delirium and approaches to diagnosing, assessing, and working up patients for delirium. It delineates the pathophysiology and underlying predisposing and precipitating factors for delirium. It also discusses recent advances in prevention and treatment, particularly multicomponent, nonpharmacological interventions. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - March 26, 2020 Category: Geriatrics Authors: Tammy T. Hshieh, Sharon K. Inouye, Esther S. Oh Source Type: research

Hearing Loss
Hearing loss is among the most frequent problems experienced by older adults, yet psychiatrists and other clinicians often ignore the problem as an aggravation rather than recognizing that the problem might benefit from appropriate hearing health care. Many psychiatric disorders have been associated with hearing loss, including depression, schizophrenia and other psychoses, anxiety, and neurocognitive disorders. In this article, hearing loss among older adults is reviewed, with special attention directed toward the recognition and proper referral to a hearing health care provider. Finally, major advances in hearing health ...
Source: Clinics in Geriatric Medicine - March 26, 2020 Category: Geriatrics Authors: Dan G. Blazer Source Type: research

Anxiety Disorders in Late Life
This article reviews late-life anxiety disorders. Pharmacologic and psychotherapy approaches to treat late-life anxiety are reviewed, including a summary of current innovations in clinical care across settings, treatment models, and treatment delivery. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - March 26, 2020 Category: Geriatrics Authors: Katherine Ramos, Melinda A. Stanley Source Type: research

Older Age Bipolar Disorder
Further understanding of older age bipolar disorder (OABD) may lead to more specific recommendations for treatment adjusted to the specific characteristics and needs caused by age-related somatic and cognitive changes. Late-onset mania has a broad differential diagnosis and requires full psychiatric and somatic work-up, including brain imaging. Research on pharmacotherapy in OABD is limited. First-line treatment of OABD is similar to that for adult bipolar disorder (BD), with specific attention to vulnerability to side effects and somatic comorbidity. Because findings in younger adults with BD cannot be extrapolated to OAB...
Source: Clinics in Geriatric Medicine - March 26, 2020 Category: Geriatrics Authors: Annemiek Dols, Aartjan Beekman Source Type: research

Managing Behavioral and Psychological Symptoms of Dementia
Behavioral and psychological symptoms of dementia (BPSD) are universally experienced by people with dementia throughout the course of the illness and cause a significant negative impact on quality of life for patients and caregivers. Nonpharmacologic treatments have been recommended as first-line treatment of BPSD by multiple professional organizations and should target patients with dementia factors, caregiver factors, and environmental factors. Psychotropic medications are often prescribed off-label without significant evidence to support their use. The Describe, Investigate, Create, Evaluate approach can provide a struc...
Source: Clinics in Geriatric Medicine - March 26, 2020 Category: Geriatrics Authors: Lauren B. Gerlach, Helen C. Kales Source Type: research

Integrated Care for Older Adults with Serious Mental Illness and Medical Comorbidity
The excess risk of early mortality, medical comorbidity, early institutionalization, and high costs among older adults with serious mental illness necessitates development and dissemination of effective and sustainable integrated care models that simultaneously address mental and physical health needs. This overview highlights current, evidence-based integrated care models, which predominantly adopt the following approaches: (1) psychosocial skills training, (2) integrated illness self-management, and (3) collaborative care and behavioral health homes. Finally, innovative models that build on these approaches by incorporat...
Source: Clinics in Geriatric Medicine - March 26, 2020 Category: Geriatrics Authors: Stephen J. Bartels, Peter R. DiMilia, Karen L. Fortuna, John A. Naslund Source Type: research

Posttraumatic Stress Disorder in the Elderly
Posttraumatic stress disorder (PTSD) can occur at any point in the life span and can last for decades. Chronic PTSD can affect quality of life and have a negative impact on physical function and health in the elderly and may be associated with premature aging and dementia. It is critical that clinicians screen for trauma-based symptoms and to treat as appropriate. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - March 26, 2020 Category: Geriatrics Authors: Rebekah J. Jakel Source Type: research

Cognitive Impairment and Dementia in Parkinson Disease
In the comprehensive care of people with Parkinson disease (PD), recognition of cognitive impairment is essential. Cognitive impairment in PD can be varied in its clinical features and rates of progression and is now recognized to occur throughout the disease, from early, de novo to more advanced stages. However, the many factors related to the disease itself, underlying pathologies, comorbidities, and genetics may play a role in the development of mild cognitive impairment (PD-MCI) and dementia (PDD). To date, the field lacks curative or disease-modifying treatments for PD cognitive impairment and has few effective, robus...
Source: Clinics in Geriatric Medicine - March 26, 2020 Category: Geriatrics Authors: Jennifer G. Goldman, Erica Sieg Source Type: research

Geriatric Psychiatry
CLINICS IN GERIATRIC MEDICINE (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - March 26, 2020 Category: Geriatrics Authors: Dan G. Blazer, Susan K. Schultz Source Type: research

Copyright
ELSEVIER (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - March 26, 2020 Category: Geriatrics Source Type: research

Contributors
DAN G. BLAZER, MD, MPH, PhD (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - March 26, 2020 Category: Geriatrics Source Type: research

Contents
Dan G. Blazer and Susan K. Schultz (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - March 26, 2020 Category: Geriatrics Source Type: research

Forthcoming Issues
Diabetes in Older Adults (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - March 26, 2020 Category: Geriatrics Source Type: research

Neurological Changes and Depression
This article covers current research on the relationship between depression and cognitive impairment in older adults. First, it approaches the clinical assessment of late-life depression and comorbid cognitive impairment. Cognitive risk factors for suicide are discussed. Research is then provided on neuropsychological changes associated with depression, discussing subjective cognitive impairment, mild cognitive impairment, and dementia profiles. In addition, literature regarding neuroimaging and biomarker findings in depressed older adults is presented. Finally, therapeutic models for treatment of late-life depression are ...
Source: Clinics in Geriatric Medicine - February 25, 2020 Category: Geriatrics Authors: Ryan D. Greene, Alex Cook, Dustin Nowaskie, Sophia Wang Source Type: research

Palliative Care for Dementia
Dementia management is complicated by neuropsychiatric symptoms such that the longitudinal care of a psychiatrist or other mental health provider is often an essential part of patient care and a major source of family support. Given the importance of end-of-life continuity of care, the involvement of psychiatry in palliative and hospice services affords an important opportunity for growth. Common challenges involve sharing prognostic information with patients and families to aid in advance planning, and management of persistent pain and nutritional issues. Future research will yield important new insights and guidelines fo...
Source: Clinics in Geriatric Medicine - February 20, 2020 Category: Geriatrics Authors: Jaffrey Hashimie, Susan K. Schultz, Jonathan T. Stewart Source Type: research

Geriatric Psychiatry
The evidence base for treating older adults with psychiatric disorders is ever increasing, yet few persons are trained to treat the elderly through geriatric psychiatry fellowship training programs. Therefore, the bulk of patient care devolves to general psychiatrists, primary care practitioners, and mental health professionals other than psychiatrists. Even so, specialty-trained geriatric psychiatrists must keep up with the latest in our understanding of psychiatric disorders and their comorbidities among older adults. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - January 29, 2020 Category: Geriatrics Authors: Dan G. Blazer, Susan K. Schultz Tags: Preface Source Type: research

Depression and Cardiovascular Disorders in the Elderly
The world ’s older population continues to grow at an unprecedented rate. This trend amplifies the necessity of improving the care of older patients with chronic health problems. Of those with chronic health problems, those with cardiovascular diseases and depression are particularly challenging due to the multifaceted nature of these conditions. This review discusses the significance of this aging trend and ways to better care for this particular population. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - January 28, 2020 Category: Geriatrics Authors: Wei Jiang Source Type: research

Cognitive Reserve from the Perspective of Preclinical Alzheimer Disease
The concept of cognitive reserve (CR) was proposed to account for the discrepancy between levels of brain pathologic process or damage and clinical and cognitive function. We provide a detailed review of prospective longitudinal studies that have investigated the interaction between CR and Alzheimer disease (AD) biomarkers on clinical and cognitive outcomes among individuals with normal cognition at baseline. Current evidence is consistent with the view that higher levels of CR are associated with a delay in the onset of symptoms of mild cognitive impairment and that there may be multiple pathways by which CR exerts its pr...
Source: Clinics in Geriatric Medicine - January 28, 2020 Category: Geriatrics Authors: Anja Soldan, Corinne Pettigrew, Marilyn Albert Source Type: research

Electroconvulsive Therapy in Geriatric Psychiatry
Electroconvulsive therapy (ECT) remains an important treatment of geriatric patients. ECT treats severe depression, mania, psychosis, catatonia, and comorbid depression and agitation in dementia. ECT also serves a crucial role in treating urgent illness requiring expedient recovery, such as catatonia, or in patients with severe suicidal ideation or intent. ECT is even more effective in the elderly than in mixed-age adult populations. ECT is a safe treatment option with few medical contraindications. Cognitive effects are largely transient, even in patients with preexisting cognitive impairment. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - January 28, 2020 Category: Geriatrics Authors: Justin P. Meyer, Samantha K. Swetter, Charles H. Kellner Source Type: research

Advances in the Conceptualization and Study of Schizophrenia in Later Life: 2020 Update
This article provides an overview of the advances in the conceptualization and study of schizophrenia in later life. Theoretic and clinical models in psychiatry and gerontology are integrated. Specifically, recovery is examined in the context of aging, how clinical dimensionality affects diagnoses in older adults, how various features of schizophrenia are implicated in models of accelerated and paradoxic aging, and how outcome in later life is a more dynamic and heterogeneous than assumed previously. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - January 13, 2020 Category: Geriatrics Authors: Carl I. Cohen, Ksenia Freeman, Dina Ghoneim, Aninditha Vengassery, Brian Ghezelaiagh, Michael M. Reinhardt Source Type: research

Advances in the Conceptualization and Study of Schizophrenia in Later Life: 2019 Update
This article provides an overview of the advances in the conceptualization and study of schizophrenia in later life. Theoretic and clinical models in psychiatry and gerontology are integrated. Specifically, recovery is examined in the context of aging, how clinical dimensionality affects diagnoses in older adults, how various features of schizophrenia are implicated in models of accelerated and paradoxic aging, and how outcome in later life is a more dynamic and heterogeneous than assumed previously. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - January 13, 2020 Category: Geriatrics Authors: Carl I. Cohen, Ksenia Freeman, Dina Ghoneim, Aninditha Vengassery, Brian Ghezelaiagh, Michael M. Reinhardt Source Type: research

Does This Patient Have Parkinson Disease or Essential Tremor?
In the elderly patient with tremor, the differential diagnosis is usually between essential tremor (ET) and Parkinson disease (PD). A careful history and examination are the keys to the diagnosis. Essential tremor is a bilateral action tremor of the upper limbs whereas PD begins unilaterally and is a rest tremor. A handwriting sample can usually distinguish PD from ET as the former is small (micrographic) but atremulous whereas writing in ET is tremulous but normal sized. In ET, there are no signs aside from tremor but in PD, the tremor is accompanied by bradykinesia and rigidity. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - November 14, 2019 Category: Geriatrics Authors: Stephen G. Reich Source Type: research

Parkinson Disease
Parkinson disease (PD) is the second most prevalent neurodegenerative disorder, next only to Alzheimer disease. As the average age of the United States and European populations increases, physicians caring for the elderly will be confronted with an increasing number of PD patients. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - November 14, 2019 Category: Geriatrics Authors: Carlos Singer, Stephen G. Reich Tags: Preface Source Type: research

Parkinson Disease
CLINICS IN GERIATRIC MEDICINE (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - November 14, 2019 Category: Geriatrics Authors: Carlos Singer, Stephen G. Reich Source Type: research

Copyright
ELSEVIER (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - November 14, 2019 Category: Geriatrics Source Type: research

Contributors
CARLOS SINGER, MD (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - November 14, 2019 Category: Geriatrics Source Type: research

Contents
Carlos Singer and Stephen G. Reich (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - November 14, 2019 Category: Geriatrics Source Type: research

Forthcoming Issues
Geriatric Psychiatry (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - November 14, 2019 Category: Geriatrics Source Type: research

Diagnosis and Differential Diagnosis of Parkinson Disease
Parkinsonism is one of the most common neurologic disorders in the aging population. Although Parkinson disease (PD) is the most common cause, there is a lengthy differential diagnosis. The diagnosis of PD hinges on recognizing its typical features, including bradykinesia, rest tremor, unilateral onset, cogwheel rigidity, and beneficial and sustained response to levodopa. Equally important is to be familiar with the “red flags,” which are features not expected with PD and suggest an alternative diagnosis, usually a parkinsonian syndrome. In general, it is best to have the diagnosis confirmed by a neurologist, e...
Source: Clinics in Geriatric Medicine - October 29, 2019 Category: Geriatrics Authors: Stefano Caproni, Carlo Colosimo Source Type: research

Multidisciplinary Care to Optimize Functional Mobility in Parkinson Disease
This review elaborates on multidisciplinary care for persons living with Parkinson disease by using gait and balance impairments as an example of a treatable target that typically necessitates an integrated approach by a range of different and complementary professional disciplines. Using the International Classification of Functioning, Disability, and Health model as a framework, the authors discuss the assessment and multidisciplinary management of reduced functional mobility due to gait and balance impairments. By doing so, they highlight the complex interplay between motor and nonmotor symptoms, and their influence on ...
Source: Clinics in Geriatric Medicine - October 28, 2019 Category: Geriatrics Authors: Anouk Tosserams, Nienke M. de Vries, Bastiaan R. Bloem, Jorik Nonnekes Source Type: research

Management of Motor Features in Advanced Parkinson Disease
Advanced Parkinson disease (PD) is characterized by the presence of motor fluctuations becoming the focus of treatment, prominent postural instability, significant disability despite levodopa therapy, and the presence of symptoms refractory to levodopa therapy. In this article, the authors review the motor manifestations of patients with advanced PD, as well as the most common pharmacologic and nonpharmacologic available therapies. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - October 18, 2019 Category: Geriatrics Authors: Henry Moore, Danielle S. Shpiner, Corneliu C. Luca Source Type: research

Depression and Anxiety in Parkinson Disease
Depression and anxiety are common neuropsychiatric manifestations of Parkinson disease. However, they are often under-recognized because the somatic symptoms of depression often overlap with the motor symptoms of Parkinson disease and there is low self-reporting. Clinicians need to be vigilant about early detection and treatment of anxiety and depression in the patient with Parkinson disease. The development of new therapeutic strategies, including diet, exercise, and counseling along with antidepressants provide a holistic approach to management. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - October 18, 2019 Category: Geriatrics Authors: Sudeshna Ray, Pinky Agarwal Source Type: research

Parkinson Disease Epidemiology, Pathology, Genetics, and Pathophysiology
Parkinson disease is a complex, age-related, neurodegenerative disease associated with dopamine deficiency and both motor and nonmotor deficits. Many environmental and genetic factors influence Parkinson disease risk, with different factors predominating in different patients. These factors converge on specific pathways, including mitochondrial dysfunction, oxidative stress, protein aggregation, impaired autophagy, and neuroinflammation. Ultimately, treatment of Parkinson disease may focus on targeted therapies for pathophysiologically defined subtypes of Parkinson disease patients. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - October 17, 2019 Category: Geriatrics Authors: David K. Simon, Caroline M. Tanner, Patrik Brundin Source Type: research

Management of Early Parkinson Disease
Early Parkinson disease is the approximate time period between initial diagnosis and the onset of motor fluctuations. Treatment requires an integrative approach, including identification of motor and nonmotor symptoms, choice of pharmacologic treatment, and emphasis on exercise. Patients should be treated for motor symptoms, whereas medications may be delayed for milder symptoms. The choice of treatment in patients with early Parkinson disease must be weighed against financial considerations, ease of administration, and potential long-term adverse events. Nonmotor symptoms should also be identified and treated. Exercise is...
Source: Clinics in Geriatric Medicine - October 17, 2019 Category: Geriatrics Authors: Theresa A. Zesiewicz, Yarema Bezchlibnyk, Nicolas Dohse, Shaila D. Ghanekar Source Type: research

Gastrointestinal Care of the Parkinson Patient
This article reviews the most common gastrointestinal (GI) problems that occur in patients with Parkinson disease, including weight loss, drooling, dysphagia, delayed gastric emptying, constipation, and defecatory dysfunction. Appropriate workup and treatment options are reviewed in detail in order to provide clinicians with a comprehensive and practical guide to managing these problems in Parkinson disease patients. GI adverse effects of commonly used Parkinson disease motor medications are also reviewed. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - October 17, 2019 Category: Geriatrics Authors: John Legge, Nicholas Fleming, Leslie Jameleh Cloud Source Type: research

Hallucinations, Delusions and Impulse Control Disorders in Parkinson Disease
Psychotic and compulsive symptoms in Parkinson disease are highly prevalent and associated with poor outcomes and greater caregiver burden. When acute, delirium should be ruled out or treated accordingly. When chronic, comorbid systemic illnesses, dementia, and psychiatric disorders should be considered. Reduction and discontinuation of anticholinergics, amantadine, dopamine agonists, and levodopa as tolerated, as well as adjunctive clozapine or quetiapine are frequently effective to manage Parkinson disease psychosis. Pimavanserin appears effective but is not widely available, and more experience is needed. Dopamine agoni...
Source: Clinics in Geriatric Medicine - October 17, 2019 Category: Geriatrics Authors: Karlo J. Lizarraga, Susan H. Fox, Antonio P. Strafella, Anthony E. Lang Source Type: research

Overview of Sleep and Circadian Rhythm Disorders in Parkinson Disease
Sleep disorders are common among PD patients and affect quality of life. They are often under-recognized and under-treated. Mechanisms of sleep disorders in PD remain relatively poorly understood. Improved awareness of common sleep problems in PD. Tailored treatment and evidence for efficacy are lacking. The purpose of this review is to provide an overview and update on the most common sleep disorders in PD. We review specific features of the most common sleep disorders in PD, including insomnia, excessive daytime sleepiness, sleep-disordered breathing, restless legs syndrome, circadian rhythm disorders and REM sleep behav...
Source: Clinics in Geriatric Medicine - October 17, 2019 Category: Geriatrics Authors: Priti Gros, Aleksandar Videnovic Source Type: research

Orthopedic Care of Patients with Parkinson Disease
This article summarizes existing literature examining orthopedic interventions for patients with Parkinson disease (PD). It reviews complications and functional outcomes of shoulder, spine, knee, and hip surgeries in PD. Causes of fall-related fractures in PD and the risk of postoperative cognitive decline after orthopedic interventions in PD are also briefly discussed. (Source: Clinics in Geriatric Medicine)
Source: Clinics in Geriatric Medicine - October 17, 2019 Category: Geriatrics Authors: Marian Livingston Dale Source Type: research