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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Older African Americans constitute an expanding part of the elderly population in the United States. Although socioeconomic factors affect longevity and functional status more than race, African-American elders, as a whole, show poorer health status, as well as greater levels of financial strain and care-giver burden. Incidence rates of hypertension, heart disease, stroke, end-stage renal disease, dementia and prostate cancer are higher among African Americans than among the white population. The incidence of depression, however, is lower. Cancer survival rates are also lower, in part because of lower rates of cancer screening in this group. Physicians should carefully choose instruments to assess cognitive and physical status in African-American elders. The Activities of Daily Living scale and the Short Portable Mental Status Questionnaire are two tools that have been specially tested and shown to be reliable and valid in this population group. The Geriatric Depression Scale is a useful diagnostic tool that is quick to use in a busy office practice. Taking the time during an initial visit to understand the patient's values and perceptions of health and illness builds a sense of comfort and trust that will set a positive tone for the entire doctor-patient relationship and may empower the patient to take positive steps to improve health habits.
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PMID:Special health considerations in African-American elders. 909 85

The disease is named after George H. Whipple who, in 1907, was the first to describe an intestinal "lipodystrophy". Although Whipple's disease is generally recognized as a multisystem chronic granulomatous disease, primarily involving the digestive system, it can also appear as a primary neurological disorder in rare cases. Most often it is manifested with loss of weight, diarrhea, malabsorption, abdominal pain, lymphadenopathy, cardiopathy, hyperpigmentation and hypotension. The presence of periodic acid-Schiff (PAS)-positive macrophages in biopsy specimens (not only jejunal) and demonstration of "Whipple's bacilli" visible by electron microscopy, are diagnostic signs of active Whipple's disease. Whipple's disease confined to the CNS is rare. It is rarely found in the differential diagnosis of patients with progressive neurological deterioration. The most common neurological picture includes progressive dementia, external ophalmoplegia, myoclonus, seizures, ataxia, hypothalamic dysfunction (sleep disorders, hyperphagia, polydipsia) and meningitis. Oculofacial-skeletal myorhythmia as a movement disorder, associated with Whipple's disease, is reported. Fulminant course of cerebral Whipple's disease is unusual and unfavourable. The confusing and nonspecific clinical appearance is typical for primary CNS involvement. It has recently been suggested that CNS involvement occurs in all cases, although only 10-20% of patients may show it. The CNS is the most common site of disease relapse. The CT scans and MRI of the brain are often normal, but may show cortical/subcortical atrophy, hydrocephalus, focal or intracerebral mass lesions. The cerebrospinal fluid can sometimes contain PAS-positive macrophages. Brain biopsy is suggested as a diagnostic method in cases of high suspicion of CNS Whipple's disease. However, the lesions are frequently inaccessible and false negative. Without extended antibiotic therapy, the course of Whipple's disease is lethal. Now, the prognosis is good, although the optimal antimicrobial regimen is not clearly established. Initial parenteral therapy (tetracycline, penicilline, streptomycine, chloramphenicol, ampicilline) and peroral long-term treatment with trimetoprime-sulphametoxasole, are recommended. As CNS relapse of Whipple's disease may occur after several years, long-term treatment should include antibiotics that are able to cross the blood-brain barrier. The CNS relapse, in contrast to the systemic ones, is resistant to the treatment. Appropriate therapy instituted earlier in the course of the disease is associated with a better neurological outcome. Early recognition can be critical in Whipple's disease because of irreversible neurological sequelae seen later in the course of this potentially treatable condition. In cases with high clinical suspicion in which Whipple's disease cannot be diagnosed with procedures such as jejunal biopsy, antibiotic therapy is recommended. Recovery of an established neurological deficit may rarely occur. Longterm follow-up studies would help to identify the optimal antibiotic regimen and duration of treatment.
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PMID:[Neurologic disorders in Whipple's disease]. 910 28

A major societal challenge is to improve quality of life and prevent or reduce disability and dependency in an ageing population. Increasing age is associated with increasing risk of disability and loss of independence, due to functional impairments such as loss of mobility, hearing and vision; a major issue must be how far disability can be prevented. Ageing is associated with loss of bone tissue, reduction in muscle mass, reduced respiratory function, decline in cognitive function, rise in blood pressure and macular degeneration which predispose to disabling conditions such as osteoporosis, heart disease, dementia and blindness. However, there are considerable variations in different communities in terms of the rate of age-related decline. Large geographic and secular variations in the age-adjusted incidence of major chronic diseases such as stroke, hip fracture, coronary heart disease, cancer, visual loss from cataract, glaucoma and macular degeneration suggest strong environmental determinants in diet, physical activity and smoking habit. The evidence suggests that a substantial proportion of chronic disabling conditions associated with ageing are preventable, or at least postponable and not an inevitable accompaniment of growing old. Postponement or prevention of these conditions may not only increase longevity, but, more importantly, reduce the period of illnesses such that the majority of older persons may live high-quality lives, free of disability, until very shortly before death. We need to understand better the factors influencing the onset of age-related disability in the population, so that we have appropriate strategies to maintain optimal health in an ageing population.
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PMID:Epidemiological aspects of ageing. 946 67

There have been few studies of hypertension in nursing home patients. To assess the prevalence, demographic characteristics, comorbidity and drug therapy in hypertensive nursing home patients compared with those who are normotensive, we reviewed all medical charts of patients in three nursing home facilities. Of the 804 patients, 355 (44.2%) have hypertension. Calcium channel blockers were the most frequently prescribed anti-hypertensive (30.3%) and together with diuretics (28.4%) and ACE inhibitors (27.7%) account for more than 85%. Hypertensive patients take more cardiac, hypoglycaemic, and analgesic drugs (P = <0.001, <0.001, and 0.004, respectively) than those who are normotensive. Overall patients take an average of 8.68 medications daily. In hypertensive patients, the average number of comorbid conditions (excluding hypertension) is 5.02 compared with 3.23 in normotensive patients. Hypertension is significantly associated with diabetes, heart disease, cerebrovascular disease, neoplasms, endocrine disorders, gastrointestinal diseases, psychiatric disorders, dementia, other central nervous system diseases, skin problems, blood diseases and inversely with hip fracture. Blood pressure control (<140/90 mm Hg) is achieved in 88.8%, is not related to age and is significantly more frequent in males than females (91.8% vs 82.6% P = 0.025). The problem of hypertension in nursing home patients is complex and has received insufficient study. Since studies demonstrating benefit from anti-hypertensive therapy in the elderly excluded the very elderly and those with significant comorbid conditions, additional research is needed.
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PMID:Hypertension in nursing home patients. 950 52

The key areas of scientific research in general internal medicine are (1) prevention; (2) the natural history of common illnesses; (3) improving the outcomes and efficiency of the health care system and (4) orphan diseases. Disease prevention is at the top of the list because of the enormous role preventable causes play in morbidity and mortality, above all tobacco. Research in this field is difficult because it touches such questions as individual behaviour and personal choice. Research in the natural history of common illnesses is critical to informed patient decision making. Recent studies show that procedures thought to be safe bear a high percentage of complications, when viewed from the generalist's point of view: high incidence of strokes after elective coronary bypass surgery; higher mortality rates among patients having had pulmonary catheterization; high incidence of incontinence and impotence after transurethral resection of the prostate. A third area for research in primary care is how to improve outcome and efficiency through improvements in the health care delivery system. This field touches the problem of unnecessary surgical interventions and inappropriate prescription of antibiotics. Orphan diseases in this context are conditions no speciality wants to study, such as dementia and low back pain. The most important obstacle for research in the field of general internal medicine is funding. It is much easier to be funded for research in high profile conditions, like heart disease, cancer and AIDS. A second barrier to research relates to the role of special interest groups in influencing not only funding but also policy. Important examples were the pressure on consensus conference decisions on the role of spinal fusion surgery for low back pain and on the question whether women between 40 and 50 should have annual mammography. For generalist research to be fruitful it is of outmost importance to have an adequate intellectual infrastructure, i.e. support by epidemiologists, biostatisticians, economists and research methodologists.
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PMID:Scientific evidence and research in primary care. 954 Jan 37

While the role of diet in heart disease and cancer has received much attention, a possible role for diet in the development of cognitive impairment and dementia is just now being investigated. In this presentation, the putative mechanisms through which anti-oxidants could modulate cellular life in the brain will be briefly discussed. Epidemiologic studies that describe the relation of selected dietary nutrients to cognitive impairment and dementia will be reviewed. In particular, recent results from the analyses of community based follow-up studies, including the Rotterdam Study and the Zutphen Study will be presented. Briefly, these studies provide a mixed picture concerning the relation of anti-oxidants to cognitive impairment or dementia.
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PMID:Anti-oxidants and cognitive function: a review of clinical and epidemiologic studies. 970 Jun 41

Stroke continues to be the third most common cause of death and a major cause of disability among those aged 70 years and older. The risk of stroke doubles for every decade after age 55. It is 25% higher in men. Age, cardiovascular disease, and hypertension are major determinants of cerebral blood flow; all have a negative impact on cerebral reperfusion. The risk of stroke can be reduced at any age by treating and correcting concomitant risk factors: hypertension; heart disease and cardiac arrhythmias (treatment with anticoagulants); transient ischemic attacks (treatment by platelet inhibitors or anticoagulants); and carotid stenosis (by endarterectomy). Cessation of smoking, control of diabetes, reduction of serum lipids, and control of obesity can reduce the risk of stroke. When stroke occurs, early treatment with rt-PA and aggressive patient care results in reduced mortality and morbidity and makes for better neurologic outcomes. Finally, prevention of stroke reduces risk of vascular dementia and makes a better functioning advanced age.
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PMID:Stroke and the aging of the brain and the arteries. 974 37

Alzheimer disease (AD) is the most common form of dementia affecting elderly people. It is the fourth leading cause of death among adults in the United States, following heart disease, cancer, and stroke. The prevalence of AD increases with increasing age. An estimated 10% of people aged 65 years have this progressive, degenerative disease, and this percentage increases to 47.2% for people aged 85 years and older. An early-onset form of AD can affect individuals who are middle-aged, with the youngest documented case being that of a 28-year-old. In the Framingham cohort, women with AD outnumbered men by a ratio of 2.8:1 for those aged 75 years or older. Undoubtedly, as our population continues to age, the increasing prevalence of AD will have an even greater impact on society than it does today. Approximately 4 million Americans have AD, and it is projected that the number will rise to 14 million by the middle of the next century. The financial impact of AD is staggering, with the average lifetime cost for an individual with AD exceeding $170,000. Although the majority of individuals with AD are cared for by family and friends at home, individuals with AD constitute half of all nursing home residents. The average cost of a year of nursing home care for an individual with AD is $42,000, and this cost can exceed $70,000. The purpose of this article is to provide an overview of the etiology of AD, the tools used in the diagnosis of AD, and the treatment of individuals with AD. In addition, the clinical presentation of the various stages of AD is described, and the psychosocial implications of this disease are discussed.
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PMID:An overview of the etiology, diagnosis, and treatment of Alzheimer disease. 985 51

Sleep is important for health and quality of life at all ages, and poor sleep interacts with many medical conditions. Somatic and psychiatric diseases, and unfavourable habits and life-style factors, increase the propensity to insomnia in older persons. As health deteriorates with age, sleep becomes poorer. Heart disease and stroke, cancer, painful conditions, breathing disorders and nocturnal polyuria syndrome often disturb sleep. Dementia and depression, which are often associated with sleep disturbances, are also more prevalent in the elderly. Moreover, true age-related sleep deterioration occurs after the age of 75 years. Attempts to improve sleep should first and foremost be focused on elimination of somatic and psychiatric symptoms as far as possible, and on modification of lifestyle factors that may affect sleep quality. For short term treatment, hypnotics are appropriate; for longer periods, nonpharmacological methods, for example light therapy or behavioural modification techniques, should be considered, as many hypnotic drugs are less suitable for long term use. However, there are situations when sleep medication must continue for long periods, especially in elderly patients with severe diseases and poor quality of life. In these patients, careful individualisation of therapy is appropriate.
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PMID:Sleep disorders in the elderly. 1008 63

A report of a study to analyze the effect of sociocultural patient characteristics (age, terminal diseases, drug abuse, alcoholism, mental retardation, dementia, suicide attempts, institutionalization, noncompliance with medical regimens, violent crimes, lack of support system, or relationship to a staff physician) on decisions to initiate or withhold cardiopulmonary resuscitation in an emergency situation. Pairs of vignettes were presented to residents in internal medicine and graduate students in an MBA program for comparisons of physicians' decisions with administrators' decisions. On some patient characteristics there were significant differences between the two groups. For most factors (drug abuse, multiple suicide attempts, age, violent crime, lack of known support systems, and relationship to staff), doctors are more likely to initiate CPR than are business students representing health care administrators. In chronic, long-term situations (carcinoma or heart disease, dementia, mental retardation, and institutionalization), the doctors are less likely to initiate CPR than the business students. If objectivity is a goal in deciding whether or not to initiate CPR, physicians should be aware of differences between their opinions and others'.
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PMID:Values and CPR decisions: a comparison of physicians and administrators in training. 1027 38


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