ABSTRACT
The clinical diagnosis of Parkinson's disease may be difficult. In elderly patients there may be other causes of the triad of rigidity, bradykinesia and tremor. This study was designed to assess whether a single levodopa challenge could predict dopa responsiveness in patients with Parkinson's disease. Twenty-two of 27 newly diagnosed patients completed the study. Of the 22, 17 (77%) responded positively to the initial test and five (23%) showed no response. At 1 month, 18 (82%) were improved on treatment and four (18%) were not. Thus the initial test predicted 17 (94%) of the 18 who responded at 1 month and correctly identified the response of 21 (95%) of the 22 patients. There was only one false negative result. Patients with negative results turned out to have other parkinsonian syndromes. A positive levodopa test helps to confirm the diagnosis of Parkinson's disease and a negative test should alert one to alternative diagnoses.
Subject(s)
Carbidopa , Levodopa , Parkinson Disease/diagnosis , Aged , Aged, 80 and over , Carbidopa/therapeutic use , Diagnosis, Differential , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Geriatric Assessment , Humans , Levodopa/therapeutic use , Male , Motor Skills/drug effects , Neurologic Examination/drug effects , Parkinson Disease/drug therapy , Parkinson Disease, Secondary/diagnosis , Parkinson Disease, Secondary/drug therapy , Parkinson Disease, Secondary/etiology , Reaction Time/drug effects , WalkingABSTRACT
Hypothyroidism may present with weight gain and/or cardiovascular manifestations such as bradycardia or cardiac failure, but has not previously been documented as presenting with atrial fibrillation and weight loss. Our case highlights the importance of thyroid function tests in heart failure and emphasises the importance of regular follow-up after irradiation to the thyroid.
Subject(s)
Atrial Fibrillation/etiology , Hypothyroidism/complications , Weight Loss/physiology , Aged , Follow-Up Studies , Humans , Hypothyroidism/etiology , Male , Radiotherapy/adverse effects , Thyrotoxicosis/radiotherapyABSTRACT
Information about their practice has been obtained from 652 consultant physicians in geriatric medicine representing 203 (78%) of the 259 health districts in the United Kingdom (UK). Joint appointments in general and geriatric medicine are held by 19.6%. Admissions policies included admissions selected by suitability for the department (58%) or on an age-related basis (37%)--the most common cut-off age being 75 years. In only a minority, however, were all medical patients above the designated age accepted. The policy generally applied only as long as empty geriatric beds were available. Integrated service (admitting geriatric and internal medicine patients of all ages to a common pool of beds) was practised in 5% of districts. Only one provided long-term care alone. Specialist interests within or in addition to geriatrics were reported by 26% of whole time and 48% of joint appointees. 'Pure' geriatrics remains the most popular form of practice.
Subject(s)
Family Practice/organization & administration , Geriatrics/organization & administration , Hospitals, District/statistics & numerical data , Hospitals, Public/statistics & numerical data , Patient Admission/statistics & numerical data , Age Factors , Aged , Humans , Interprofessional Relations , Referral and Consultation/statistics & numerical data , Surveys and Questionnaires , United KingdomABSTRACT
There have so far been no reported studies of localization of urinary tract infection (UTI) in elderly women. The site of infection, renal or bladder, in significant urinary tract infection in 50 elderly women (mean age 80) admitted acutely to a geriatric unit was determined by the Fairley bladder washout method. Of the 31 patients with an unequivocal result, 17 (55%) had renal infection and in only 14 (45%) was the infection confined to the bladder. This study has shown that, contrary to widely-held belief and standard teaching, in over 50% of cases of UTI in elderly hospitalized female patients the infection is renal.
