Managing Diabetes and Dementia.

Dementia and type 2 diabetes are a serious public health problem worldwide, with increasing incidence with age. Diabetes is a risk factor for the development of dementia. Having cognitive dysfunction impairs a person's ability to perform self-care tasks. Also, community dwelling adults can have varying levels of functional impairment and can also have other geriatric syndromes. This article presents a multidisciplinary approach and treatment and goals tailored individually to patients with different levels of cognitive and activities of daily living impairments. Three case studies show the management of diabetes in older adults with different levels of care needs.

Dorsal vagal complex of the brainstem: conformal avoidance to reduce nausea.

PURPOSE: To investigate the role of dose to the dorsal vagal complex (DVC) as an emetic stimulus in head-and-neck cancer patients treated with intensity modulated radiation therapy but without chemotherapy. METHODS AND MATERIALS: Seventy consecutively treated patients were analyzed for factors associated with nausea. The DVC was contoured on treatment planning scans using a previously published template and mean dose to the structure was analyzed for dose response. RESULTS: Nausea occurred in 26 of 70 patients (37%). Two patients (3%) experienced grade 2 nausea, with the remainder having grade 1 nausea. On univariate analysis, dose to the DVC, age, and T-stage were the only significant predictors of nausea. The highest quartile of dose to the DVC (>3000 cGy) was associated with an incidence of nausea of 67% compared with less than 30% in each of the other 3 quartiles (P = .0255). CONCLUSIONS: Dose to the DVC of the brainstem appears to correlate with radiation-induced nausea and vomiting. Attentive treatment planning efforts can reduce dose to this critical structure and hopefully minimize the risk of nausea.

Factors associated with radiation-induced nausea and vomiting in head and neck cancer patients treated with intensity modulated radiation therapy.

BACKGROUND AND PURPOSE: To investigate factors associated with radiation-induced nausea and vomiting (RINV) in the setting of head and neck intensity modulated radiation therapy (IMRT). MATERIALS AND METHODS: Forty-three patients treated with IMRT for head and neck cancer between 2002 and 2007 comprise the cohort. The majority (79%) were treated with an accelerated altered fractionation scheme, and concurrent chemotherapy was delivered to 23. A retrospective review of factors associated with nausea was performed. RESULTS: Eighteen patients (42%) reported grade 1 acute nausea, and seven patients (16%) reported grade 2 nausea. Factors significant for grade 1-2 nausea on univariate analysis included dose to the dorsal vagal complex of the mid-medulla, younger age, use of a low neck field, and Amifostine use. Only young age retained significance on multivariate analysis. High-grade nausea was associated with use of Amifostine (p=0.003) and concurrent chemotherapy (p=0.015). CONCLUSIONS: In addition to previously recognized emetic factors, young age and radiation dose to the dorsal vagal complex of the brainstem may play a role in development of nausea during head and neck IMRT.

Disorders of male sexual function.

Sexuality remains an important issue in the older population. In spite of a decreased ability to achieve an erection, there is continued sexual desire. Many studies suggest that erectile dysfunction in the aged is primarily caused by age-associated chronic disease rather than normal, healthy aging. Therefore, preventive measures that are aimed at the underlying diseases should be sought. Nevertheless, effective treatment options are now available to successfully regain sexual function and thereby, improve quality of life.