[Palliative neurology]. / Palliativneurologie.

Palliative medicine represents the holistic multiprofessional treatment of severely and incurably ill people and their relatives, addressing their complex physical, psychological, social and spiritual needs. The central therapeutic goals are the quality of life and alleviation of suffering. In the course of many neurological diseases, high symptom burden, long and variable trajectories and unfavorable prognosis at times create a need for palliative care even at an early stage, which is currently still inadequately met. This can be countered by qualified neuropalliative care. In addition to intensifying interdisciplinary collaboration, this requires neurologists to have core competencies in palliative care. These include a team-oriented attitude, communication skills, expertise in symptom control and knowledge of biomedical ethics including palliative options at the end of life.

[Parkinson's syndromes in geriatric patients : Epidemiological, clinical and therapeutic characteristics]. / Parkinson-Syndrome bei geriatrischen Patienten : Epidemiologische, klinische und therapeutische Besonderheiten.

Due to their high prevalence, Parkinson's syndromes are exemplary geriatric syndromes. In addition to idiopathic Parkinson's disease, drug-induced and vascular Parkinson's syndromes are especially relevant in older age. A comprehensive anamnesis, thorough clinical neurological examination and rational additional diagnostics ensure the correct differential diagnostic classification. The multidimensional geriatric assessment is used to quantify the syndrome-specific ability impairments. The primary therapeutic objective in old age is the preservation of everyday competences. Drug treatment is centered around L­dopa because of its favorable effect-side effect ratio. In cases of motor fluctuations, entacapone, opicapone or safinamide can be added, whereas dopamine agonists are generally unsuitable. Rivastigmine is indicated in mild to moderate Parkinson's dementia and furthermore can possibly improve gait stability. Speech therapy, as well as physical and occupational therapy, including the Parkinson's disease-specific Lee Silverman voice treatment are indispensable components of the multiprofessional treatment concept.

[Gait disorders in the elderly]. / Gangstörungen im Alter.

Gait disorders are one of the most common gerontoneurological symptoms. Falls that occasionally cause severe injuries are highly relevant consequences. A clinical neurological examination and inspectoral gait analysis are the core investigations of the diagnostic process, which yields hypotheses with respect to the impaired structures as well as to specific diagnostic measures. The supplemental motor assessment quantifies the resulting impairment of mobility and risk of falling with the help of well-established instruments. Characteristic of gait disorders in the elderly are the multifactorial causes which make the complete identification, correct prioritization and adequate treatment the biggest challenges. The therapeutic concept is multiprofessional and includes the causal treatment of underlying diseases, physiotherapeutic training programs, prescription of medical aids and nutritional interventions. Identification and modification of risk factors (including those that are iatrogenic) are of superior importance.