Neurology

Herpes zoster (HZ) affects millions of older adults annually worldwide and lowers quality of life in a substantial number of older individuals via acute and chronic pain or postherpetic neuralgia (PHN). Herpes zoster is caused by the reactivation of varicella-zoster virus (VZV) in sensory ganglia and is spread in afferent peripheral nerves in the setting of age, disease, and drug-related decline in cellular immunity to VZV. This article reviews treatment strategies and recent research for the prevention and treatment of HZ and PHN. Pharmacotherapeutic strategies to reduce HZ pain include an...

When examining the musculoskeletal system, neurological aspects must be considered. Strength testing, as discussed in Part I of this article (Clinical Geriatrics 2005;13[11]: 16-24), helps to assess whether a pattern of muscular weakness is due to a spinal nerve problem, or other musculoskeletal diseases. Examining the reflexes and the sensory system helps to differentiate neuronal damage from musculoskeletal pathology. Weakness associated with reflexive changes and discrepancies within the sensory system may indicate the nervous system as the culprit that is causing disease. Furthermore, e...

The patient’s chief complaint directs the musculoskeletal exam. Identical complaints often have different etiologies and require the exam to progress in different directions. Weakness, balance, changes in the appearance and functional ability of the muscles, and sensation are common complaints that may be primarily muscular or neurological in origin. Deciding which direction to pursue in terms of an evaluation depends first on a thorough exam and a logical approach.

Abnormal postures and bodily asymmetries can be muscular or neurological in origin. Muscle weakness of the hand can ...

An estimated 22% of adults 65 years of age or older have Alzheimer’s disease (AD).1 Because the incidence of AD doubles every 5 years after age 65, its prevalence is expected to increase as the United States population ages.2 The impact of this neurodegenerative disease encompasses a range of symptoms affecting cognition, function, and behavior.

Like many other diseases, there is a spectrum of continuum for AD, and there are different features at each stage. Artificially, the spectrum has been divided into mild, moderate, and severe stages. In the mild stage (Mini-Mental State Exa...

An estimated 22% of adults 65 years of age or older have Alzheimer’s disease (AD).1 Because the incidence of AD doubles every 5 years after age 65, its prevalence is expected to increase as the United States population ages.2 The impact of this neurodegenerative disease encompasses a range of symptoms affecting cognition, function, and behavior.

Like many other diseases, there is a spectrum of continuum for AD, and there are different features at each stage. Artificially, the spectrum has been divided into mild, moderate, and severe stages. In the mild stage (Mini-Mental State Exa...

In most cases, home care takes place with little direct contact between the supervising physician and the rest of the home care team. In this article, I hope to demystify the process, review key features of Medicare reimbursement for home health agencies and how it may affect physicians, and outline some strategies for using home care to improve outcomes and reduce hospitalization. Home is where most of us prefer to be treated, and we should make our best efforts to honor that preference.1

THE PROCESS OF MEDICARE HOME HEALTH AGENCY CARE

When the physician refers a homebound M...

Methicillin-resistant S. aureus infection is a particularly serious problem in hospitals, where MRSA often exceeds 25% of S. aureus isolates. Because MRSA strains are not susceptible to cephalosporin or semi-synthetic penicillin antibiotics, intravenous vancomycin is usually employed when MRSA infections occur. For reasons of cost, toxicity, and to avoid driving the emergence of vancomycin-resistant Enterococcus (VRE) or the more fearsome vancomycin-resistant S. aureus (VRSA), vancomycin is not routinely ordered at the outset of most infections. Rather, empiric antibiotics are selected that...