Dementia and Amnestic Conditions​

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, is a sporadic or inherited neurodegenerative disease of upper motor neurons (UMNs) and lower motor neurons (LMNs). Amyotrophic lateral sclerosis is the most common progressive motor neuron disease in North America, primarily affecting men and individuals of Caucasian ethnicity. This disease is characterized by the coexistence of UMN and LMN signs and symptoms. The diagnosis is made clinically. Management is supportive and symptomatic, progressing to end-of-life care.

Geriatric care includes the prevention and diagnosis of diseases, as well as the management of diseases, disabilities, and other health concerns in individuals ≥ 65 years of age. Special consideration is given when addressing multiple aspects that are specific to ageing. Preventive measures such as vaccinations as well as cancer and disease screening are essential in this age group because of the high risk for infections and developing cancer and chronic diseases. A majority of older individuals have at least 1 chronic medical condition, which increases the likelihood of polypharmacy and adverse drug reactions. Vision, hearing, cognitive function, gait, and balance are among the functions that decline in the geriatric population. These disease- and age-related factors affect the activities of daily living. As such, fall risk should be assessed in all vulnerable individuals. Assessing the financial and social resources of older adults  is also important, given the direct impact of these factors on their health. A multidisciplinary approach involving various professionals in the healthcare field is important in achieving comprehensive care for older adults.

A number of changes normally occur in the aging individual. These changes affect neurocognitive function, organ function, senses, metabolism, sexual function, and sleep patterns. Of particular importance in aging adults, physicians need to understand the difference between normal cognitive decline associated with aging and pathologic decline. History, physical examination, imaging, laboratory studies, and neuropsychological testing may help determine possible causes of pathologic decline. Many conditions that cause pathologic cognitive decline have no cure, but symptoms may be managed with medications and a strong support system.

Major neurocognitive disorders (NCDs), also known as dementia, are a group of diseases characterized by decline in a person’s memory and executive function. These disorders are progressive and persistent diseases that are the leading cause of disability among elderly people worldwide. There are several distinct etiologies for major NCDs. While there are known risk factors and measures to prevent major NCDs, there are no effective curative treatments.

As the most common cause of dementia, Alzheimer disease affects not only many individuals but also their families. Alzheimer disease is a progressive neurodegenerative disease that causes brain atrophy and presents with a decline in memory, cognition, and social skills. Several genetic defects and risk factors have been described, although there is no clear cause in the majority of cases. The main pathologic features are neuritic plaques, extracellular deposits of amyloid peptides, and neurofibrillary tangles. The clinical features are memory impairment, loss of executive function and judgment, impaired cognitive function, and behavioral changes. Diagnosis is based on clinical examination, neuropsychiatric testing, and imaging. There is no curative therapy, but symptomatic management with medications may slow progression; these include cholinesterase inhibitors, the N-methyl-D-aspartate (NMDA) receptor antagonist memantine, and a recently approved anti-amyloid monoclonal antibody.

Acute shoulder injuries are a common reason for visits to primary care physicians and EDs. Common acute shoulder injuries include acromioclavicular joint injuries, clavicle fractures, glenohumeral dislocations, proximal humerus fractures, and rotator cuff tears. Evaluation of acute shoulder pain requires an understanding of the mechanism of injury, as well as the appropriate physical examination and radiologic studies needed in the acute setting. A focused history and physical examination is essential and should include inspection, palpation, and a thorough neurovascular exam. Imaging begins with plain radiographs and is occasionally supplemented by MRI or CT imaging. Management includes pain control and varies based on diagnosis.

Normal pressure hydrocephalus (NPH) is a neurodegenerative disorder characterized by the triad of gait abnormalities, dementia, and urinary urgency or incontinence. Normal pressure hydrocephalus can be either idiopathic or secondary to intraventricular or subarachnoid hemorrhage. Symptoms may be similar to those of Alzheimer and Parkinson's diseases. Diagnosis of NPH is clinical, in addition to lumbar puncture testing and neuroimaging. Management is with surgical shunt placement to drain excess CSF from the cerebral ventricles.

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, is a sporadic or inherited neurodegenerative disease of upper motor neurons (UMNs) and lower motor neurons (LMNs). Amyotrophic lateral sclerosis is the most common progressive motor neuron disease in North America, primarily affecting men and individuals of Caucasian ethnicity. This disease is characterized by the coexistence of UMN and LMN signs and symptoms. The diagnosis is made clinically. Management is supportive and symptomatic, progressing to end-of-life care.