GERIATRIC DISEASES
1 . DEMENTIA
Dementia is defined as a decline in cognitive, intellectual
and memory function due to disease process affecting the Cerebra Nervous
System. It is detected by using criteria of DSM IV.
Causes of Dementia
Dementia can be caused by a variety of diseases mentioned
below –
1.Vascular – This includes diffuse small vessel disease
(commonest), amyloidal antipathy
multiple emboli & cerebral vacuities.
2. Neoplastic – This includes some primary cerebral tumor ,
& secondary deposits
3. Inflammatory – This includes diseases like sarcoidosis
& multiple sclerosis & multiple sclerosis
4. Traumatic – This includes chronic subdural haematoma.
post head injury ( commonest) & punch drunk syndrome.
5. Hydrocephalous, toxic & infective cause
Symptoms of dementia
1.Disturbances in personality or memory dysfunctiuon
2. Forgetfulness- usually has a slow onset
3. Loss of interest in surroundings
4. Impairment in social skills and personality
5. Depression – usually in early stages
6. Disorientation in time & space which is followed by
language impairment, aphasia, apraxia fits & paralysis.
Investigations
In order to find out the exact cause of the disease imaging
of the brain is important and so either CT Scan / MRI of head is done. other
investigations include-
. Blood test – This includes full blood count, ESR , urea
electrolytes, glucose, calcium, liver function test, thyroid function test,
Vit B 12, VDRL test , ANA & anti- ds
DNA.
.Chest X-Ray
. EEG
. And in some selected patients following tests are also
done –Lumbar puncture, HIV Serology & brain biopsy can be performed.
2. URINARY INCONTINENCE
It is defined as the involuntary passage of urine through
urethral orifice. It is common in females.
Urinary incontinence may occur with a normal urinary tract
for example with poor cognition or poor mobility or during hospitalization or
acute illness in older people.
Some of the urodynamic abnormalities found in patients with
urinary incontinence are mentioned below-
1. Stress incontinence- in this condition as such the
patient remains normal but during the act of coughing, sneezing urine leaks as
there is passive increase in the vesical pressure & which is more than the
urethral pressure. This is most commonly found in females after childbirth and
rarely in males.
2. Urge incontinence- Sometimes during filling the detrusor
muscle contracts which leads to increased vesical pressure and if this vesical
pressure is greater than the urethral pressure, leaking occurs . The incidence
of the condition increases with age.
3. Overflow incontinence – In this case the bladder is full
and there is no contraction of detrusor muscle but a minimum quantity of
abdomen & vesical pressure result in urine leakage.
4. Prostatic obstruction – In this condition the storage
phase is normal but there is a problem in voiding phase. During the act of
voiding of urine detrusor muscle contracts which results in increased vesical
pressure but besides this increased vesical pressure there is a poor/ wavy flow
of urine because of obstruction in the prostatic urethra also.
Cause of Urinary
Incontinence
Causes of urinary incontinence van be classified as follows-
1. Established – This includes various diseases such as
cerebral or spinal cord lesion , stroke, dementia, bladder diseases,
parkinsonism & myelopathy.
2. Transient – This included the following diseases dementia
, UTI, atrophic senile vaginitis, pharmaceutical or drug induced, incrased
urine output, restricted mobility, stool impaction.
Investigations
Urinary incontinence is evaluated by taking history and
conducting physical examination including neurological, rectal &
gynaecological examination.
Some of the specific tests are mentioned below-
. Cystoscopy
. Urodynamic studies
.Cystometry
.Sphincter electromyography
Prostate enlargement occur from the periurethral
(transitional) zone & involves both glandular and stromal tissue. Prostate
increases in volume by 2.4 cm3 / yr on an average after 40 yrs.
SYMPTOMS
Symptoms associated with BHP are seen after 60 yrs &
over 80 yrs of age, men face symptoms as mentioned below-
. Due to prostate obstructing urethra- Hesitancy, poor
prolonged flow & sensation of incomplete emptying.
. In cases of chronic urinary retention , bladder slowly
distends due to inadequate emptying over a long period of time. The following
symptoms include- hydroureter, hydronephrosis and renal failure.
Investigations
Symptoms relating to the disease can help in assessing the
urinary problems & following investigations can be done-
1. Flow meter can help in measuring the flow rate
2. Prostate volume can be measured- Rectal examination or
TRUS (transrectal ultrasound scan)
3.Objective assessment of obstruction is done by
urodynamics.
4. OSTEOPOROSIS
Osteoporosis is defined as a group of bone disorders in which
the absolute bone mass is less than normal & which result into decrease in
micro – architecture leading to increased bone fragility & risk. The
mineral- matrix ratio is reduced. It usually remains silent or asymptomatic
until a fracture occurs. In India around 35% post-menopausal women are at risk
of developing osteoporosis.
Types Of Osteoporosis
Primary osteoporosis this can be classified into the
following
. Post-menopausal (type-I),senile ( type-II)
.Idiopathic which is further divided into juvenile & in
adults (premenopausal)
Secondary Osteoporosis- This can be classified into-
Genetic – This basically includes heritable disorders of
connective tissue & includes ontogenesis imperfect, marfan’s syndrome, otomocystinuria.
Nutritional
. Calcium deficiency
. Protein deficiency
. Scurvy
. Malabsorption , malnutrition
Endocrine
. Hypogonadism
. Cushing’s syndrome
. Thyrotoxicosis
.Hyerparathyroidism
.Acromegaly
. Diabetes mellitus
Iatrogenic
. Steroids
. Heparin
. Anti-convulsant
Regional osteoporosis
. Immobilization
. Post- traumatic
. Transient
. Migratory
As the eole grow both the sexes tend to lose on the bone
mass but the bone mass loss is accelerated in females during their menopausal
time and this is known as age-related osteoporosis or involutional
osteoporosis. This can be divided into following types-
Type I (postmenopausal) –This occurs in the age group of
51-70 yrs with a female: male as 5:2
Mainly there is an accelerated bone loss from the trabecular
region & vertebrae (crush) & distal radius are the fractured sites are.
There is a decrease in calcium absorption , parathyroid function & renal
conversion of 25 (OH) D to 1,25 (OH)2D. The main cause of this type of
osteoporosis arew the factors related to
menopause.
Symptoms Of Osteoporosis
Mostly the patients remain asymptomatic until they develop a
complicating fracture which can be caused by slightest trauma. Most common
sites for fracture are hip, humerus, ribs & wrists.
Symptoms include- PPain in the back , deformity of the spine
(Kyphosis) & loss of height, pain usually results from collapse of the
vertebral bodies, especially in lower dorsal and upper lumbar region.
Diagnosis
In earlier days the diagnosis was made after the manifestation
of fracture in old age. But now the diagnosis can be made easily by-
Bone densitometry which includes
. Dual energy X-Ray
absorptiometry
. Quantitative
computed tomography
. Quantitative ultrasound
. Radiographic absorptiometry
.Single energy X-Ray absorptiometry
Interpretation of result is done in terms of T- score or
Z-score. T-score represent bone mass of patient compared to mean peak bone mass
& Z-sore compares the patient bone mineral density (BMD) with the mean BMD
of the person of same age.
According to the WHO osteoporosis is diagnosed using T-score
as-
1. BMD within 1.0 SD –Normal
2. BMD between 1.0 SD or more – Osteopaenia
3. BMD below 2.5 SD or more – Osteoporosis
4. BMD beyond 2.5 SD with one or more fragility fracture-
severe osteoporosis.
X-RAY is useful when 30-50% bone mass is lost. The
radiological changes are more market in bones of the axial skeleton &
consist of loss of bone density, decrease in number & size of the
trabeculae and thinning of the cortex.
Risk factors
1. Age- Mostly found at the age group of 50 yrs or more
2. Sex- Most commonly found in females
3. Race-Mostly found in caucasian or oriental ethnic origin
4. Menopause
5. Diet-Excess of
caffeine, alcohol and reduced calcium,
protein & phosphate can cause osteoporosis.
6. Sedentary life style
7. Multiparity
8. Medications such as – steroids, anti-epileptics,
anti-coagulants
9. Cigarette smoking
PREVENTION
Osteoporosis can be prevented or early treatment can be
opted in order to prevent the disease by using following measures-
. Calcium intake 1.0-1.5 g/ day
. Moderate phosphorous intake
. Moderate Vit. D intake
. Appropriate exercise programmed
Avoidance of alcohol & cigarette
.Periodic assessment of skeletal status
OTHER TYPES OF OSTEOPOROSIS
Idiopathic osteoporosis
This is found in children, younger men or premenopausal
women. Juvenile osteoporosis, rare condition is found in age group between 8-14
yrs. Onset is usually abrupt with appearance of bone pains and fracture after
minimal trauma .Investigation reveal malabsorption of calcium and/or increased
urinary calcium loss.
Steroid induced osteoporosis
Sometimes osteoporosis is seen with some other disease such
as Cushing’s syndrome etc. Glucocorticoid excess can result in increased rate
of bone desorption and decreased rate of bone formation.
5. MENOPAUSE
Menopause occurs in both males (Andropause) & females
(Menopause)
Andropause
Andropause occurs in males due to decline of androgenic
hormone with ageing It is not universal and but is a gradual rocess which is not
associated with any other complaint as in females. There is a decrease in
testosterone and serum inhibin with an increase in sex hormone binding globulin
(SHBG).Some of symptoms which usually seen are fatigue, depression, loss if
energy and increased risk of cardiovascular problems and osteoporosis.
Menopause
Menopause is defined as the tie of cassation of ovarian
function resulting in permanent amenorrhea. Menopause usually occurs between
the age group of 45 and50 yrs.
Menopause after the age of 50 indicates the good health and
nutrition of the female but late menopause is also found in females with
uterine fibroids and who have a risk of endometrial cancer. If the menopause
occurs before the age of 40 then it is known as premature menopause.
Risk factors for menopause
There are certain factors which can become risk factors for
menopause related diseases are mentioned below-
. Early menopause
. Surgical menopause or radiation
. Chemotherapy especially alkalytic agents
.Smoking , caffeine , alcohol
.Family history of menopausal diseases
Drugs related like heparin , corticosteroids and clomiphene
etc. If given for a prolonged period then can lead to estragon deficiency.
Symptoms of menopause
Menstrual flow can cases in the following three ways-
. Sudden cassation
. Gradual diminution in the amount of blood loss with each
regular period until menstruation stops
.Gradual increase in the spacing of the periods until they
cease for at least a period of one year.
symptoms relating to the menopause are mentioned below-
. Hot flushes – They are the waves of vasodilatation which
effect the face and neck for 2-5 minutes and occur at several times in a day .
Hot flushes lead to sweating . These flushes are also preceded by headaches.
. Palpitation
. Mild depression due to disturbed sleep
. Irritability
.Lack of concentration
Various other symptoms include-
. Neurological – Vasomotor symptoms , par aesthesia which
causes a sensation of pins and needles in various parts.
. Urinary symptoms – Urethral carbuncle dysuria with or
without infection, urge and stress incontinence like symptoms are seen because
of the estrogen deficiency.
Various sort of urinary symptoms are clubbed together and
are known as urethral syndrome.
. Genital- Atrophic vagina reduces the vaginal secretion
which leads to dryness of vagina and cause dyspareunia.
Menopausal women because of the estrogen deficiency can also
develop various disease as mentioned below-
.Arthritis, osteoporosis and fracture
. Cardio vascular accidents such as ischemic heart disease,
myocardial infarction and atherosclerosis
.Stroke
.Skin changes – There is a decrease in collagen content
which leads to wrinkling of the skin
. Alzheimer disease
. Ano- colonic cancer
.Tooth decay
Investigations
Investigations which can be done in order to find out the
cause of the symptoms are mentioned as-
.History of various symptoms
.General examination which includes blood ppressure
recording, palpation of the breast, weight, hirsuitism.
.Pelvic examination
.Blood sugar , lipid profile
.Mammograhy, pelvic ultrasound
.Bone density study
. Estrogen level , FSH to decide on the need of hormone
replacement therapy.
HOMEOPATHY MEDICINES IN CASES OF GERIATRIC DISEASES
LIQUID DILUTIONS
|
INDICATIONS
|
ALTHEAS CYNAPIUM
|
Sudden redness in the face with a wild look, especially and during
menopause.
|
ALUMINA
|
Prostatic discharge. Flowing of prostate fluid during difficult
stools. There is fullness and enlargement of the prostate gland & various
disturbances of the prostate, with sensation of fullness in the perineum.
|
AMYLENUM NITROSUM
|
For nervous , sensitive , plethoric women, during or after the menopause.
|
ANACARDIUM ORIENTALE
|
Senile dementia. Dementia of old people, with rapid loss of memory
& mental vigor; mental fatigue & brain-fag from overexertion;
syphilitic mental debility.
|
APIS MELLIFICA
|
Incontinence of urine, with
great irritation of the parts; can scarcely retain the urine a moment, &
when passed scalds severely; frequent, painful, scanty, bloody.
|
ARNICA MONTANA
|
Retention or incontinence of urine after labor(op.)
|
ARSENICUM ALBUM
|
Incontinence of urine , which escapes almost involuntarily, even at
night, in bed .
|
AURUM MURIATICUM
|
Hemorrhaging at menopause. Female- BLEEDING, uterus, metrorrhagia-
menopausal period, during. Diseases- PROSTATE, benign enlargement
|
BENZOICUM ACIDUM
|
Enuresis nocturna of delicate children; dribbling urine of old men
with enlarged prostate; strong characteristic odor; excesses of uric acid.
|
CALCAREA ARSENICOSA
|
Complaints of fleshy women when approaching the menopause.
|
CALCAREA CARBONICA
|
Curvature of bones, especially spine and long bones; extremities
crooked , deformed; bones irregularly developed.
|
CALCAREA PHOSPHORICA
|
Spine weak, disposed to curvatures , especially to the left; unable
to support body ; neck weak, unable to support head
|
CIMICIFUGA RACEMOSA
|
Uneasy, restless feeling in limbs.
|
CAPSICUM ANNUUM
|
Uterine hemorrhage near the menopause, with nausea. PROSTATE GLAND-
COMPLAINTS of prostate
|
CONIUM MACULATUM
|
Great difficulty in voiding urine; flow intermits, then flow again;
prostatic or uterine affections. Discharge of prostatic fluid . It is a well
indicated medicine for urinary complaints arising from enlarged prostate and
uterine affections.
|
CROTALUS HORRIDUS
|
Menopause; intense flushing & drenching perspiration ; faintness
& sinking at stomach; prolonged metrorrhagia dark, fluid, offensive;
profound anemia.
·
Flushing and sinking of menopause.
|
DULCAMARA
|
Urine, difficulty in passing;
incontinence of.
|
HELONIAS DIOICA
|
Debility attending the menopause.
|
HYOSCYAMUS NIGER
|
Paralysis of bladder: after labor, with retention or incontinence of
urine; no desire to urinate in lying- in women (Arn., op.)
|
KRESOTUM
|
Incontinence of urine; can only urinate when lying; copious , pale;
urging, cannot get out of bed quick enough (Apis, Petros.); during first
sleep (sep)
|
LACHESIS MUTUS
|
Climacteric ailments: hemorrhoids, hemorrhages; hot flushes and hot
perspiration ; burning vertex headache , especially at or after the menopause
|
LYCOPODIUM
|
|
PULSATILLA
|
Frequently called for in acute symptoms of the bladder and urethra,
with enlarged prostate, the faces are flattened. Menopausal and post- natal
hormonal changes can also upset pulsatilla’s delicate emotional balance. She
is listed in Kent’s repertory under the rubrics ‘Insanity-puerperal’
,and ‘Insanity- puerperal’ , but I am
sure that emotional liability at these times is far more common than insanity
in pulsatilla women . Affections of the bladder and prostate gland
|
SECALE CORNUTUM
|
Enuresis: of old people ; urine pale , watery, or bloody; urine
suppressed.
|
SEPIA OFFICINALIS
|
Hot flashes at menopause with weakness and perspiration.
|
SILICA TERRA
|
Sciatica , pains through hips , legs and feet.
|
Bibliography
1. API Textbook of medicine , 9th edition, Yash
Pal Munjal.
2. A Concise textbook of surgery, S. Das
3. Davidson’s, principles- practice of medicine, 21st
edition, Nicki Ra .Colladge, Brian R Walker, Stuart H. Ralston.
4. Shaw’s textbook of Gynecology
Compiled
by:
Dr. Nidhi
Navin Sharma for Homeobuzz 
