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Expert Opinion: The influence of testosterone on cognitive functions in older men

The influence of testosterone on cognitive functions in older men

Background

Older age comes with cognitive decline, with 40% of adults ³65 years experiencing age-associated memory loss.1 In addition, 20% of men >60 years have physiologically reduced serum testosterone levels.2 Prior observational studies demonstrated an association between low circulating testosterone and impaired cognitive performance.3,4 Two small trials yielded conflicting results, with one showing memory improvement with testosterone supplementation and one reporting negative findings.5,6 Hence, convincing evidence supporting testosterone intervention in this group is lacking. In this article, we discuss the largest trial to date evaluating the cognitive effects of testosterone treatment in older men.

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Editorial: Geriatric Medicine

Geriatric Medicine

The older population is growing rapidly and is already a substantial part of our current patient population. Their part will increase over time and we will see more and more differences in older patients compared to their younger counterparts. Therefore, we devoted this AMSj edition to this particular field of medicine: Geriatric Medicine.

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Solving Statistics: Stepped-wedge randomized controlled trial

Stepped-wedge randomized controlled trial

Background

The performance of activities of daily living (ADL) at home is important for the recovery of older individuals after hip fracture. However, 20-90% of these individuals lose ADL function and never fully recover. Although exercise interventions have been proven to improve physical function, especially elderly do not seem to benefit from these interventions. In this prospective, stepped-wedge randomized controlled trial, care as usual [CaU] is compared to 1) occupational therapy (OT) with coaching based on cognitive behavioural treatment (CBT) [OTc], and 2) OT-CBT with sensor monitoring embedded [OTcsm]. More specifically, during 12 months, six nursing homes will start with providing CaU, then cross over to provide OTc and finally cross over to provide OTcsm. The timing of crossing over is randomized: two nursing homes will cross over for the first time after two months, two after four months and the last two after six months. OTc will always be provided for 4 months, CaU for two, four and siex months respectively, and OTcsm for six, four and two months. The primary outcome measure, perceived daily functioning, is measured 6 months after start of rehabilitation and compared to baseline functioning.1

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Clinical Image: A 69 year-old woman with chest pain and syncope

A 69 year-old woman with chest pain and syncope

[headline_subtitle subtitle=”Can you come up with the proper diagnosis?”]
Presentation

A 69-year-old woman, with a medical history of myocardial infarction and hypertension, visits the doctor with the following symptoms: fatigue, confusion, chest pain and syncope. These symptoms occur a few times a week. Ambulatory ECG monitoring for two weeks was indicated. During her symptoms the ECG shows the following:

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Radiology Image: Osteoporosis screening after a bike fall

Osteoporosis screening after a bike fall

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Patient data
  • Age: 62
  • Gender: Female
  • Ethnicity: Caucasian
  • Medical history: Fallen of her bike, 6 months ago. Suffered a distal radius fracture.
  • Initial presentation: Because of a low energy trauma that caused a fracture, the patient is screened for osteoporosis.
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Interview: dr. N. van der Velde

dr. N. van der Velde

My first job was at the department of clinical geriatrics at Slotervaart hospital. Your first job is always exciting. It is a lot to take in, an exhilarating experience. During my final internship at the clinical geriatrics department, I learned that this was the domain I wanted to pursue. I felt that geriatrics reflected what I thought the essence of being a doctor. In geriatrics, the patient is observed holistically, opposed to addressing a single organ system. We look from the somatic, psychiatric as well as the functional and social perspective.

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Interview: dr. M. Muller

dr. M. Muller

Looking back, I made a detour in my career to become an internist-geriatrician. I have always liked working with elderly. For example, during high school I already had a summer job in an elderly home. Nonetheless my interest in working with the elderly patients came much later. After high school, I initially started studying in the field of Human Movement Sciences. I enjoyed classes in neurology and the musculoskeletal system. I found that I did not only want to know about these subjects but also treat patients, therefore I switched to studying medicine, after my master.

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Subject 101: Cancer incidence in the aging population

Cancer incidence in the aging population

Cancer is the leading cause of death in the Netherlands, with ~48.000 deaths and ~108.000 new diagnoses in 2016.1,2 The incidence of cancer is expected to increase by ~70% in the next 20 years.3 A possible cause for this apparent increase in incidence may be due to improvements in diagnostic modalities and may imply that a proportion of the increasing cancer incidence is due to overdiagnosis, which has been described for breast cancer and thyroid cancer.4,5

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Changing Perspectives: Putting bedrest to rest

Putting bedrest to rest

In the previous century, bedrest was often used as a therapy by itself.1 The ancient Greeks prescribed it, as did clinicians in the late 19th century until the Second World War. Back then, a myocardial infarction required patients to lie down for four weeks.

The logistic challenges of the Second World War changed the paradigm. Hospitals full of wounded soldiers had to make room for the most wounded, thus mobilising patients earlier than usual. Clinicians noted that this improved outcomes. Additionally, studies carried out in preparation for space missions demonstrated muscle loss and functional decline in immobile subjects. Since then, detrimental health effects of immobilisation have been reported for almost any organ in the human body.2-4 Myocardial damage, postural hypotension, atelectasis, higher rate of pulmonary and urinary tract infections, thrombosis, sarcopenia, reflux disease, constipation, diverticulitis and numerous other effects are associated with prolonged bedrest.

This insight has shaped current practice: the use of physiotherapists and enhanced ambulatory care are examples of measures implemented throughout modern medicine. However, while the importance of mobilisation is undeniable, health institutions are still designed primarily around the bed. Further measures, for example altered ward designs, may be introduced to promote patient mobility and further reduce adverse health effects in an increasingly sedentary, obese and aging society.

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Trial and Error: Polypharmacy

Polypharmacy

Geriatric medicine has always fascinated me. I wanted to gain more experience with complex cases of the growing population of the elderly with comorbidities and polypharmacy. Therefore, I decided to pursue my last medical internship at the geriatric medicine department. Evaluating my first patient I realized how easy it is for a (soon to be) doctor to think a patient current medication would not need any alternations.  After all, all drugs are all prescribed for a reason. As you would figure, I was too, naïve. When I discussed the first patient with my supervisor I was confronted with the question: “What is the indication to continue this drug?” To be honest, I had no idea. I knew what the indications were of certain drugs, but I did not look into the indications for which this specific drug was prescribed to this patient. It seemed quite straightforward to me: this patient had pregabalin, marketed under the brand name Lyrica, so she was probably suffering from neuropathic pain.

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