In the 21st century we mock the adventurers such as Ponce de Leon who sought the ever-elusive Fountain of Youth. However, one can make a compelling argument that in 2005 we are still chasing the holy grail of eternal youth, only now we are using advanced technology rather than sailing to faraway lands. Cosmetic surgery and enhancements are now in the mainstream of modern life. Rates of utilization of cosmetic procedures are rising rapidly among men, and gender equality in this sphere is likely to be achieved. Still, no matter how attractively any gift is wrapped, ultimately we cherish (or despise) the gift for what is inside the wrapping. In that respect, the state of our arteries is a better indication of our biological age than is the state of our skin. Survey after survey has revealed that stroke and dementia are what older adults fear the most. As I have mentioned in previous issues, our current strategy for preventing dementia is stroke prevention, so both of these concerns of older adults can be translated into concern about cerebral circulation. Fittingly, the focus of this month’s journal is on cerebrovascular disease.
The two most significant risk factors for stroke in the older population are atrial fibrillation and hypertension. The article, “Hypertension Management and Early Morning Risk in Older Patients” by Dr. Yves Lacourcière looks at an evolving area of hypertension research: namely, the importance of diurnal variation. Dr. Vadim Beletsky reviews the topic of “Cervical Arterial Dissection.” New imaging techniques have revealed that dissections occur more frequently than we once thought. Drs. Andreas Kastrup and Klaus Gröschel review the “Treatment of Symptomatic and Asymptomatic Internal Carotid Artery Stenosis in Older Adults,” while Dr. Ashfaq Shuaib writes a complementary article on “Antithrombotic Therapy and the Prevention of Stroke in Older Adults.” The critical question of how aggressive stroke management should be in older adults is addressed by Drs. J.E. Simon and M.D. Hill in their article, “Can Older Patients with Acute Ischemic Stroke Be Treated Safely with Thrombolysis?”
Our dementia column in this edition is by Drs. Linda Boise and C. Connell and is entitled, “Diagnosing Dementia--What to Tell the Patient and Family.” On the respiratory front, Dr. D’Arcy Little provides an article on “Allergies in the Aging” while the Drugs and Aging column by Drs. Eric M. Morrow and William E. Falk is on the topic of “Diagnosis and Pharmacotherapy of Anxiety in Older Patients.” Our eye disease column, by Dr. Sohel Somani, reviews the “Latest Treatment Options in Age-Related Macular Degeneration.” Dr. Mark Clarfield discusses inherent problems in complex medication regimes in “Possible Polypharmacy Perils Await Older Adults.” Finally, our Technology in Medicine column discusses “Virtual Support Groups for Family Caregivers of Persons with Dementia” and is contributed by Dr. Elsa Marziali.
Enjoy this issue,
Barry Goldlist
