Jiska Cohen-Mansfield, PhD, ABPP, Department of Health Promotion, School of Public Health and Herczeg Center on Aging, Tel-Aviv University, Tel-Aviv, Israel, and Department of Health Care Sciences and of Prevention and Community Health, George Washington University Medical Center, Washington, DC, USA.

Approximately 20% of older people with dementia manifest visual or auditory hallucinations. In order to effectively diagnose and treat these individuals, the etiology of hallucinations must be addressed; however, there has been very limited research in this area. There is an association between vision loss and hallucinations, and analyses of case studies suggest other potential etiologies. Accordingly, hallucinations can occur when the person with dementia either misinterprets reality, experiences sensory deprivation, is exposed to inappropriate sensory stimulation, has delirium/medical problems, or when his/her behaviour is misinterpreted due to cultural differences with caregivers. Understanding the etiology of hallucinations will assist in developing an appropriate nonpharmacological treatment, which may improve quality of life.
Key words: hallucinations, dementia, etiology, nonpharmacological, treatment.

Muzumel A. Chaudhary, MD, Psychiatry Resident, University of British Columbia, Vancouver, BC.
Kiran Rabheru, MD, CCFP, FRCP, ABPN, Clinical Associate Professor, Department of Psychiatry, University of British Columbia; Geriatric Psychiatrist, Vancouver General, University of British Columbia, and Riverview Hospitals, Vancouver, BC.

New-onset paranoid symptoms are common among older individuals. They can signify an acute mental status change owing to medical illness, correspond to behavioural and psychological symptoms of dementia, or equate to an underlying affective or primary psychotic mental disorder. The implications of paranoid symptoms are considerable and affect patients, families, and caregivers alike. Accurate identification, diagnosis, and treatment of late-life paranoid symptoms present a unique clinical challenge as issues of morbidity and mortality are inherent both to the illness state and available treatment approaches.
Key words: paranoia, delusions, etiology, older adults, atypical antipsychotic.

Samir Gupta, MD, FRCPC, Division of Respirology, Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, ON.

Robert Hyland, MD, FRCPC, Division of Respirology, Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, ON.

Hemoptysis is an important clinical problem that is especially ominous when seen in older patients. The main causes of hemoptysis in first world nations are bronchogenic carcinoma, bronchitis, and bronchiectasis. In older patients cancer remains the main concern, especially if there is a smoking history. The diagnostic approach to nonmassive hemoptysis starts with a chest x-ray, followed by a CT scan and then fibre optic bronchoscopy, which is well tolerated by older adults. In massive hemoptysis, chest x-ray is usually followed immediately by fibre optic or rigid bronchoscopy. Older patients require closer monitoring due to poor cardiopulmonary reserve; management options include endoscopic interventions, bronchial artery embolization,
surgery, and radiation.

Key words: hemoptysis, etiology, management, older adults, bronchiectasis.

Nariman Malik, BSc

Introduction
Mitral regurgitation is a common valvular heart disease, especially in the elderly.¹ It is defined as a condition in which there is an abnormal flow of blood from the left ventricle to the left atrium across an incompetent mitral valve during ventricular systole.² The mitral valve consists of four main components: the annulus, anterior and posterior leaflets, the chordae tendinae and the papillary muscles. Mitral regurgitation has a number of underlying etiologies that can be broadly classed into two groups: mitral regurgitation due to organic disease (e.g. rheumatic disease or infective endocarditis) or mitral regurgitation due to functional causes (regurgitation results from myocardial dysfunction as opposed to valvular problems). In developed countries, the etiologic profile of mitral regurgitation has changed over recent years due to the decreased incidence of rheumatic heart disease.³ Mitral regurgitation is most frequently due to degenerative and ischemic causes in the western world.⁴ See table 1