AM Johnson, PhD, Assistant Professor, School of Communication Sciences and Disorders, the University of Western Ontario, London, ON.
SG Adams, PhD, Associate Professor, School of Communication Sciences and Disorders, the University of Western Ontario, London, ON.

In addition to its widely recognized effects on gait, posture, balance, and upper limb coordination, Parkinson’s disease (PD) can have a profound effect on speech and voice, within a cluster of speech characteristics termed hypokinetic dysarthria. Although dopaminergic therapy produces significant benefits in the early stages of PD, speech symptoms may show selective resistance to pharmaceutical therapy in patients with a disease history of more than 10 years. This article discusses the pathophysiology of PD as it relates to speech disorders and considers nonpharmaceutical therapeutic options for hypokinetic dysarthria.
Key words: Parkinson’s disease, speech pathology, dysarthria, treatment.

Steven E. Lo, MD, The Neurological Institute, Columbia University Medical Center, New York, NY, USA.
Steven J. Frucht, MD, The Neurological Institute, Columbia University Medical Center, New York, NY, USA.

Parkinson’s disease (PD) is a neurodegenerative disorder that can significantly impact older patients’ quality of life. Although there are many pharmacologic options to treat PD, the clinician needs to know the indications and potential adverse effects of new medications in the older patient population. Carbidopa/levodopa remains the gold standard for treatment, and new formulations and levodopa-extenders fill specific niches. This article reviews the pros and cons of these medications in older PD patients, and demonstrates therapeutic strategies through case presentations.
Key words: Parkinson’s disease, treatment, levodopa, COMT inhibitor, aging.

Raj C. Shah, MD, Rush Alzheimer’s Disease Center; Department of Family Medicine, Rush University Medical Center, Chicago, IL, USA.
David A. Bennett, MD, Rush Alzheimer’s Disease Center; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.

Mild cognitive impairment (MCI), the presence of cognitive difficulties without having dementia, is viewed as a preclinical state for Alzheimer’s disease (AD) or another dementing illness. With the burden of AD expected to increase, research efforts have focused on interventions to delay the progression of MCI to AD. In this review, we first discuss the current conceptual understanding of MCI. Then, we outline a simplified approach to help clinicians diagnose MCI. Finally, we provide an overview of how to address the clinical needs of individuals with MCI.
Key words: mild cognitive impairment, Alzheimer’s disease, diagnosis, prognosis, treatment.

S. Gogov, MD, Department of Medicine, University Health Network, Toronto, ON.
Shabbir M.H. Alibhai, MD, MSc, FRCPC, Department of Medicine, University Health Network; Departments of Medicine and Health Policy, Management, and Evaluation, University of Toronto, ON.

Prostate cancer remains the most common malignancy in men. Screening remains controversial due to a lack of evidence from randomized trials that it decreases mortality. Treatment decisions are based on assigning patients to one of three risk groups (low, intermediate, or high) based on stage, tumour grade, and prostate-specific antigen level, and considering remaining patient life expectancy (affected by age and comorbidity). Men with low-risk disease can consider expectant management, surgery, or radiotherapy (either external beam or brachytherapy). In intermediate-risk patients, all options except expectant management are associated with excellent long-term survival. In high-risk patients, combining either radiation or surgery with androgen deprivation has emerged as the best option. There is no role for primary androgen deprivation for most patients.
Key words: prostate cancer, screening, treatment, surgery, radiotherapy.

Natasha B. Leighl, MD, FRCPC, Assistant Professor of Medicine, Division of Medical Oncology, Princess Margaret Hospital/University Health Network; Department of Medicine, University of Toronto, Toronto, ON.

Lung cancer is the leading cause of cancer-related mortality in North America and most commonly affects older patients. Patterns of investigation and treatment in older individuals differ, which may compromise outcome. Older patients should be carefully evaluated, using comprehensive geriatric assessment, to assess for function, functional reserve, comorbidities, polypharmacy, and other issues. Fit patients with few or no comorbidities should be offered standard treatments such as surgical resection for early-stage lung cancer with adjuvant chemotherapy, combined modality treatment (chemotherapy and radiation) for locally advanced disease, and systemic chemotherapy with supportive care for metastatic disease. Frail patients should be reviewed to optimize function and comorbid illnesses, and then considered for other treatment alternatives aimed at minimizing toxicity while still trying to maximize the curative or palliative potential of lung cancer therapy depending upon disease stage.
Key words: lung cancer, aging, chemotherapy, surgery, radiation, treatment.

D’Arcy Little, MD, CCFP, Lecturer, Department of Family and Community Medicine, University of Toronto, Toronto, ON.

The few studies that have been done suggest that the prevalence of allergies in the older adult population is underestimated. Geriatric rhinitis is also underdiagnosed and under-treated. Though allergy must be considered in this population, therapy must be appropriately tailored.

Key words: allergy, rhinitis, aging, adult, skin testing, treatment.

Diego H. Delgado, MD, Division of Cardiology and Transplant, Toronto General Hospital, Toronto, ON.

The incidence of heart failure is rising rapidly, and it is currently the most common cardiovascular disease. Approximately 20–40% of patients with heart failure have preserved left ventricular systolic function, and an impairment of ventricular relaxation is considered the primary cause. There is controversy surrounding the definition of diastolic dysfunction and the diagnostic criteria for diastolic heart failure. Moreover, there are few studies on therapy for diastolic heart failure, which makes the management of these patients a real challenge.

Key words: heart failure, treatment, diagnosis, diastolic dysfunction.

Scott RA Walsh, MD, PhD, Division of Dermatology, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto Medical School, Toronto, ON.

Madhuri Reddy, MD, MSc, FRCPC, Divisions of Dermatology and Geriatric Medicine, Department of Medicine, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto Medical School, Toronto, ON.

Psoriasis is a chronic, recurring T-cell- mediated skin disease that causes significant morbidity. The disease is often life-long and thus prevalence is highest in older adults. Severe clinical variants are also more frequent. Complicating psoriasis presentation and treatment in older adults are issues related to polypharmacy, including a higher frequency of drug-induced or drug-exacerbated disease and potential drug interactions. Treatment should be tailored to the individual with his/her respective limitations and reflect disease severity. This review examines suitable treatment protocols, including patient education and topical and systemic medications in older populations coping with psoriasis.

Key words: psoriasis, older adults, complications, treatment, immunologic disease

George P. Chandy, MD, MSc, Department of Medicine, University of Ottawa, Ottawa, ON.
Shawn D. Aaron, MD, MSc, Department of Medicine and the Ottawa Health ResearchInstitute, University of Ottawa, Ottawa, ON.

Chronic Obstructive Pulmonary Disease (COPD) has been increasing in prevalence over the past several decades. The impact of COPD on the health status of Canadians will continue to be a major issue, despite declining rates of smoking, as physiologic manifestations of COPD may only be evident decades after the initiation of smoking. Given the delay between the initiation of smoking and the development of significant disease, COPD is primarily a disease of the older population. While a cure for COPD is not available, a number of medications have been noted to have a significant impact on symptoms, exercise tolerance, and quality of life.

Key words: COPD, treatment, management, older adults.

Mitchell Sabloff, MD, Assistant Professor of Medicine, Ottawa Hospital, Ottawa, ON.

Non-Hodgkin’s lymphoma is on the rise in the older population. Traditional therapies have had limited impact upon this illness because they are compromised by toxicity and, in many cases, patients’ performance status is suboptimal at initial presentation. There has been some progress recently in addressing these issues with novel therapeutic options, permitting the delivery of more effective therapy while still limiting the toxicity.

Key words: non-Hodgkin’s lymphoma, immunotherapy, treatment, aging.