Michael J. Borrie, BSc, MB, ChB, FRCPC
Chair, Division of Geriatric Medicine, The University of Western Ontario

Prevalence studies of urinary incontinence in the elderly report widely-varying rates from 4.5-44% in healthy, elderly women to 4.6-24% in healthy, elderly men. The prevalence in institutionalized people ranges from 22-90%.¹

Choice of definition, wording of the questionnaire and study population contribute to this variability. The International Continence Society has defined incontinence as a condition in which involuntary loss of urine is a social or hygienic problem and is objectively demonstrated.² Based on the symptom complex, urinary incontinence is characterized as urge, stress, mixed, overflow, functional, or iatrogenic.

Urgency urinary incontinence is the most common type and is divided into sensory or motor urgency. Ambulatory or longer-term urodynamic studies have demonstrated involuntary detrusor contractions and calls into question the notion of sensory urgency. A new classification of overactive bladders has been proposed but has not yet been resolved.³ Detrusor instability is commonly associated with neurologic conditions such as stroke or Parkinson's Disease. It can also accompany prostatic obstruction.

Chris Daniels

Canada's only national brain bank is "functioning at 50 per cent capacity right now", says the medical director of the bank.

Because of the recession and provincial cuts to research agencies, the bank went from collecting 120 brains a year to 60, director Dr. John Wherrett said of Canada's largest provider of brain tissues.

For fifteen years, the brain bank at the Toronto General Hospital, Western Division, has provided researchers brain tissue for studying neurodegenerative diseases like Alzheimer's Disease (AD) and Parkinson's Disease.

But for the last few years, the bank has been experiencing growing pains. Its main sources of income, the Medical Research Council, voluntary agencies, and the Ontario Mental Health board, had to reduce their commitment because of difficulty raising funds. This lack of funding has left the bank with fewer tissues for researchers and, without diseased tissues as well as controls for the studies, research has been moving more slowly, said Dr. Wherrett.

"We've had to pick and choose what we do," he said. "There has been a slow down in research in recent years because of massive cutbacks on top of the recession."

It's a trend he thinks will soon change.

Agustinus S. Suhardja, MD

Introduction

Dementia is reported to affect 3-11% of the population over 65 years of age, with a greater propensity among institutionalized residents.¹

Due to the increasing number of dementing illnesses in the elderly population, the prevalence of dementia can be expected to continue to rise. The evaluation and care of patients with dementia could ultimately become a major component of the health care delivery system.

Dementia by definition, is the loss of intellectual abilities previously attained. Even though memory loss is the cardinal feature, the diagnosis of dementia according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), requires at least one more intellectual deficit (language, perception, visuospatial function, calculation, judgment, abstraction, and problem solving skills) which leads to impairment in day to day functioning.

Within the last two decades, some authors have proposed that as many as 10% of dementias are potentially treatable.² It is more likely that treatable dementias occur in less than 5% of cases.

Robin Dwarka, BSc, BAA

The incidence of depression among the elderly has been widely documented in recent studies. Approximately 2% of the population over 65 years of age who remain in the community have major depression, while up to 15% show significant depressive symptoms. In institutional settings, the figures jump to over 10% having major depression, and symptoms.

With the proportion of Canadians over 65 growing rapidly, recognition and treatment of depression in senior citizens is of growing concern.

Recognizing depression in the elderly poses a unique problem because of its symptomatic links to Alzheimer's Disease (AD), according to geriatric psychiatrist Dr. Richard Shulman of Sunnybrook Health Science Centre in Toronto.

Kim Wilson, BSc, MSc

Cataract patients may now choose to have a multifocal implantable lens which corrects for distance, intermediate and near vision. During surgery, the patient's cataract or cloudy crystalline lens is removed and replaced by the foldable multifocal lens which then unfolds once positioned in the eye.

"This lens is significant to the elderly", said Dr. Allan Slomovic, Clinical Director of the Cornea and External Ocular Diseases at the Toronto Hospital (Western Division), and the Program Director in the Department of Ophthalmology at the University of Toronto. Dr. Slomovic is one of eleven ophthalmologists originally performing this surgery in Canada, and he says "this foldable lens allows for a very small incision of about 3.2 mm, which allows the eye to heal faster and the patient recovers their vision quickly."

Other foldable lenses are available, but the multifocal lens has the added advantage of correcting for distance, intermediate and near vision. The multifocal lens has a series of zones with different refractive powers, allowing the patient to see a range of distances. Each zone has different refractive powers, with zones one, three and five allowing the eyes to focus on objects at a distance, while zones two and four allow focusing of near objects.

The multifocal lens was developed by Allergan Inc. in California.

Rhonda Witte, BSc

The process of aging is familiar to every individual. Yet, despite this familiarity, it remains one of the greatest biological mysteries. We embark on the aging journey from the very moment we are born and proceed passively until our deaths. It is a concept that some find difficult to comprehend, perhaps because it is seemingly inevitable--beyond one's control.

A multitude of theories has been proposed regarding the aging process. The question "Why do we age?" has sparked interest in many research disciplines. Of particular interest are the neurological aspects of aging. Numerous examinations of the aging brain have been performed, particularly those concerning the neurodegenerative diseases of the elderly. Interestingly, studies using animal models have suggested that estrogen replacement therapy may have a role in both the treatment and prevention of dementia by assisting the regeneration and preservation of neuronal structures.¹ Close attention has also been given to the "normal" aging brain and the events that occur over a lifetime.

Along with the heart and striated muscle, the brain is the oldest part of the mammalian body. The neurons of the brain are postmitotic once differentiated and are unable to renew themselves. Thus, the brain is highly susceptible to any cellular damage that may occur with age.

Shari Al, BSc, MSc

Alzheimer's Disease (AD) is defined as a disorder characterized by the progressive deterioration of mental function. Specific research into the genetics of this disease has recently uncovered several important details as to the pathology and progression of the disorder. These discoveries, in turn, may lead to improved diagnosis and/or treatment of AD, with obvious repercussions for clinicians. In the case of AD genetic heterogeneity and the discovery that variations at any one of several loci cause the same disease, initially made it difficult for researchers to progress. The table below summarizes the results of current genetic research showing which genes are linked to each specific type of AD, and the percentage of patients affected by each type.

Andrea Sotirakopoulos, BSc

Gonadal steroids have wide and complex roles that reach beyond the regulation of gonadotrophin and prolactin secretion and the modulation of sexual behavior.¹ These hormones have several clinical effects on brain function throughout the life span, beginning during gestation and continuing into senescence. Estrogen is a female steroid hormone that is produced in the ovary and circulates in the blood stream. The specific proteins that bind to estrogen are distributed throughout the limbic brain, forebrain, hypothalamus, midbrain and anterior pituitary, and in organs such as the ovary and uterus. The widespread hormonal influence of estrogen on brain function could prove to be an important tool in the fight against Alzheimer's Disease (AD).

AD is characterized by neuropathologic features such as the accumulation of neurofibrillary tangles, neuritic plaques and amyloid deposits within regions of the cerebrum and brainstem² and by the progressive decline of mental function affecting long-term memory and other cognitive domains.³ A close relationship between neurofibrillary tangles and cell death exists within the brains of patients with AD. In the cholinergic basal forebrain and the hippocampus, these tangles are found inside neurons of cell groups that are progressively depopulated.

Lilia Malkin, BSc

According to a study conducted by Dr. Elaine Hyle and associates at the Massachusetts General Hospital and Harvard Medical School in Boston and reported in the March 4, 1998 issue of the Journal of the American Medical Association (JAMA), acetaminophen significantly increases the level of anticoagulation, measured and commonly reported as the international normalized ratio (INR). Other important risk factors for increased anticoagulation identified in the study included decreased food intake, diarrhea, and increased warfarin dosage, as well as a recently initiated course of antibiotics or other medications previously known to augment the response to warfarin. Hylek and associates also identified factors that inversely affected the INR, such as alcohol and increased dietary intake of Vitamin K.

Kim Wilson, BSc, MSc

Regular exercise is associated with cardiovascular, respiratory, neuromuscular and metabolic benefits. It is also an important factor in improving the immune system and preventing diseases, such as osteoporosis and coronary artery disease, while reducing disability. Physical activity also gives an energy boost, lowers cholesterol, enhances mood, and increases general feelings of well being.^1,2,3

Research has shown that regular exercise decreases the mortality rate in middle-aged men and probably in middle-aged women, but whether this occurs in the elderly has not been studied extensively.⁴ Very little research has been done to determine how much exercise an elderly person needs to do to obtain health benefits.

The intensity of exercise required to promote cardiovascular health among older persons has remained controversial.⁵ Some studies suggest strenuous activity reduces coronary disease risk while other studies found that less intense activity reduces the risk of coronary disease.^4,5 Not surprisingly, physicians are confused about how to prescribe an exercise regimen to their older patients.

Research in the area of exercise and health has traditionally focused on younger individuals.