Rita Moretti, MD, Clinica Neurologica, Dipartimento Medicina Clinica e Neurologia, Università degli Studi, Trieste, Italy.
Paola Torre, MD, Clinica Neurologica, Dipartimento Medicina Clinica e Neurologia, Università degli Studi, Trieste, Italy.
Rodolfo M. Antonello, MD, Clinica Neurologica, Dipartimento Medicina Clinica e Neurologia, Università degli Studi, Trieste, Italy.

Cerebrovascular disease is a potential cause of vascular dementia. Vascular dementia is not an univocal entity; it encompasses at least four types of dementia: multi-infarct, subcortical, strategic infarct, and posthemorrhage dementia. Vascular dementia does not contain cognitive problems only. There are also noncognitive behavioural alterations. The major noncognitive behavioural situations are depression, anxiety, agitation, delusions, and insomnia. Disorders such as depression, anxiety, and psychosis not only affect the quality of life of a patient but also that of the caregiver. Behavioural disturbances may also contribute to morbidity and are a major cause of institutionalization since they result in inadequate nutrition and sleep and enhance cognitive disruption. Diagnosing depression in the context of vascular dementia is challenging given the overlap of signs and symptoms between depression and dementia. Both disorders can be characterized by apathy and loss of interest, an impaired ability to think, psychomotor agitation, and psychomotor retardation.
Key words: behaviour, subcortical vascular dementia,, vascular dementia, small-vessel dementia.

Lana S. Rothenburg, BSc(Hons), Neuropsychopharmacology Research Program, Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON.
Nathan Herrmann, MD FRCP(C), Neuropsychopharmacology Research Program; Department of Psychiatry, Sunnybrook Health Sciences Centre; Department of Psychiatry, University of Toronto, Toronto, ON.
Krista L. Lanctôt, PhD, Neuropsychopharmacology Research Program; Department of Psychiatry, Sunnybrook Health Sciences Centre; Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON.

Depression is a common sequela of stroke, occurring in approximately 33% of all patients. Post-stroke depression (PSD) is associated with greater cognitive and functional impairments, excess mortality, and increased health care costs, although symptoms are often mild. Diagnosis of PSD can be made using standard clinical criteria, despite the potential overlap with the somatic and vegetative symptoms of stroke. Post-stroke depression responds to standard antidepressant pharmacotherapies, but use of tricyclic antidepressants may result in increased cardiac adverse events. Given the high prevalence and major negative impact of PSD, active screening of all stroke patients for depression and aggressive treatment is recommended.
Key words: stroke, depression, diagnosis, risk factors, treatment.

Lili Liu, PhD, Associate Professor and Associate Chair, Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB.
Alison Barnfather, MSc, Co-Director, Social Support Research Program, University of Alberta, Edmonton, AB.
Miriam Stewart, PhD, Scientific Director, Institute of Gender and Health, Canadian Institutes of Health Research; Professor, Faculties of Nursing, Medicine and Dentistry, and School of Public Health; Principal Investigator, Social Support Research Program. University of Alberta, Edmonton, AB.

In Canada, older adults are the most likely of all age groups to experience chronic health conditions. Most Canadians living with disabilities or chronic conditions and most older adults are supported by family members or close friends. Caregivers frequently describe the emotional, physical, and financial burdens associated with the caregiver role. Accessible support programs can improve health outcomes for family/friend caregivers of older adults with chronic conditions. Practitioners can use the strategies presented to help caregivers access timely and accessible support resources.
Key words: family caregivers, caregiver support, older adults, home care, chronic conditions.

Susan L. Eldred, RN, BScN, MBA, PhD candidate, University of Ottawa, Ottawa, ON.
Wendy A. Gifford, RN, PhD candidate, University of Ottawa, Ottawa, ON.

HIV/AIDS is rapidly increasing among adults age 50 and older. However, limited research has been conducted to understand the issues associated with HIV/AIDS in advancing age. This paper describes issues related to the transmission and contraction of HIV/AIDS among older adults, their complex clinical picture, and management of antiretroviral therapy, as well as social considerations. Cognizance of polypharmacy and comorbidities common with advanced age as well as the double stigmatization of age and HIV/AIDS is essential. Further research is needed to better understand the interactions between HIV/AIDS and age, and to determine effective, safe treatments and appropriate highly active antiretroviral therapy dosing in older adults.
Key words: HIV, AIDS, sexually transmitted diseases, older adults, highly active antiretroviral therapy.

Elizabeth Hazel, MD, FRCPC, PGY6 Rheumatology, McGill University Health Centre, Montreal, QC.
Michael Starr, MD, FRCPC, Director, Rheumatology Program; Assistant Professor, Department of Medicine, McGill University, Montreal, QC.

Giant cell arteritis (GCA) is the most common form of vasculitis in the older adult population. There are variable clinical presentations of this entity and no perfect diagnostic test, often making the diagnosis challenging. Prompt initiation of corticosteroids may prevent visual loss in affected individuals. Temporal artery biopsy remains the gold standard for diagnosing GCA. Patients require an individualized steroid tapering schedule to minimize side effects. Physicians caring for these patients should be aware of the potential for long-term vascular complications of GCA.
Key words: giant cell arteritis, temporal arteritis, vasculitis, ESR, corticosteroids.

Børge Sivertsen, PhD, Department of Clinical Psychology, University of Bergen, Bergen, Norway.

Chronic primary insomnia is a sleep disorder with no known secondary etiology, and the prevalence increases with advancing age. Insomnia is associated with a range of adverse consequences, both on an individual and societal level. While pharmacotherapy is still the most common form of treatment of late-life insomnia, it is associated with a number of side effects, and recent evidence shows cognitive-behavioural therapy (CBT) to be more effective in managing chronic primary insomnia. This article will discuss the development, consequences, assessment and treatment of chronic primary insomnia among older adults.
Key words: sleep initiation and maintenance disorders, aged, morbidity, treatment, insomnia.

Kerstin Stieber Roger, PhD, Assistant Professor, Department of Family Social Sciences, Faculty of Human Ecology, University of Manitoba, Winnipeg, MB.

This article discusses current research in the social sciences on end-of-life care and people living with dementia. Given the projected increase within the next twenty years of older adults living with dementia, end-of-life care for this demographic will become more relevant than ever before. The main themes emerging in the literature are discussed in this article: personhood, decision-making, counselling and spirituality, pain management, training for professionals, and settings of primary care. Recommendations for further research are offered.
Keywords: care, dementia, end-of-life, family, personhood.

Oren K. Steinmetz, MDCM, FRCSC, Associate Professor of Surgery, McGill University; Chief, Division of Vascular Surgery, McGill University Health Centre, Montreal, QC.
Peter I. Midgley, MD, FRCSC, Vascular Surgery Fellow, McGill University, Montreal QC.

Abdominal aortic aneurysms are a common cause of death among older adults in North America. Most commonly they are asymptomatic until they rupture. Rupture of an abdominal aortic aneurysm is usually lethal, so effective treatment to prevent rupture depends on accurate diagnosis on physical exam or one of various imaging modalities such as ultrasound, CT scan, or magnetic resonance imaging. Once the diagnosis is made, choice of treatment will depend on several factors including patient age and comorbidity, and aneurysm diameter. If elective treatment is contemplated there are currently two main options available to most patients: open surgical repair and endovascular repair. The fundamental differences between these two treatment options are outlined in this review.
Key words: abdominal aortic aneurysm, open surgical repair, endovascular aneurysm repair, older adults, aortic rupture.

Philippe Voyer, RN, PhD, Associate Professor, Faculty of Nursing, Laval University; Researcher, Laval University Geriatric Research Unit,St-Sacrement Hospital, Quebec, QC.
Michel Préville, MD, Associate Professor, Faculty of Medicine, Université de Sherbrooke; Researcher, Research Centre on Aging, Sherbrooke Geriatric University Institute, Sherbrooke, QC.
and Researchers of the Étude sur la santé des aînés team.

Sleep complaints by older adults constitute a very common situation faced by health care providers. However, not all professionals respond to the complaint the same way. Some will briefly assess the complaint and resort rather quickly to medication while others will assess the complaint carefully in order to exclude the diagnosis of primary insomnia and prescribe alternative interventions to improve sleep. When medicine is prescribed, the type of compound often selected is benzodiazepine. However, benzodiazepine carries a significant risk of adverse reaction, including drug dependency, both of which are clinical problems that should not be underrated, especially when treating a subjective complaint and not a specific diagnosis.
Key words: insomnia, benzodiazepine, dependency, addiction, older adults.

Victoria A. Walker, MD, Department of Internal Medicine, Division of Geriatric Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Heather E. Whitson, MD, Department of Internal Medicine, Division of Geriatric Medicine, Duke University Medical Center, Durham, North Carolina, USA.

Smoking is the leading cause of preventable death worldwide. Though older adults are the segment of the population least likely to smoke, they incur significant morbidity and mortality from tobacco use and can benefit from quitting. Older smokers have beliefs regarding smoking and motivating factors for cessation that differ from younger adults. Clinicians should understand these unique factors and can then use strategies to assist the older adult in smoking cessation.
Key words: smoking cessation, tobacco, epidemiology, older adults, prevention.