Hello and welcome to the Medical Narratives podcast with Dr. Michael Gordon. I'm Regina Starr. And in today's episode, we will continue our series on the top ten issues affecting the elderly. We are excited to present another informative episode on the topic of Forgetfulness and Mild Cognitive Impairment. This is a topic that affects many older adults and their families.
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RS: Hello and welcome to the Medical Narratives podcast with Dr. Michael Gordon. I'm Regina Starr. And in today's episode, we will continue our series on the top ten issues affecting the elderly. We are excited to present another informative episode on the topic of Forgetfulness and Mild Cognitive Impairment. This is a topic that affects many older adults and their families.
RS: As our population continues to age, it's becoming increasingly common for people to experience memory lapses and cognitive changes. According to the Alzheimer's Society of Canada, an estimated 10 to 15% of Canadians over the age of 65 have mild cognitive impairment. The prevalence of mild cognitive impairment increases with age, with studies suggesting that up to 25 to 50% of people over the age of 85 may also have it.
RS: It's worth noting that mild cognitive impairment can be difficult to diagnose, and some individuals may not seek medical attention for their symptoms. As a result, the true prevalence of mild cognitive impairment in the Canadian or North American population may be higher than reported. While forgetfulness can be a normal part of aging. It can also be a symptom of more serious conditions, such as mild cognitive impairment or even dementia.
RS: It's important for doctors to understand the nuances of forgetfulness and cognitive decline and to be able to provide patients with accurate information and effective interventions. Today, in my conversation with Dr. Gordon, he will shed light on this complex and often misunderstood topic. So let's get started. Hello, Michael. How are you?
MG: Good morning. I should say good afternoon. Fine, thank you.
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Dr. Michael Gordon recently retired after a fulfilling career as a geriatrician that spanned 56 years, 44 of which he spent working at the Baycrest Center in Toronto. He is Emeritus Professor of Medicine at the University of Toronto. Dr. Gordon is a recognized ethicist and a thought leader on all topics of care of the elderly and end-of-life decisions. Currently, Dr. Gordon provides part-time professional medical consulting mainly in the domain of cognition and memory loss.
Welcome to 3P: Pills, Pearls, and Patients where we will discuss current events in medicine, stories from real patient-physician encounters, and gain insight into what it's like being a physician in today's society.
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Hello and welcome to the next episode of 3P, Pills, Pearls, and Patients. I'm your host, Dr. Marina Malak and today's episode is called Owning Osteoporosis. Osteoporosis can be an easy topic or a difficult topic, like all things in medicine.
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Dr. Marina Malak is a family physician in Mississauga, Ontario and a lecturer and faculty member at the University of Toronto. She is actively involved in medical advocacy, and is a board member of the Mississauga Primary Care Network. She is also a member of the National Committee of Continuing Professional Development at the College of Family Physicians of Ontario, and a member of the Research Ethics Board at Trillium Health Partners.
She is passionate about patient care; medical education; and promoting mental, physical, and emotional wellness. She enjoys reading, writing, public speaking, puzzles, doodling in her bullet journal, and creating drawings on Procreate.
1 Adult Spine Fellow, Division of Spine Surgery, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA. 2 Assistant Professor of Orthopaedic Surgery, Division of Spine Surgery, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
Abstract: Though they have significant morbidity and mortality, spine infections are a rare cause of back pain. Because they are uncommon, it is important to recognize the signs and symptoms of a spine infection, to establish the diagnosis, and to treat appropriately, guided by culture results, with antibiotic therapy. Surgical intervention is indicated in cases of significant neurologic deficit, significant spinal deformity, instability, and/or failed medical management.
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Patients with spine infections often present with back pain and may have radicular pain, neurologic deficits, or constitutional signs and symptoms of infection
Workup begins with laboratory studies including, CBC, CRP, and ESR
The gold standard for imaging is MRI
Definitive diagnosis may require CT-guided biopsy and culture
The mainstay of treatment is at least 6 weeks of antibiotic therapy guided by culture results
Surgical intervention is indicated in cases of progressive neurologic deficit or spinal deformity, instability, or failed medical management
Spinal infections can present insidiously
Refer early if patients present with back pain and unexplained fever
Prompt identification with MRI improves likelihood of recovery
Antibiotic treatment for 6 weeks is recommended
Surgery is useful for neurological deficit or instability
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1Professor of Psychiatry (Emeritus), Queen's University, Canada.2Professor of Psychiatry and Ophthalmology (Emeritus) University of Toronto, Canada Director of the Youthdale Child & Adolescent Sleep Clinic and International Sleep Clinic Parry Sound Toronto, Canada. 3Clinical Psychologist, Sleep on the Bay, Toronto, Canada.
Abstract: There is increasing appreciation of the relevance of sleep to general well-being, especially for those with medical—including psychiatric—illnesses. This growing recognition of the relevance of sleep is reflected in the DSM-V guidelines. We endeavor to present a nuanced understanding and usage of sedative hypnotic medications in the management of insomnia. New medications that reduce wakefulness is also mapped out in this overview. In addition, we briefly discuss the intervention of cognitive behavior therapy for insomnia (CBT-I) as the mainstay of treatment for chronic insomnia.
Insomnia is a sleep disorder in its own right. It is no longer regarded as just a symptom. It calls for specific, targeted insomnia treatment, especially in situations where insomnia is comorbid with medical conditions.
Cognitive behavioural therapy for insomnia (CBT-I) produces moderate to large effects on insomnia measures when insomnia is comorbid with chronic medical conditions. It is the mainstay of treatment in most cases of chronic insomnia.
The use of hypnotics should be planned strategically. In general, short term hypnotic use should be the objective, but for many patients long term use may be necessary and appropriate.
The initial dose of sedative-hypnotics should be determined on an individual basis and titrated in accordance with the patients' needs. While too high dose is not desirable, too low a dose would result in under-treatment and is counter-productive.
Insomnia may become a chronic disorder and as such may necessitate long-term management. Prescribe carefully-chosen hypnotics for the requisite period and re-evaluate patients in follow up. Consider CBI-I as a treatment option, independently or in conjunction with pharmacotherapy.
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1 University of British Columbia, Vancouver, British Columbia, Canada. 2Department of Pediatrics, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract: Body-focused repetitive behaviours (BFRBs) are common yet poorly understood conditions with significant mental and physical implications. Dermatological findings associated with BFRBs can be atypical, and recognizing them can be very beneficial. This paper reviews the dermatological findings associated with BFRBs, including habit-tic nail deformity, onychophagia, onychotillomania, trichotillomania, lip/cheek biting, dermatillomania, and compulsive washing. Recognition of these classic dermatological signs can help clinicians differentiate them from other common dermatological conditions. Body-focused repetitive behaviours require multidisciplinary management, and dermatology can contribute to their recognition and treatment.
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BFRBs are common yet poorly understood conditions with significant mental and physical implications.
Recognition of classic dermatological signs can help clinicians differentiate BFRBs from other common dermatological conditions.
Dermatological findings associated with BFRBs can be atypical, and recognizing them can be very beneficial.
BFRBs require multi-disciplinary management, and dermatology can contribute to their recognition and treatment.
Recognizing dermatological findings associated with BFRBs can help clinicians make an accurate diagnosis and develop an effective treatment plan.
BFRBs can cause significant physical and psychological harm and require a multi-disciplinary approach to management.
Early recognition and treatment of BFRBs can prevent long-term physical and psychological complications.
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