Diseases, Disorders & Syndromes
The Geriatric Medicine physicians of Pinehurst Medical Clinic are primary care physicians who specialize in the prevention, diagnosis, and treatment of adult diseases, especially those that affect adults in the second half of life. In addition to the diseases described in the Internal Medicine section, the following conditions are among those addressed by our Geriatric Medicine physicians:
Alzheimer’s disease (AD). A progressive degenerative brain disease that causes destruction of nerve cells and a decrease in neurotransmitters (chemical messengers), resulting in problems in memory, thinking, and behavior. There are two types of AD, early onset and late onset. The early onset form, which appears before age 60, is much less common, accounting for only 5 to 10 percent of cases. At present, AD is not curable, but treatments are available to delay the progression of the disease.
Delirium. Confusion that begins suddenly and may vary from slight to severe within hours. People who have delirium cannot pay attention or think clearly. Delirium has many causes, including infections, dehydration, poorly controlled diabetes, drug side effects, and stress. Delirium requires immediate medical attention to identify the cause and correct it.
Dementia due to metabolic causes. Deterioration of mental function caused by an endocrine disorder (e.g., hypothyroidism), metabolic disorder (e.g., porphyria), or nutritional disorder (e.g., vitamin B-12 deficiency). Treatment focuses on the cause of the disorder and the control of symptoms. The outcome depends on the cause and extent of damage to the brain.
Dementia. Progressive impairment of thinking, memory, reasoning and other mental functions. Dementia is not a disease itself but a group of symptoms that may accompany certain diseases or conditions. Some causes of dementia (e.g., drugs, alcohol, hormone or vitamin imbalances, depression) are treatable. However, dementia that is caused by a disease (such as Alzheimer’s disease) or injury (such as multiple strokes in the brain) is usually considered irreversible.
Depression. Extraordinary sadness that interferes with the ability to function. Clinical depression is different from the mild unhappiness that affects us all from time to time. Symptoms of depression include sleep disturbances, change in appetite, fatigue and lack of energy, feelings of worthlessness or inappropriate guilt, difficulty concentrating, lack of pleasure in usual activities, hopelessness, and thoughts of death or suicide. Treatment may include social interventions, cognitive behavioral therapy and/or antidepressant medication. It is also important to address any underlying medical conditions that are causing or contributing to depression.
Falls. Falls occur in more than 30% of adults over age 65, and serious injury occurs in over 20% of these falls. Most falls occur in and around the home. Risk factors include altered gait or balance, lower extremity muscle weakness, dizziness, fainting spells, postural hypotension, decreased visual acuity, arthritis, and certain medications. The risk of falls can be reduced by wearing flat, rubber-soled shoes, using a cane or walker as needed, controlling hypertension, and avoiding medications that increase the likelihood of falls. Modifying the home environment, using proper lifting technique, and participating in regular exercise can also help reduce the risk of falls.
Hypothyroidism (underactive thyroid). A condition that results from a decrease in the production of thyroid hormones, which slows vital body functions. In older adults, hypothyroidism can cause symptoms of confusion, dizziness, fatigue, depression, decreased appetite, sensitivity to cold, constipation, and joint stiffness. Some of these symptoms may resemble those of dementia, but treatment with thyroid hormone usually results in improved mood and mental function as well as resolution of other symptoms.
Lewy body dementia. Development of abnormal deposits of protein (called Lewy bodies) in nerve cells throughout the brain, causing the death of nerve cells and a decline in mental abilities. Symptoms of Lewy body dementia are similar to those of Alzheimer’s disease, including memory loss, disorientation, and problems remembering, thinking, understanding, communicating, and controlling behavior. However, Lewy body dementia is more likely to cause hallucinations, paranoia, and delusions.
Multi-infarct dementia (vascular dementia). A disorder in which a few large strokes or many small strokes in the brain cause brain tissue in the area to die. The dead tissue is called an infarct. Memory, thinking, understanding, and other abilities often decline in steps, after each stroke. Vascular dementia can sometimes be prevented by correcting or eliminating the risk factors for stroke, such as high blood pressure.
Normal pressure hydrocephalus (“water on the brain”). A brain disorder that occurs when the flow of cerebrospinal fluid (CSF) is blocked and the fluid fills up within the brain, compressing brain tissue. Symptoms include changes in gait, weakness of the legs, urinary or bowel incontinence, apathy and withdrawn behavior, and dementia. Normal pressure hydrocephalus is estimated to account for about 5 percent of all dementias. Surgical placement of a shunt to route CSF around the obstruction and back into circulation sometimes reverses the dementia and other symptoms.
Parkinson’s disease. A disorder of the brain characterized by shaking (tremors) and difficulty with walking, movement, and coordination. The disease is associated with damage to a part of the brain that is involved in movement. Severe Parkinson’s disease can cause dementia.
Pernicious anemia. A type of vitamin deficiency anemia caused by low levels of intrinsic factor, a protein produced in the gastrointestinal tract that is needed to absorb vitamin B-12 from the stomach. Pernicious anemia is rare before age 30, but it is estimated that nearly 2 percent of adults over age 60 are affected. Symptoms include shortness of breath, fatigue, pallor, rapid heart rate, loss of appetite, tingling and numbness in the hands and feet, impaired sense of smell, and personality changes. Treatment is vitamin B-12 (usually in the form of monthly injections) to correct the underlying nutritional deficiency.
Pick’s disease. A rare and irreversible form of dementia that causes personality changes, loss of social skills, loss of intellectual function, and speech disturbances.
Polypharmacy. Use of too many medications or use of unnecessary drugs. Polypharmacy increases the risk of unwanted drug interactions and side effects such as constipation, diarrhea, or incontinence; tremor; falls; confusion or dizziness; loss of appetite; tiredness, sleepiness, or decreased alertness; depression or anxiety; and decreased sexual desire. Polypharmacy also increases the risk of medication errors (taking too much or not enough of the prescribed drugs).
Subdural hematoma. An accumulation of blood beneath the outer covering of the brain that results from a broken blood vessel, usually as a result of head injury. The blood may put more pressure on surrounding brain tissue, progressively impairing mental function. Even soft falls or slight head injuries can cause hematomas, especially in people who take anticoagulants.
Urinary incontinence. Loss of bladder control, causing occasional leakage of urine or complete inability to hold urine. The two main types are stress incontinence (loss of urine during certain activities such as coughing, sneezing, laughing, or exercise) and urge incontinence (strong, sudden need to urinate followed by involuntary loss of urine). Urinary incontinence may be a short-term problem due to infection, drug side effects, or other causes, or may be a long-term problem due to injury or disease. Treatment may include bladder retraining, Kegel exercises, lifestyle changes, medication and/or surgery.
