Common Causes of Vertigo and Dizziness in Different Age Groups of Patients

© 2016, Springer Science+Business Media New York.Dizziness and vertigo are among the most common symptoms occurring in clinical practice. However, the data on the main causes of dizziness and vertigo remain contradictory. We have analyzed the causes of dizziness in 590 outpatients who were referred to the neurologist. The most common causes of vertigo and dizziness in outpatient practice were benign paroxysmal positional vertigo (BPPV) (33.9 %), phobic postural vertigo (PPV) (21.4 %), Ménière’s disease/delayed endolymphatic hydrops (20 %), vestibular neuronitis/labyrinthitis (8.1 %), and vestibular migraine (4.1 %). Stroke as a cause of vertigo or dizziness was diagnosed only in 0.8 % of patients. Peripheral vestibular disorders were the most frequent cause of vertigo and dizziness in all age groups of patients: in patients younger than 45 years they were diagnosed in 57 % and in patients older than 60 years in 63.3 % of cases. PPV was the second most common cause of dizziness in patients younger than 45 years (37.4 %) but was established only in 7.6 % of patients older than 60 years. Most of the causes of vertigo and dizziness can be reliably diagnosed with bedside examination while laboratory investigation can be considered as an important but complementary entity

Diagnosis and rational treatment of painful diabetic peripheral neuropathy: an interdisciplinary expert consensus

Diabetic peripheral neuropathy is a common chronic complication of diabetes mellitus, significantly impairing well-being, quality of life and functioning of patients. The prevalence of diabetic peripheral neuropathy in the Russian Federation ranges from 0.1% to 67.2% in type 1 and from 0.1 to 42.4% in type 2 diabetes mellitus. However, based on the large-scale epidemiological studies, the true prevalence of diabetic peripheral neuropathy is much higher (50 to 70%), with its painful variant occurring in 16% to 30% of patients. Despite the fact that diabetic peripheral neuropathy remains the most common chronic complication of diabetes mellitus, its diagnosis and therapy leave much to be desired. To optimize diagnostic and treatment approaches to painful diabetic peripheral neuropathy, a group of experts representing the leading Russian professional medical associations has developed clinical guidelines for the diagnosis and rational therapy of patients with painful diabetic peripheral neuropathy. This document presents practical aspects of the clinical diagnosis of painful diabetic peripheral neuropathy and an algorithm for differential diagnosis of pain in the lower extremities in patients with diabetes mellitus. The use of symptomatic analgesics with central action, such as anticonvulsants, antidepressants and opioids, is based on the main aspects of neuropathic pain pathophysiology. The characteristics of each drug class are given, with consideration of evidence on their efficacy, tolerability, and the possibility of combination therapy. The data on the first, second, and third lines of agents is presented in accordance with several international clinical guidelines. The need for a tailored drug choice, taking into account the evidence-based data on their efficacy and safety, concomitant drug therapy, tolerability, cost and preferences of the patient, age of the patient and concomitant disorders, is emphasized

Brain Training Game Improves Executive Functions and Processing Speed in the Elderly: A Randomized Controlled Trial

The beneficial effects of brain training games are expected to transfer to other cognitive functions, but these beneficial effects are poorly understood. Here we investigate the impact of the brain training game (Brain Age) on cognitive functions in the elderly.Thirty-two elderly volunteers were recruited through an advertisement in the local newspaper and randomly assigned to either of two game groups (Brain Age, Tetris). This study was completed by 14 of the 16 members in the Brain Age group and 14 of the 16 members in the Tetris group. To maximize the benefit of the interventions, all participants were non-gamers who reported playing less than one hour of video games per week over the past 2 years. Participants in both the Brain Age and the Tetris groups played their game for about 15 minutes per day, at least 5 days per week, for 4 weeks. Each group played for a total of about 20 days. Measures of the cognitive functions were conducted before and after training. Measures of the cognitive functions fell into four categories (global cognitive status, executive functions, attention, and processing speed). Results showed that the effects of the brain training game were transferred to executive functions and to processing speed. However, the brain training game showed no transfer effect on any global cognitive status nor attention.Our results showed that playing Brain Age for 4 weeks could lead to improve cognitive functions (executive functions and processing speed) in the elderly. This result indicated that there is a possibility which the elderly could improve executive functions and processing speed in short term training. The results need replication in large samples. Long-term effects and relevance for every-day functioning remain uncertain as yet.UMIN Clinical Trial Registry 000002825

Комплексный подход к выбору терапии у пациентов с остеоартритом при первичном обращении к врачу. Консенсус экспертов (обзор литературы и резолюция)

Osteoarthritis (OA) is the most common pathology of the musculoskeletal system and is a serious medical and social problem. OA is of particular importance in elderly and senile people due to the high frequency of comorbid pathology. Pain relief is a priority in the formation of individual therapeutic programs for patients with OA, starting from their first request for medical assistance. At the same time, due to the ambiguity of existing clinical recommendations, most experts note a number of difficulties in prescribing treatment for patients with OA.The article presents a consensus position of experts regarding a complex approach to the choice of therapy in patients with OA at the initial visit to the doctor. The article discusses: current clinical guidelines for the management of patients with OA; most common problems in the management of patients with OA in real clinical practice; goals of treatment strategies for OA taking into account the risk factors for its progression; an algorithm of pain relief during initial treatment in patients with OA; prevention of OA exacerbations with the use of basic structure-modifying drugs; recommendations for the choice of non-steroidal anti-inflammatory drugs.According to experts, a rational approach to the treatment of OA is based on the combined use of non-drug and pharmacological methods with constant monitoring of therapy regimens and side effects. These recommendations can be considered disease-modifying strategies that in many cases allow improving functional status and achieving long-term remission in patients with OA.Остеоартрит (ОА) – наиболее распространенная патология опорно-двигательного аппарата, являющаяся серьезной медико-социальной проблемой. Особое значение ОА приобретает у лиц пожилого и старческого возраста из-за высокой частоты коморбидной патологии. Купирование болевого синдрома является приоритетным при формировании индивидуальных терапевтических программ для пациентов с ОА, начиная с момента их первичного обращения за медицинской помощью. Вместе с тем из-за неоднозначности существующих клинических рекомендаций большинство экспертов отмечают ряд сложностей при назначении лечения больным ОА.В статье представлена согласованная позиция экспертов, касающаяся комплексного подхода к выбору терапии у пациентов с ОА при первичном обращении к врачу. Рассмотрены имеющиеся на сегодняшний день клинические рекомендации по ведению пациентов с ОА, наиболее часто возникающие проблемы при курации больных ОА в реальной клинической практике, цели лечебных стратегий при ОА с учетом факторов риска его прогрессирования, алгоритм лечения боли у пациентов с ОА при первичном обращении и профилактики обострений ОА с использованием базисных структурно-модифицирующих препаратов, рекомендации по выбору нестероидных противовоспалительных препаратов.По мнению экспертов, рациональный подход к терапии ОА основан на комбинированном использовании немедикаментозных и фармакологических методов при постоянном мониторинге режимов терапии и побочных эффектов. Данные рекомендации можно рассматривать как болезнь-модифицирующие стратегии, позволяющие во многих случаях улучшить функциональный статус и добиться длительной ремиссии у пациентов с ОА

Beneficial effects of reading aloud and solving simple arithmetic calculations (learning therapy) on a wide range of cognitive functions in the healthy elderly: study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Almost all cognitive functions decline with age. Results of previous studies have shown that cognitive training related to everyday life (reading aloud and solving simple arithmetic calculations), namely learning therapy, can improve two cognitive function (executive functions and processing speed) in elderly people. However, it remains unclear whether learning therapy engenders improvement of various cognitive functions or not. We investigate the impact of learning therapy on various cognitive functions (executive functions, episodic memory, short-term memory, working memory, attention, reading ability, and processing speed) in healthy older adults.</p> <p>Methods</p> <p>We use a single-blinded intervention with two parallel groups (a learning therapy group and a waiting list control group). Testers are blind to the study hypothesis and the group membership of participants. Through an advertisement in local newspaper, 64 healthy older adults are recruited. They will be assigned randomly to a learning therapy group or a waiting list control group. In the learning therapy group, participants are required to perform two cognitive tasks for 6 months: reading Japanese aloud and solving simple calculations. The waiting list group does not participate in the intervention. The primary outcome measure is the Stroop test score: a measure of executive function. Secondary outcome measures are assessments including the following: verbal fluency task, logical memory, first and second names, digit span forward, digit span backward, Japanese reading test, digit cancellation task, digit symbol coding, and symbol search. We assess these outcome measures before and after the intervention.</p> <p>Discussion</p> <p>This report is the first study which investigates the beneficial effects of learning therapy on a wide range of cognitive functions of elderly people. Our study provides sufficient evidence of learning therapy effectiveness. Most cognitive functions, which are correlated strongly with daily life activities, decrease with age. These study results can elucidate effects of cognitive training on elderly people.</p> <p>Trial registration</p> <p>This trial was registered in The University Hospital Medical Information Network Clinical Trials Registry (No. <a href="http://www.clinicaltrials.gov/ct2/show/UMIN000006998">UMIN000006998</a>).</p