Subcutaneous Infusion of Fluids for Hydration or Nutrition: A Review.

Subcutaneous infusion, or hypodermoclysis, is a technique whereby fluids are infused into the subcutaneous space via small-gauge needles that are typically inserted into the thighs, abdomen, back, or arms. In this review, we provide an overview of the technique, summarize findings from studies that have examined the use of subcutaneous infusion of fluids for hydration or nutrition, and describe the indications, advantages, and disadvantages of subcutaneous infusion. Taken together, the available evidence suggests that, when indicated, subcutaneous infusion can be effective for administering fluids for hydration or nutrition, with minimal complications, and has similar effectiveness and safety to the intravenous route.

Ultrasound Tissue Pulsatility Imaging Suggests Impairment in Global Brain Pulsatility and Small Vessels in Elderly Patients with Orthostatic Hypotension.

Background: Orthostatic hypotension (OH) is highly prevalent in the elderly, and this population can be exposed to serious complications, including falls and cognitive disorders, as well as overall mortality. However, the pathophysiology of OH is still poorly understood, and innovative methods of cerebral blood flow (CBF) assessment have been required to accurately investigate cerebrovascular reactivity in OH.

Objectives: We want to compare brain tissue pulsatility (BTP) changes during an orthostatic challenge in elderly patients over 80 with and without OH.

Safety and Efficacy of Subcutaneous Parenteral Nutrition in Older Patients: A Prospective Randomized Multicenter Clinical Trial.

Background: Many patients who cannot tolerate adequate enteral nutrition could benefit from parenteral nutrition support but fail to receive it due to difficult intravenous (IV) access. The objective of this study was to compare the safety and efficacy of subcutaneous (SC) administration of parenteral nutrition with the peripheral IV route.

Materials And Methods: This was a prospective randomized multicenter study of 121 older hospitalized patients.

Midlife plasma vitamin D concentrations and performance in different cognitive domains assessed 13 years later.

25-Hydroxyvitamin D (25(OH)D) insufficiency is very common in many countries. Yet, the extent to which 25(OH)D status affects cognitive performance remains unclear. The objective of the present study was to evaluate the cross-time association between midlife plasma 25(OH)D concentrations and subsequent cognitive performance, using a subsample from the French 'SUpplémentation en Vitamines et Minéraux AntioXydants' randomised trial (SU.

Gait disturbances as specific predictive markers of the first fall onset in elderly people: a two-year prospective observational study.

Falls are common in the elderly, and potentially result in injury and disability. Thus, preventing falls as soon as possible in older adults is a public health priority, yet there is no specific marker that is predictive of the first fall onset. We hypothesized that gait features should be the most relevant variables for predicting the first fall.

The effect of age and educational level on the cognitive processes used to comprehend the meaning of pictograms.

Background And Aims: Pictograms, designed to be a universal communication system, are often created from several concrete and easily recognizable drawings. Does understanding depend on a logical approach? Or is it the ability to inhibit the concrete sense of each picture that allows access to a higher level of comprehension? (ability to abstract). These executive functions are sensitive to the effects of aging and educational level.

Encephalopathy induced by levetiracetam in an elderly woman.

Levetiracetam is frequently used in the elderly considering its favorable pharmacological profile, efficacy, and good tolerance. We reported an encephalopathy with levetiracetam in an elderly subject who had no renal failure, no concomitant valproate medication, and no other additional co-morbidities. Levetiracetam should be discontinued when this condition is suspected.

Myasthenia gravis in the elderly: a rare cause of undernutrition.

Myasthenia gravis is not a frequent disease in the elderly. The diagnosis of this neuromuscular junction disease in the elderly is difficult because of comorbidities and the broad differential diagnosis. We report here the case of a 86-year-old woman referred to hospital for loss of weight and difficulties in feeding.

[Language disorders and neurodegenerative pathologies].

Language disorders in elderly people are not exclusively linked to the vascular pathology. There are many degenerative causes and the different clinical presentations and progression profiles must be known to clinicians. The detection of a language disorder during a "memory consultation" warrants an assessment by a speech therapist, in order to adapt the neuropsychological assessment and to decide on any complementary investigations.

[Hypothyroidism and cognition in the elderly].

The consequences of hypothyroidism on cognition are long known since the description of dementia associated with hypothyroidism. Additional data from experimental studies support the impact of thyroid hormones on the central nervous system and cognition. Cognitive impairment in relation with hypothyroidism (even sub clinical hypothyroidism) in elderly subjects involves memory, attention, and executive functions.

Hemispheric lateralization in aging: interest of the verbal-manual concurrency paradigm.

Introduction: The aim of this study was to evaluate whether the classic asymmetry seen in hemispheric functioning is modified in older adults by using a verbal-manual concurrency task.

Method: Thirty-five right-handed participants divided into two groups according to age (15 older participants, mean age: 68 ? 8 years, without cognitive decline and 20 younger participants, mean age: 23 ? 2 years) had to perform a 30-second uni-manual tapping task, in both a single task (tapping alone) and dual task (tapping and performing a letter fluency task together) condition.

Results: In younger participants, the letter fluency task disrupted the right hand more than the left hand whereas, in older participants, the letter fluency task disrupted both hands equally.

[Vitamin D and cognition in the elderly].

The understanding of the role of vitamin D in maintaining good health has considerably increased in the recent years. There is a growing evidence that vitamin D has not only a beneficial effect to prevent osteoporosis and the risk of falls in the elderly, but also may reduce incidence of cancers, infections, autoimmune, cardiovascular and neurologic diseases, and psychiatric disorders. Laboratory studies yield a biological plausibility for a positive contribution of vitamin D to brain functions: vitamin D receptor and 1,α-hydroxylase, the terminal calcitriol-activating enzyme, are widely distributed in both the fetal and adult brain.

[Decision making in the elderly: which tools for its evaluation by the clinician?].

Numerous decision-making situations occur in the activities of daily living. The consequences of the decision-making capacity disturbances may have a great impact on the patient's autonomy, financial management, and his or her reaction to a diagnosis as well as the ability to accept a therapeutic option or give informed consent. Decision-making is a complex and multi-dimensional process and brings into play attention, memory and executive functions, which are processed in the prefrontal cortex, particularly vulnerable in aging.

[Cerebral lateralization and hemispheric interaction in aging: what about dichotic listening?].

Dichotic listening is the most frequent behavioral test used to assess hemispheric lateralization. The subjects simultaneously receive competing information signals in each ear and the attention resources are mobilized. Dichotic listening may be viewed as a dual-task procedure.

A case report of exhibitionist behaviour revealing unsuspected Huntington's disease: a pitfall in forensic medicine.

We present the case of a patient who was recently convicted for exhibitionism whose clinical assessment suggested undiagnosed Huntington's disease. We summarise the clinical characteristics, the genetics involved and the diagnostic difficulties which can be encountered. Finally, we discuss the implications of this diagnosis in forensic medicine.

[Aging and hemispheric cerebral lateralization].

Cerebral hemispheric lateralization is an old concept, particularly concerning language. In children, numerous arguments favour a left hemispheric predisposition for language, but do not exclude its strengthening during childhood. In the elderly, changes in the lateralization have been described.