Jicht in de wervelkolom: een zeldzame presentatie van een veelvoorkomende aandoening

A 92-year old woman was admitted to the geriatric department because of a confusional state due to a urinary tract infection, a severe dermatitis and gout. An incomplete tetraplegia was found on physical examination. Radiological examination showed a large gouty tophus causing spinal cord compression and destruction of the dens. Gouty involvement of the spine is a less common complication of the disease. Optimal treatment of gout is important to prevent the development of such severe complications.     

Ichthyosis generalis,een geval van geslachtsgebonden erfelijkheid

Resumé Ichthyosis generalis: a case of sex-limited inheritance in man with recessiveness of the anomaly. The case can be understood from the pedigree.     

Oud en een biertje! De praktijk van een aan alcohol verslaafde 65-jarige man

Alcohol abuse and addiction in The Netherlands among the older adults aged 65 and over has increased in the last decade. Outreaching care is important as most of the elderly do not receive the care they need. We discuss the detoxification and group therapy of an elderly alcoholic. Issues that will be discussed are potential risks and choices that need to be made.     

Fragiele ouderen: De identificatie van een risicovolle populatie

Frail elderly. Identification of a population at risk In the future the number of frail independently living older people will continue to increase. It is unclear however, which people are meant exactly by those frail elderly. The aim of this article is to discuss the concept of frailty and its adequacy in identifying the frail elderly population. To this end, a literature search has been performed regarding the conceptual and operational definitions of frailty. The results show that frailty often is put on a continuum opposite to vitality. It is emphasised that the process of frailty can be modified or (partly) reversed. Focusing on this reversibility is important because frail elderly have a higher risk for adverse outcomes such as dependence, hospitalization, falls and mortality. After studying the conceptual and operational definitions it is concluded that no actual definition meets the criteria for a successful definition of frailty. Frailty is predominantly defined in terms of physical loss. This may lead to fragmentation of care with lack of an integral approach. In a follow-up study it will be tried to develop consensus on a conceptual and operational definition of frailty. Tijdschr Gerontol Geriatr 2007; 38:65-76     

Participatie in psychogeriatrische dagbehandeling. Ontwikkeling van een meetinstrument

Participants in psychogeriatric day care differ in their ability to enjoy the activities and to be engaged in the day care program. In order to reveal individual differences in the quality of participant engagement, an 18-item questionnaire was drafted and completed for 126 visitors of a psychogeriatric day care centre. Scalability of the items was tested according to criteria of nonparametric item response theory (IRT). Construct validity was determined by comparing the results with independent behaviour ratings of cognitive impairment and apathy, and scores on the Amsterdam Dementia Screening Test (ADS), a neuropsychological test of multiple cognitive domains. Nine items formed a strong primary Participation Scale with a coefficient H of 0.63. Behaviour ratings of cognitive impairment and apathy were significant predictors of the participation score. The same was true for the subtests Design Copying and Category Fluency of the ADS. Two meaningful small secondary scales were found, representing motivation and emotional stability, which add to the predominantly cognitive content of the primary scale. Total scores of the secondary scales correlated with affective parameters, but not with cognitive indices. The Participation Scale deserves to be expanded with items referring to motivation and emotional experience.     

De fonologische variant van primaire progressieve afasie, een gevalsstudie

Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by an insidious onset and gradual progression of deficits that can involve any aspect of language, including word finding, object naming, fluency, syntax, phonology and word comprehension. The initial symptoms occur in the absence of major deficits in other cognitive domains, including episodic memory, visuospatial abilities and visuoconstruction. According to recent diagnostic guidelines, PPA is typically divided into three variants: nonfluent variant PPA (also termed progressive nonfluent aphasia), semantic variant PPA (also termed semantic dementia) and logopenic/phonological variant PPA (also termed logopenic progressive aphasia). The paper describes a 79-yr old man, who presented with normal motor speech and production rate, impaired single word retrieval and phonemic errors in spontaneous speech and confrontational naming. Confrontation naming was strongly affected by lexical frequency. He was impaired on repetition of sentences and phrases. Reading was intact for regularly spelled words but not for irregular words (surface dyslexia). Comprehension was spared at the single word level, but impaired for complex sentences. He performed within the normal range on the Dutch equivalent of the Pyramids and Palm Trees (PPT) Pictures Test, indicating that semantic processing was preserved. There was, however, a slight deficiency on the PPT Words Test, which appeals to semantic knowledge of verbal associations. His core deficit was interpreted as an inability to retrieve stored lexical-phonological information for spoken word production in spontaneous speech, confrontation naming, repetition and reading aloud.     

E-mental health interventies voor mantelzorgers van ouderen: een overzicht

E-mental health interventions for family caregivers of older adults: a review Purpose: To present a systematic overview of the different e-mental health interventions for caregivers of older adults. Methods: Systematic literature research of implemented and evaluated e-mental interventions for caregivers of older adults. Results: Thirteen e-mental health interventions are included: six telephone, one camera and six internet interventions. In general, research on user friendliness and client satisfaction shows positive results. The effectiveness of three e-mental health interventions have been studied. The family-based structural in-home intervention with the computer telephone integrated system shows a decrease in depressive symptoms after six and eighteen month. The telephone linked computer system did not show positive mental health effects for the total group of family caregivers. After online lessons, caregivers were more capable to organize respite care and to manage disruptive and challenging behaviours of the care recipient. Their ability to solve their own problems increased and their subjective burden decreased. A cost analysis of an internet intervention shows a reduction in costs in comparison to regular care. Conclusion: E-mental health interventions for caregivers of older adults are encouraging, although research in this field is still in its infancy. Research on the effectiveness and cost-effectiveness of these type of interventions is needed. In addition, the opportunities of internet interventions could be used more extensively. Tijdschr Gerontol Geriatr 2007; 38: 274-287