The Better Metrics Project is supported by the Healthcare Commission and involves the development of performance measures that are of particular relevance to front line clinicians €” existing metrics specific to older people's services are…

The discovery of dopamine deficiency as a cause of the disability of Parkinson's disease has led to an era of successful dopaminergic therapy. Professor Jeremy Playfer provides an overview of the evolution of dopamine agonists and their…

Self-reported back pain is common at any age; however, as a new symptom in elderly people it requirescareful assessment because it may signal a serious disorder. The challenge is to maintain clinicalvigilance for detection of cancer,…

Bilateral stroke is an extremely rare event. In a study of 1,838 patients, bilateral anterior infarctionaccounted for only 0·27% of stroke patients. We report the case of an 84-year-old woman who presentedwith bifrontal haemorrhagically…

Stroke is a major complication in patients with diabetes and hypertension. Patients should be made aware of the complications and the importance of stroke-prevention strategies. Patients with diabetes and hypertension should be treated…

Apomorphine was first synthesised in 1869, and has been used in the treatment of Parkinson's disease for morethan 50 years. It is a potent non-selective dopamine agonist. Current use is restricted to patients with advancedParkinson's…

We report a case of spontaneous intramural haematoma in an elderly woman.

We report on a patient with acute-onset facial and bulbar palsy that deteriorated within a weekneeding ventilatory support. He was initially treated for Guillain-Barre syndrome in view of the acuteonset and non-fluctuating course of…

Trigeminal neuralgia is a severe unilateral intermittent facial pain that is unresponsive to normal analgesics. First-line drug treatment is carbamazepine, but side-effects are common. Additionally, several surgical techniques are available…

More than 16,000 people die from bowel cancer each year in the UK. It is the second most commoncause of death from cancer.1 The aim of the NHS Bowel Cancer Screening Programme is to reducethe number of deaths by diagnosing patients at an…

We report on an unsual case of difficulty walking in an octogenerian on warfarin therapy.

This article discusses the evolution of central dual-energy X-ray absorptiometry (DXA) as a tool forthe diagnosis and management of postmenopausal osteoporosis. The derivation of normal values isconsidered and this is then linked with…

This article focuses on the diagnosis and treatment of men with breast cancer. Risk factors for developingthe condition are also examined. Because of the relative rarity of the condition in men, research evidenceis scant resulting in…

Alzheimer's disease seems to share the same vascular risk factors as vascular dementia and cardiovasculardisease. The evidence for this, although far from complete, continues to grow, and the potential toprevent and control Alzheimer's…

This article reviews the leading causes of involuntary weight loss in older people. We look at the underlyingpsychiatric and neuropsychiatric causes including depression, dementia, and longstanding eating disorders.We consider the negative…