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Kleine-Levin syndrome is more commonly known as recurrent primary hypersomnia. The patient can lapse into a deep sleep at any time without warning, sometimes lasting as long as 16 hours. It is often associated with compulsive overeating and hypersexuality€”this is not a passing desire for a quick nap, but is excessive daytime sleepiness, which is a much more significant problem. On awakening the person appears listless, speaks gibberish, and does not remember anything about events before falling asleep (short-term retrograde amnesia). We discuss the presentation, course of illness, pathophysiology, laboratory investigations, diagnosis, possible treatments, and the importance of early recognition of this disorder.

The Code of Practice for the Mental Capacity Act 2005 states that those working with vulnerable people must be able to demonstrate that they comply with the code. Or, as I am fond of pointing out, they may one day have to explain to the coroner why they did not. The busy doctor or nurse can be forgiven for thinking that the Mental Capacity Act is yet another administrative burden to be grudgingly borne, but it is not. In my opinion, it is the best defence for vulnerable people, and for clinicians, since the Human Rights Act.

Seizure after stroke is common and late-onset seizures have higher recurrence rate and poorer prognosis. Patients with poststroke epilepsy are difficult to rehabilitate and are more likely to be hospitalised for an extended period of time. Second generation antiepileptic drugs have emerged as a favoured drug in post-stroke epilepsy in older patients.

Management of behavioural disturbance in the setting of dementia can be challenging. There are many potential causes including poor physical health, prescribed drugs, depression, impaired vision and hearing as well numerous environmental factors. Drug prescribing in patients with behavioural disturbance has evolved over the years in a haphazard and anecdotal way. As a result patients have been exposed to a wide range of drugs, some of which have significant side-effects.

Osteoporosis management in older people should be aimed at fracture prevention. Most trial evidence involving antiosteoporoticmedications in reducing fragility fractures exists in women up to the age of 80 years. In this review we discussthe management of osteoporosis in the very elderly, those over the age of 80, focusing on the evidence for anti-resorptive andanabolic agents in reducing fragility fractures in this particular age group.

Age and obesity are two of the most prominent risk factors for cardiovascular disease and diabetes, and in combination that risk increases enormously. The National Obesity Forum (NoF) was established by medical practitioners in May 2000 to raise awareness of the growing health impact that being overweight or obese was having on patients and the NHS. Alison Bloomer talks to its chairman Dr David Haslam about obesity and the health impact on the older population.

Newer, less invasive techniques provide a wider option for the treatment of severe valvular heart disease in high risk patients. Older patients are likely to benefit from these techniques, as surgical risk increases with age.

Bullous pemphigoid is an autoimmune disease that causes blistering of the skin and is most commonly seen in older patients. It is associated with high morbidity and mortality, and the incidence is increasing. Few studies of effective and safe treatments have been done, but a Cochrane review recommends first-line treatment with topical corticosteroids. Professor Fenella Wojnarowska, a leading expert on this condition and coauthor of the Cochrane review, recently gave a presentation about this disease at the 4th Medical Dermatology Conference, London.

The Mental Capacity Act 2005 was fully implemented in England and Wales on 1 October 2007. A further important change to this Act was introduced in the new Mental Health Act 2007, providing safeguards against deprivation of liberty for residents of hospitals and care homes. These safeguards were formally implemented in October 2008.

Actinic keratoses are a common problem in general practice and are becoming even more so with the ageing population. These lesions can be treated in the surgery with topical fluorouracil. Concordance with treatment is improved if the condition and the inflammatory response to therapy are explained carefully to the patient.

Non-alcoholic fatty liver disease is the most common cause of raised liver enzymes in the developed world. It is a spectrum of disease, ranging from benign simple fatty liver disease(steatosis) to non-alcoholic steatohepatitis. Non-alcoholic fatty liver disease is associated with fibrosis and may eventually progress to cirrhosis. It is histologically indistinguishable from alcohol-related liver disease and also accounts for a substantial number of cases that are misdiagnosed as cryptogenic cirrhosis.3 It is an increasingly recognised form of liver disease and affects all age groups, including older people. We discuss the causes, clinical features, diagnosis, and management of non-alcoholic fatty liver disease and steatohepatitis.

Most of us will have to face the death of a person close to us, especially as we age. The process of adjusting to that loss is not a form of mental disorder in itself but factors can predispose to the development of abnormal grief.

The number of diabetics in the UK is growing exponentially and is expected to rise to 2.67 million people by the year 2030.1 However,the mortality rate associated with the macrovascular complications of diabetes is decreasing along with a general increase in lifeexpectancy for this population. This could lead to an increase in the time that people live with the morbidity associated with microvascularcomplications. Microvascular damage in the retina results in diabetic retinopathy and this article reviews the managementof this condition in older people.

The term Mild Cognitive Impairment is being used universally to represent the clinical condition between normal ageing and dementia in which individuals experience cognitive problems to a greater extent than one would expect for age, yet they do not meet currently accepted criteria for clinically probable dementia.

The MS Society supports health and social care professionals to develop services for people affected by multiple sclerosis (MS)based on quality standards and evidence of effectiveness. There is real hope of developing much more effective treatments forpeople diagnosed with MS. Many MS experts believe that within our lifetimes MS will be a condition that remains long term butis largely treatable.