Myasthenia gravis (MG) is an autoimmune disorder characterized by antibodies against acetylcholine receptors at the neuromuscular junction, leading to various symptoms such as muscle weakness, fatigue, and ptosis. While MG traditionally affects young women in their 30s, recent trends indicate an increasing incidence in the elderly population regardless of gender. Diagnosis and management of MG in the elderly pose challenges due to diverse presentations and higher risks of complications from standard treatments. Rituximab, an immunosuppressive agent, has shown efficacy in refractory MG cases, offering a promising therapeutic option. Here, we present a case of an 82-year-old female with Alzheimer dementia who presented with generalized weakness, ultimately diagnosed with MG. Despite initial treatment with immunoglobulin and subsequent relapse, rit-uximab therapy led to significant improvement in symptoms and functional status. Our case un-derscores the diagnostic challenges and therapeutic complexities of MG in the elderly and highlights rituximab as a valuable treatment option.
{"title":"A case of refractory myasthenia gravis in the elderly demonstrating remission following rituximab therapy","authors":"W. Jeong, Min Ju Kang","doi":"10.53991/jgn.2024.00136","DOIUrl":"https://doi.org/10.53991/jgn.2024.00136","url":null,"abstract":"Myasthenia gravis (MG) is an autoimmune disorder characterized by antibodies against acetylcholine receptors at the neuromuscular junction, leading to various symptoms such as muscle weakness, fatigue, and ptosis. While MG traditionally affects young women in their 30s, recent trends indicate an increasing incidence in the elderly population regardless of gender. Diagnosis and management of MG in the elderly pose challenges due to diverse presentations and higher risks of complications from standard treatments. Rituximab, an immunosuppressive agent, has shown efficacy in refractory MG cases, offering a promising therapeutic option. Here, we present a case of an 82-year-old female with Alzheimer dementia who presented with generalized weakness, ultimately diagnosed with MG. Despite initial treatment with immunoglobulin and subsequent relapse, rit-uximab therapy led to significant improvement in symptoms and functional status. Our case un-derscores the diagnostic challenges and therapeutic complexities of MG in the elderly and highlights rituximab as a valuable treatment option.","PeriodicalId":508255,"journal":{"name":"Journal of Geriatric Neurology","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141680934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Elderly care system of Sweden","authors":"Youngsoon Choi, So Yoon Kim","doi":"10.53991/jgn.2023.00115","DOIUrl":"https://doi.org/10.53991/jgn.2023.00115","url":null,"abstract":"","PeriodicalId":508255,"journal":{"name":"Journal of Geriatric Neurology","volume":"116 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141352426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Long-term care services for the elderly and the brain lesion disability system in South Korea","authors":"Kyum-Yil Kwon","doi":"10.53991/jgn.2024.00129","DOIUrl":"https://doi.org/10.53991/jgn.2024.00129","url":null,"abstract":"","PeriodicalId":508255,"journal":{"name":"Journal of Geriatric Neurology","volume":"39 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141355540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sung Chul Lim, Juhee Oh, Jeonghyun Park, Sanghyun Kim, Jusuck Lee
Tuberculous meningitis (TBM) is the most severe manifestation of extra-pulmonary tuberculosis, and has high morbidity and mortality. Therefore early treatment, which is empirical therapy, is essential to improve the clinical prognosis of TBM. But rapid diagnosis remains a challenge due to non-specific symptoms, low sensitivity and time-comsuming diagnostic tests. Mycobacterium tuberculosis antigen specific interferon-γ release assay (IGRA) is widely considered as an adjunctive test to confirm latent tuberculous infection or to support the diagnosis of active tuberculous infection. However, elderly patients with TBM have been shown to have a higher rate of false negative IGRA results than patients with tuberculosis at other sites. We report a case of TBM with a negative IGRA test for M. tuberculosis antigen.
结核性脑膜炎（TBM）是肺外结核病最严重的表现，发病率和死亡率都很高。因此，早期治疗（即经验疗法）对于改善 TBM 的临床预后至关重要。但由于非特异性症状、低敏感性和耗时的诊断检测，快速诊断仍是一项挑战。结核分枝杆菌抗原特异性干扰素-γ释放测定（IGRA）被广泛认为是确诊结核潜伏感染或支持活动性结核感染诊断的辅助检查。然而，与其他部位的结核病患者相比，老年 TBM 患者的 IGRA 结果假阴性率更高。我们报告了一例结核杆菌抗原 IGRA 检测呈阴性的 TBM 患者。
{"title":"False-negative interferon-γ release assay result in an elderly patient with tuberculous meningitis","authors":"Sung Chul Lim, Juhee Oh, Jeonghyun Park, Sanghyun Kim, Jusuck Lee","doi":"10.53991/jgn.2023.00108","DOIUrl":"https://doi.org/10.53991/jgn.2023.00108","url":null,"abstract":"Tuberculous meningitis (TBM) is the most severe manifestation of extra-pulmonary tuberculosis, and has high morbidity and mortality. Therefore early treatment, which is empirical therapy, is essential to improve the clinical prognosis of TBM. But rapid diagnosis remains a challenge due to non-specific symptoms, low sensitivity and time-comsuming diagnostic tests. Mycobacterium tuberculosis antigen specific interferon-γ release assay (IGRA) is widely considered as an adjunctive test to confirm latent tuberculous infection or to support the diagnosis of active tuberculous infection. However, elderly patients with TBM have been shown to have a higher rate of false negative IGRA results than patients with tuberculosis at other sites. We report a case of TBM with a negative IGRA test for M. tuberculosis antigen.","PeriodicalId":508255,"journal":{"name":"Journal of Geriatric Neurology","volume":"409 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139178009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Evaluation of drug-induced fall risk is often neglected in clinical practice. The purpose of this study was to analyze the effects of medication use on falls in hospitalized elderly patients. Methods: This was a retrospective case-control study. A total of 1,020 patients were evaluated who were 60 years and over and admitted between January 1st and December 31, 2021. Patients aged 60 years and over with reports of fall accidents in 2021 were included in the fall group. Cases were matched 1:4 on sex, age, medical department, and Morse Fall Scale (MFS) score to randomly selected control from patients with no falls. Demographics, MFS score, physical examination, and medication profile were collected from electronic medical records. Data were analyzed by chi-square test and multiple logistic regression analysis.Results: After adjustment for age, sex, medical department, MFS score and Charlson comorbidity index, hemoglobin level, sodium level, ambulatory aid, gait/transferring (impaired), mental status, polypharmacy (10 and more), use of anxiolytics, antipsychotics, opioids, and anticholinergics were significantly associated with falls. On multiple regression analysis, hemoglobin level, ambulatory aid (furniture), use of anxiolytics, and opioids were significantly associated with falls in every model. Conclusions: The type of medication, especially anxiolytics and opioids, was more significantly associated with increased risk of falls than polypharmacy. It is suggested to be aware of the effects of medication on falls and evaluate medication use on a regular basis.
{"title":"Association of medication use with increased fall risk in inpatients: a single-center matched study","authors":"Hae-Jin Jeon, Eun-Joo Choi, Min-Jung Kim, Ae-Hee Jung, Sun-Hoi Jung, Hyo-Nam Woo, Kyu-Nam Heo, Ju-Yeun Lee, Hyung-Min Kwon","doi":"10.53991/jgn.2023.00094","DOIUrl":"https://doi.org/10.53991/jgn.2023.00094","url":null,"abstract":"Background: Evaluation of drug-induced fall risk is often neglected in clinical practice. The purpose of this study was to analyze the effects of medication use on falls in hospitalized elderly patients. Methods: This was a retrospective case-control study. A total of 1,020 patients were evaluated who were 60 years and over and admitted between January 1st and December 31, 2021. Patients aged 60 years and over with reports of fall accidents in 2021 were included in the fall group. Cases were matched 1:4 on sex, age, medical department, and Morse Fall Scale (MFS) score to randomly selected control from patients with no falls. Demographics, MFS score, physical examination, and medication profile were collected from electronic medical records. Data were analyzed by chi-square test and multiple logistic regression analysis.Results: After adjustment for age, sex, medical department, MFS score and Charlson comorbidity index, hemoglobin level, sodium level, ambulatory aid, gait/transferring (impaired), mental status, polypharmacy (10 and more), use of anxiolytics, antipsychotics, opioids, and anticholinergics were significantly associated with falls. On multiple regression analysis, hemoglobin level, ambulatory aid (furniture), use of anxiolytics, and opioids were significantly associated with falls in every model. Conclusions: The type of medication, especially anxiolytics and opioids, was more significantly associated with increased risk of falls than polypharmacy. It is suggested to be aware of the effects of medication on falls and evaluate medication use on a regular basis.","PeriodicalId":508255,"journal":{"name":"Journal of Geriatric Neurology","volume":"337 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139177322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hokyu Kim, Minkyung Kim, J. Han, H. Kim, Chi Kyung Kim, K. Oh, Keon-Joo Lee
{"title":"A case of sudden cardiac arrest after carotid artery stenting in a patient with acute myocardial infarction","authors":"Hokyu Kim, Minkyung Kim, J. Han, H. Kim, Chi Kyung Kim, K. Oh, Keon-Joo Lee","doi":"10.53991/jgn.2023.00059","DOIUrl":"https://doi.org/10.53991/jgn.2023.00059","url":null,"abstract":"","PeriodicalId":508255,"journal":{"name":"Journal of Geriatric Neurology","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139233046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Numb chin syndrome as the first manifestation of an advanced metastatic cancer","authors":"Soei Ann, B. Suh","doi":"10.53991/jgn.2023.00080","DOIUrl":"https://doi.org/10.53991/jgn.2023.00080","url":null,"abstract":"","PeriodicalId":508255,"journal":{"name":"Journal of Geriatric Neurology","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139229001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comprehensive insight into common urinary problems in older adults","authors":"Sung-Tae Cho, Ha Ri Na","doi":"10.53991/jgn.2023.00087","DOIUrl":"https://doi.org/10.53991/jgn.2023.00087","url":null,"abstract":"","PeriodicalId":508255,"journal":{"name":"Journal of Geriatric Neurology","volume":"368 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139242050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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