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<h4></h4> <p>The purpose of this study was to determine the frequency with which over-the-counter and prescription medications with potential anticholinergic side effects were used by a sample of 193 older adults with memory problems. Medications with anticholinergic side effects are contraindicated in this population because they can worsen memory impairment and increase confusion. A retrospective chart review of clients seen between October 1999 and April 2004 was completed, with a secondary analysis of the medications older adults (older than 50 years) were taking at their initial clinic visit. Findings revealed that 10.3% of these older adults were consuming one or more medications with anticholinergic side effects. These findings demonstrate an ongoing opportunity for nurses to educate health care providers, as well as consumers, regarding the dangers of these medications.</p>

Dementia and depression are common disorders among elderly populations. Their frequent co-morbidity and similar presentations create a complex clinical scenario for the health care professional. The objective of this study was to determine common characteristics of older adults with dementia that were associated with depression. Data from a retrospective chart review of 242 patients visiting an outpatient geriatric clinic were analyzed to determine the potential relationship between depression and several social- and health-related variables. Results from regression analysis show that taking greater numbers of medications and living in a less independent environment were both associated with greater depression, while using alcohol was associated with less depression. This information could be easily obtained during an office visit and used to help identify patients who suffer from dementia and are at risk for depression and require further evaluation.

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T he patient is a 35-year-old man with a background of crystalproven gout. The image on the left side in the Figure represents a dual-energy computed tomography (DECT) scan, which demonstrate a tophaceous deposit (green color) and erosive changes with joint destruction of the right second metatarsophalangeal (MTP) joint (white arrow). There are also minimal tophi deposits in the first MTP joint, around the ankle, and in proximity to the Achilles tendon insertion (green color). The clinical image on the right side of the screen in the Figure shows the corresponding tophus swelling of the second MTP joint (black arrow).Dual-energy CT uses 2 x-ray tubes with DECT scanning (80 and 140 kVp) to simultaneously acquire 2 sets of images of the desired anatomic region. 1 Chemical composition of the targeted material is determined by attenuation images acquired by the dual scanner. Dual-energy CT is a new noninvasive modality that is useful in identifying monosodium urate (MSU) crystals. 2 Dualenergy CT imaging has been reported to provide a high sensitivity (0.93) and specificity (0.78-0.95) for detection of MSU crystal deposits in gout. 3 There are no studies to date to address how early in the course of disease or what is the volumetric-threshold for tophus detection. Dual-energy CT may be used as an objective measure in monitoring response to therapy 2 and in diagnosis of acute gout if arthrocentesis fails or is not possible to perform. 3 However, DECT scan should not replace arthrocentesis whenever the latter is feasible. Synovial fluid examination should remain the diagnostic test of choice in acute arthritis to confirm presence of MSU and to exclude other causes of acute arthritis, specifically, septic arthritis. REFERENCES1. Karcaaltincaba M, Aktas A. Dual-energy CT revisited with multidetector CT: review of principles and clinical applications. Diagn Interv Radiol. 2011; 17:181-194. 2. Desai MA, Peterson JJ, Garner HW, et al. Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics. 2011;31:1365-1375; discussion 76-77. 3. Bongartz TG, Katrina N, Kavros SJ, et al. Diagnosis of gout using dual-energy computed tomography: an accuracy and diagnostic yield study [abstract]. Arthritis Rheum. 2011;63(suppl 10):1617. From the