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Article ; Online: Freezing of gait in older people: associated conditions, clinical aspects, assessment and treatment.

Thanvi, Bhomraj / Treadwell, Sean D

2010 Volume 86, Issue 1018, Page(s) 472–477

Abstract: Freezing of gait (FOG) is a disabling condition in older people. It is common in Parkinson's disease (PD) and other parkinsonian syndromes. The assessment of this condition poses challenges due to its episodic and transient nature and its frequent ... ...

Abstract	Freezing of gait (FOG) is a disabling condition in older people. It is common in Parkinson's disease (PD) and other parkinsonian syndromes. The assessment of this condition poses challenges due to its episodic and transient nature and its frequent association with cognitive impairment. The pathophysiology of FOG is complex and poorly understood. Morphological brain imaging is of limited value in the evaluation of FOG, and functional imaging techniques are currently being developed to study the phenomenon. The treatment of 'off' time FOG in PD is relatively straight forward, but 'on' freezing in PD and FOG associated with other conditions may be difficult to treat. FOG is a strong risk factor for falls and adversely affects the quality of life of patients and carers. A multidisciplinary team approach is essential for optimum management.
MeSH term(s)	Aged ; Dopamine Agents/therapeutic use ; Gait Disorders, Neurologic/etiology ; Gait Disorders, Neurologic/therapy ; Humans ; Neurodegenerative Diseases/complications ; Neurodegenerative Diseases/diagnosis ; Parkinson Disease/complications ; Parkinsonian Disorders/complications ; Patient Care Team
Chemical Substances	Dopamine Agents
Language	English
Publishing date	2010-08
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	80325-x
ISSN	1469-0756 ; 0032-5473
ISSN (online)	1469-0756
ISSN	0032-5473
DOI	10.1136/pgmj.2009.090456
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Article ; Online: Malignant middle cerebral artery (MCA) infarction: pathophysiology, diagnosis and management.

Treadwell, Sean D / Thanvi, Bhomraj

Postgraduate medical journal

2010 Volume 86, Issue 1014, Page(s) 235–242

Abstract: Malignant MCA infarction' is the term used to describe rapid neurological deterioration due to the effects of space occupying cerebral oedema following middle cerebral artery (MCA) territory stroke. Early neurological decline and symptoms such as ... ...

Abstract	'Malignant MCA infarction' is the term used to describe rapid neurological deterioration due to the effects of space occupying cerebral oedema following middle cerebral artery (MCA) territory stroke. Early neurological decline and symptoms such as headache and vomiting should alert the clinician to this syndrome, supported by radiological evidence of cerebral oedema and mass effect in the context of large hemispheric infarction. The prognosis is generally poor, and death usually occurs as a result of transtentorial herniation and brainstem compression. Treatment options include general measures and pharmacological agents to limit the extent of oedema, and surgical decompression to relieve the pressure effects. Until recently there has been little evidence to guide appropriate treatment, though in the last few years randomised data have been published addressing the role of surgical decompression. A pooled analysis of three European randomised controlled trials suggests that hemicraniectomy performed within 48 h significantly reduces mortality, and improves functional outcome in selected patients, and this has been reflected in recent national guidelines.
MeSH term(s)	Brain Edema/prevention & control ; Decompression, Surgical/methods ; Humans ; Infarction, Middle Cerebral Artery/diagnosis ; Infarction, Middle Cerebral Artery/etiology ; Infarction, Middle Cerebral Artery/therapy ; Intracranial Hypertension/prevention & control ; Patient Positioning ; Stroke/prevention & control ; Tomography, Emission-Computed, Single-Photon ; Tomography, X-Ray Computed
Language	English
Publishing date	2010-04
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	80325-x
ISSN	1469-0756 ; 0032-5473
ISSN (online)	1469-0756
ISSN	0032-5473
DOI	10.1136/pgmj.2009.094292
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Article ; Online: Complete occlusion of extracranial internal carotid artery: clinical features, pathophysiology, diagnosis and management.

Thanvi, Bhomraj / Robinson, Tom

Postgraduate medical journal

2007 Volume 83, Issue 976, Page(s) 95–99

Abstract: A complete occlusion of the internal carotid artery (ICA) is an important cause of cerebrovascular disease. A never-symptomatic ICA occlusion has a relatively benign course, whereas symptomatic occlusion increases future risk of strokes. Ultrasonography, ...

Abstract	A complete occlusion of the internal carotid artery (ICA) is an important cause of cerebrovascular disease. A never-symptomatic ICA occlusion has a relatively benign course, whereas symptomatic occlusion increases future risk of strokes. Ultrasonography, magnetic resonance imaging and contrast angiography are useful diagnostic tests, and functional imaging of the brain (eg, with positron emission tomography) helps to understand haemodynamic factors involved in the pathophysiology of brain ischaemia. Recently, there has been a resurgence of interest in the role of extracranial-intracranial bypass surgery for the treatment of completely occluded ICA. With advances in the measurement of cerebral haemodynamics, it may be possible to identify high-risk patients who could benefit from the bypass surgery.
MeSH term(s)	Anticoagulants/therapeutic use ; Brain Ischemia/etiology ; Carotid Artery, Internal ; Carotid Stenosis/diagnosis ; Carotid Stenosis/etiology ; Carotid Stenosis/therapy ; Cerebral Revascularization/methods ; Fibrinolytic Agents/therapeutic use ; Humans ; Ischemia/etiology ; Prognosis ; Retinal Vessels
Chemical Substances	Anticoagulants ; Fibrinolytic Agents
Language	English
Publishing date	2007-02
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	80325-x
ISSN	1469-0756 ; 0032-5473
ISSN (online)	1469-0756
ISSN	0032-5473
DOI	10.1136/pgmj.2006.048041
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Article: Sporadic cerebral amyloid angiopathy--an important cause of cerebral haemorrhage in older people.

Thanvi, Bhomraj / Robinson, Tom

Age and ageing

2006 Volume 35, Issue 6, Page(s) 565–571

Abstract: Cerebral amyloid angiopathy (CAA) is an important cause of primary intracerebral haemorrhage (PICH) in older people, accounting for approximately 10% of all types of PICH. The amount of amyloid deposition in the vessels and vasculopathic changes ... ...

Abstract	Cerebral amyloid angiopathy (CAA) is an important cause of primary intracerebral haemorrhage (PICH) in older people, accounting for approximately 10% of all types of PICH. The amount of amyloid deposition in the vessels and vasculopathic changes determine the propensity to PICH. The risk factors of CAA include advanced age and the presence of certain alleles of apolipoprotein E. There are no specific clinical features of CAA-related PICH, although lobar, recurrent or multiple simultaneous haemorrhages in older patients should raise suspicion of its diagnosis. A definitive diagnosis of CAA requires pathological examination of the affected tissue. However, with modern imaging techniques, it is possible to make a diagnosis of 'probable CAA' in patients presenting with PICH. Gradient-echo magnetic resonance imaging is a sensitive, non-invasive technique for identifying small haemorrhages in life. Currently, there is no specific treatment available for CAA. Recent advances in the immunopathology and pathogenesis of CAA are expected to help in developing specific anti-amyloid therapy.
MeSH term(s)	Aged ; Brain/blood supply ; Brain/pathology ; Cerebral Amyloid Angiopathy/complications ; Cerebral Amyloid Angiopathy/diagnosis ; Cerebral Amyloid Angiopathy/therapy ; Cerebral Hemorrhage/etiology ; Humans ; Prognosis ; Risk Factors
Language	English
Publishing date	2006-11
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	186788-x
ISSN	1468-2834 ; 0002-0729
ISSN (online)	1468-2834
ISSN	0002-0729
DOI	10.1093/ageing/afl108
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Article: Reducing hospital bed use by frail older people: results from a systematic review of the literature.

Philp, Ian / Mills, Karen A / Thanvi, Bhomraj / Ghosh, Kris / Long, Judith F

International journal of integrated care

2013 Volume 13, Page(s) e048

Abstract: Introduction: Numerous studies have been conducted in developed countries to evaluate the impact of interventions designed to reduce hospital admissions or length of stay (LOS) amongst frail older people. In this study, we have undertaken a systematic ... ...

Abstract	Introduction: Numerous studies have been conducted in developed countries to evaluate the impact of interventions designed to reduce hospital admissions or length of stay (LOS) amongst frail older people. In this study, we have undertaken a systematic review of the recent international literature (2007-present) to help improve our understanding about the impact of these interventions. Methods: WE SYSTEMATICALLY SEARCHED THE FOLLOWING DATABASES: PubMed/Medline, PsycINFO, CINAHL, BioMed Central and Kings Fund library. Studies were limited to publications from the period 2007-present and a total of 514 studies were identified. Results: A total of 48 studies were included for full review consisting of 11 meta-analyses, 9 systematic reviews, 5 structured literature reviews, 8 randomised controlled trials and 15 other studies. We classified interventions into those which aimed to prevent admission, interventions in hospital, and those which aimed to support early discharge. Conclusions: Reducing unnecessary use of acute hospital beds by older people requires an integrated approach across hospital and community settings. A stronger evidence base has emerged in recent years about a broad range of interventions which may be effective. Local agencies need to work together to implement these interventions to create a sustainable health care system for older people.
Language	English
Publishing date	2013-12-05
Publishing country	England
Document type	Journal Article
ISSN	1568-4156
ISSN	1568-4156
DOI	10.5334/ijic.1148
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Article ; Online: Reducing hospital bed use by frail older people

Ian Philp / Karen Anne Mills / Judith F Long / Bhomraj Thanvi / Kris Ghosh

International Journal of Integrated Care, Vol 13, Iss

results from a systematic review of the literature

2013 Volume 4

Abstract: Introduction Numerous studies have been conducted in developed countries to evaluate the impact of interventions designed to reduce hospital admissions or length of stay amongst frail older people. In this study we have undertaken a systematic review of ... ...

Abstract	Introduction Numerous studies have been conducted in developed countries to evaluate the impact of interventions designed to reduce hospital admissions or length of stay amongst frail older people. In this study we have undertaken a systematic review of the recent international literature (2007-present) to help improve our understanding about the impact of these interventions. Methods We systematically searched the following databases: PubMed / Medline, PsycINFO, CINAHL, BioMed Central, Kings Fund library. Studies were limited to publications from the period 2007-present and a total of 514 studies were identified. Results A total of 48 studies were included for full review consisting of 11 meta-analyses, 9 systematic reviews, 5 structured literature reviews, 8 randomised controlled trials and 15 other studies. We classified interventions into those which aimed to prevent admission, interventions in hospital, and those which aimed to support early discharge. Conclusions Reducing unnecessary use of acute hospital beds by older people requires an integrated approach across hospital and community settings. A stronger evidence base has emerged in recent years about a broad range of interventions which may be effective. Local agencies need to work together to implement these interventions to create a sustainable healthcare system for older people.
Keywords	older people ; hospital bed use ; admissions avoidance ; Medicine (General) ; R5-920
Subject code	360
Language	English
Publishing date	2013-12-01T00:00:00Z
Publisher	Ubiquity Press
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Reducing hospital bed use by frail older people

Ian Philp / Karen Anne Mills / Judith F Long / Bhomraj Thanvi / Kris Ghosh

International Journal of Integrated Care, Vol 13, Iss

results from a systematic review of the literature

2013 Volume 4

Abstract	Introduction Numerous studies have been conducted in developed countries to evaluate the impact of interventions designed to reduce hospital admissions or length of stay amongst frail older people. In this study we have undertaken a systematic review of the recent international literature (2007-present) to help improve our understanding about the impact of these interventions. Methods We systematically searched the following databases: PubMed / Medline, PsycINFO, CINAHL, BioMed Central, Kings Fund library. Studies were limited to publications from the period 2007-present and a total of 514 studies were identified. Results A total of 48 studies were included for full review consisting of 11 meta-analyses, 9 systematic reviews, 5 structured literature reviews, 8 randomised controlled trials and 15 other studies. We classified interventions into those which aimed to prevent admission, interventions in hospital, and those which aimed to support early discharge. Conclusions Reducing unnecessary use of acute hospital beds by older people requires an integrated approach across hospital and community settings. A stronger evidence base has emerged in recent years about a broad range of interventions which may be effective. Local agencies need to work together to implement these interventions to create a sustainable healthcare system for older people.
Keywords	older people ; hospital bed use ; admissions avoidance ; Medicine (General) ; R5-920
Subject code	360
Language	English
Publishing date	2013-12-01T00:00:00Z
Publisher	Ubiquity Press
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Levodopa-induced dyskinesia in Parkinson's disease: clinical features, pathogenesis, prevention and treatment.

Thanvi, Bhomraj / Lo, Nelson / Robinson, Tom

Postgraduate medical journal

2007 Volume 83, Issue 980, Page(s) 384–388

Abstract: Levodopa is the most effective drug for treating Parkinson's disease. However, long-term use of levodopa is often complicated by significantly disabling fluctuations and dyskinesias negating its beneficial effects. Younger age of Parkinson's disease ... ...

Abstract	Levodopa is the most effective drug for treating Parkinson's disease. However, long-term use of levodopa is often complicated by significantly disabling fluctuations and dyskinesias negating its beneficial effects. Younger age of Parkinson's disease onset, disease severity, and high levodopa dose increase the risk of development of levodopa-induced dyskinesias (LID). The underlying mechanisms for LID are unclear though recent studies indicate the importance of pulsatile stimulation of striatal postsynaptic receptors in their pathogenesis. The non-human primates with MPTP-induced parkinsonism serve as a useful model to study dyskinesia. Once established, LID are difficult to treat and therefore efforts should be made to prevent them. The therapeutic and preventative strategies for LID include using a lower dosage of levodopa, employing dopamine agonists as initial therapy in Parkinson's disease, amantadine, atypical neuroleptics, and neurosurgery. LID can adversely affect the quality of life and increase the cost of healthcare.
MeSH term(s)	Antiparkinson Agents/adverse effects ; Dopamine Agents/adverse effects ; Dyskinesia, Drug-Induced/etiology ; Dyskinesia, Drug-Induced/prevention & control ; Dyskinesia, Drug-Induced/therapy ; Humans ; Levodopa/adverse effects ; Neurosurgical Procedures/methods ; Parkinson Disease/complications ; Receptors, N-Methyl-D-Aspartate/drug effects ; Risk Factors
Chemical Substances	Antiparkinson Agents ; Dopamine Agents ; Receptors, N-Methyl-D-Aspartate ; Levodopa (46627O600J)
Language	English
Publishing date	2007-06
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	80325-x
ISSN	1469-0756 ; 0032-5473
ISSN (online)	1469-0756
ISSN	0032-5473
DOI	10.1136/pgmj.2006.054759
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Article: Essential tremor-the most common movement disorder in older people.

Thanvi, Bhomraj / Lo, Nelson / Robinson, Tom

Age and ageing

2006 Volume 35, Issue 4, Page(s) 344–349

Abstract: Essential tremor (ET) affects approximately 4% of the population above 65 years of age. The traditional view that ET is a familial monosymptomatic disorder with a benign prognosis has recently been challenged, as it is now known to be a progressive and ... ...

Abstract	Essential tremor (ET) affects approximately 4% of the population above 65 years of age. The traditional view that ET is a familial monosymptomatic disorder with a benign prognosis has recently been challenged, as it is now known to be a progressive and clinically heterogeneous condition with sporadic and familial forms. The pathogenesis of ET is not fully understood, though a disordered central mechanism is the most likely site of origin with possible modulation by muscle adrenoreceptors. The limited post-mortem studies have not shown consistent abnormalities in the brains of ET patients. ET is often misdiagnosed as Parkinson's disease, particularly in the older population. Tremor amplitude increases with age, accounting for substantial disability in older people. Current therapy (drugs and neurosurgery) has significant limitations in older people. A better understanding of its pathophysiology in the future will help in developing more effective therapy, including neuroprotective strategies.
MeSH term(s)	Adrenergic beta-Antagonists/therapeutic use ; Aged ; Anti-Dyskinesia Agents/therapeutic use ; Anticonvulsants/therapeutic use ; Benzodiazepines/therapeutic use ; Botulinum Toxins/therapeutic use ; Carbonic Anhydrase Inhibitors/therapeutic use ; Diagnosis, Differential ; Dopamine Plasma Membrane Transport Proteins ; Essential Tremor/diagnosis ; Essential Tremor/epidemiology ; Essential Tremor/etiology ; Essential Tremor/therapy ; Humans ; Primidone/therapeutic use
Chemical Substances	Adrenergic beta-Antagonists ; Anti-Dyskinesia Agents ; Anticonvulsants ; Carbonic Anhydrase Inhibitors ; Dopamine Plasma Membrane Transport Proteins ; Benzodiazepines (12794-10-4) ; Primidone (13AFD7670Q) ; Botulinum Toxins (EC 3.4.24.69)
Language	English
Publishing date	2006-07
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	186788-x
ISSN	1468-2834 ; 0002-0729
ISSN (online)	1468-2834
ISSN	0002-0729
DOI	10.1093/ageing/afj072
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Article: Vascular parkinsonism--an important cause of parkinsonism in older people.

Thanvi, Bhomraj / Lo, Nelson / Robinson, Tom

Age and ageing

2005 Volume 34, Issue 2, Page(s) 114–119

Abstract: Parkinsonism due to cerebrovascular disease (vascular parkinsonism, VP) is a distinct clinicopathological entity. It accounts for 4.4-12% of all cases of parkinsonism. Since there are no specific diagnostic criteria, true incidence and prevalence rates ... ...

Abstract	Parkinsonism due to cerebrovascular disease (vascular parkinsonism, VP) is a distinct clinicopathological entity. It accounts for 4.4-12% of all cases of parkinsonism. Since there are no specific diagnostic criteria, true incidence and prevalence rates of VP are not known. Typically, parkinsonism in slow-onset VP tends to be bilaterally symmetrical, affecting the lower limbs more than the upper limbs ('lower-body parkinsonism'), and resting tremor is usually absent. Commonly noted lesions on brain imaging in VP are lacunes, white matter changes and, rarely, territorial infarcts. As coincidental vascular lesions in idiopathic Parkinson's disease (PD) are common, the mere presence of these lesions on brain imaging is not diagnostic of VP. Pathological evidence of a vascular disease in the absence of typical PD lesions (e.g. Lewy bodies) is the diagnostic 'gold standard'. VP is generally considered to be poorly or non-responsive to L-dopa therapy. However, recent studies have shown a beneficial effect of L-dopa in a subset of patients. Despite great advances in overall understanding of the disease, there are several gaps in our knowledge.
MeSH term(s)	Aged ; Antiparkinson Agents/therapeutic use ; Brain/drug effects ; Brain/pathology ; Cerebral Infarction/complications ; Cerebral Infarction/diagnosis ; Diagnostic Imaging ; Humans ; Intracranial Arteriosclerosis/complications ; Intracranial Arteriosclerosis/diagnosis ; Levodopa/therapeutic use ; Neurologic Examination ; Parkinson Disease/diagnosis ; Parkinson Disease, Secondary/diagnosis ; Parkinson Disease, Secondary/drug therapy ; Risk Factors ; Treatment Outcome
Chemical Substances	Antiparkinson Agents ; Levodopa (46627O600J)
Language	English
Publishing date	2005-03
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	186788-x
ISSN	1468-2834 ; 0002-0729
ISSN (online)	1468-2834
ISSN	0002-0729
DOI	10.1093/ageing/afi025
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