By M. Hurit. Chapman University. 2017.

How to Read a Paper: The Basics of How to use an article about disease probability for differ- Evidence-Based Medicine purchase rosuvastatin 20 mg without prescription, 2nd ed discount rosuvastatin 20mg fast delivery. Evidence-Based Medicine: How to Practice and to finding and using the best evidence in caring for patients. Are there general Nomenclature principles that may usefully apply generally to senes- cence, or is senescence simply a collection of degenera- Aging: showing the effects of time; a process of change, usually tive entropic processes that have in common only that gradual and spontaneous they occur over time? Both views are supportable; Senescence: the loss of the power of cell division and growth indeed, the latter is perhaps the more common view (and function with time, leading to death) (The New Shorter among gerontologists and is the most supportable by evo- Oxford Dictionary) 1 Gerontologists consider the term aging insufficiently lutionary theory. However, gerontology, like geriatrics, has evolved precise because any process that occurs over time, for into a discipline in part because senescence entails example, rusting or development, may be reasonably several general characteristics and because impairments referred to as aging. Furthermore, although there are associated with senescence are largely predictable within reasons to imagine that "aging" is a continuum beginning a species. For example, mortality (and other senescent with development, these two terms are usually used to changes) conform (within limits) to a precise mathemat- refer to distinct processes. Specifically, development (as in ical description, the Gompertz curve, whose parameters an embryo) refers to a generative process over time nec- 2 essary for (and primarily evident at the beginning of) life, are characteristic of each species. Similarly, dietary restriction dramatically reduces many age-related whereas senescence refers to a degenerative process ulti- impairments and increases maximum life span across a mately incompatible with (and primarily evident at the wide range of phyla. Whether development and aging form, in any These general characteristics and the specificity of informative way, a mechanistic continuum is a hypothe- senescence require explanation, and seeking these ex- sis that is far from proven. Furthermore, base searches have been greatly complicated by the recent studies have suggested that senescence may entail assignment of the term aging to the process of develop- simpler and more orderly molecular processes than ment, without a concomitant general use of the term previously assumed. Thus, for example, the some of these age-related impairments as any other wisdom (or, at any rate, experience that ought to lead to disease. This integration of geriatrics into the tradi- that occur during aging are usefully considered a mani- tional medical model is an outcome of recent progress in festation of senescence. Mobbs Theories of Aging convincingly by evolutionary biologists, that senescence did not evolve because it bestowed advantage on the species, but rather senescence is essentially an evolu- Is Senescence an Entropic Process? An Evolutionary Theories of Aging essential feature of life is the low level of internal entropy that characterizes biologic entities compared to the envi- The fact that each species is characterized by a charac- ronment.

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Cognitive problems Research has identified two broad areas where MS seems to be involved or has effects that are not so much to do with the mind in general cheap 10mg rosuvastatin fast delivery, but with what are more neatly and technically considered as cognitive issues on the one hand order 5mg rosuvastatin, and attitudinal and emotional issues on the other. FATIGUE, COGNITIVE PROBLEMS AND DEPRESSION 81 Cognitive issues are those that concern our thinking, memory and other skills, which we use to form and understand language; how we learn and remember things; how we process information; how we plan and carry out tasks; how we recognize objects, and how we calculate. It was thought until recently that memory loss and some other cognitive problems were a rare occurrence. However, more recent research has suggested that a range of cognitive problems varying widely in type and severity may be present in many people with MS. Of course people with MS, just like anyone else of a similar age and sex, can suffer mental illness or dementia but, clinically, people with MS do appear to have more depression (see next section) compared to other people, and perhaps have what might be called mood swings rather more often. More recently, studies have shown that many people with MS have some problems with memory and with what are called their cognitive abilities, and these seem to be associated with the effects of the disease. It is thought that MS could lead to a subcortical dementia but this is not inevitable. How to recognize the problem We can all change without necessarily realizing the nature or extent of that change – until someone tells us. Sometimes people with MS may be so depressed or anxious that they think their cognitive problems are worse than in fact they are; on the other hand, they may not want to acknowledge them at all, for they do not want to think that MS may affect their cognitive as well as their physical functions. In addition to the general variability of symptoms, an issue that we have indicated is characteristic of MS, we have also noted that previously it has been very difficult to link cognitive performance to any other aspect of MS. However, more recently, studies using MRI (magnetic resonance imaging) have shown that the more general the demyelination the more likely it is that significant cognitive problems will also exist. Moreover, MS lesions in certain areas of the brain seem to be associated with cognitive difficulties. Further work will, it is hoped, be able to identify more precisely the relationship between certain kinds of cognitive problems and areas of the brain affected by MS. In addition, during acute attacks of MS, it has been observed that cognitive performance – memory and concentration, for example – may get significantly worse and then improve again; on the other hand, if the cognitive problems have arisen gradually and have been present for some time, then it is unlikely that they will improve substantially. To avoid possible uncertainties, concerns or perhaps even recriminations, you should seek an objective assessment of any cognitive problems, if possible with a referral to a clinical psychologist, or more specifically to a neuropsychologist – usually from your neurologist. Professional opinions Until the results of recent research, many GPs and neurologists did not consider cognitive symptoms to be a major issue in relation to MS.

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