Delirium is an acute, life-threatening condition manifested by disturbance in consciousness, attention and cognition, which has a multifactorial genesis, severe consequences and commonly seen in older and senile people inpatient. Clinical experience in domestic practice shows that delirium diagnosis in older and senile patients is often missed, and its signs may be considered as manifestations of other diseases, while the state of delirium is often perceived only as an alcohol withdrawal. The article presents a clinical protocol developed and based on the firsthand experience and modern ideas by a multidisciplinary team of the Russian Gerontology Research and Clinical Centre, in which the delirium in older and senile people is considered as a geriatric syndrome. The article shows the latest diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the main diagnostic tools are given — Confusion assessment method (CAM), diagnostic and differential diagnostic algorithms; clinical subtypes, management tactics, non-drug and drug approaches to treatment, as well as principles for the prevention of geriatric delirium are described.

Osteoporosis and various cognitive disorders occupy a special place among a number of specific pathological conditions associated with age. Epidemiologically these two conditions are closely related thus the presence of cognitive impairment increases the risk of osteoporosis; and, visa versa, dementia, in particular, caused by Alzheimer's disease, and is more often detected among patients with osteoporosis. Osteoporosis in patients with dementia is an extremely serious problem, since the development of osteoporotic fractures is fraught with a sharp deterioration in cognitive status and a significant increase in disability and mortality. The connection between changes in bone mineral density and cognitive status in older adults is not well understood. The review presents data from non-clinical and clinical studies that describe common genetic and metabolic factors underlying the pathogenesis of the pathological conditions under discussion, which should be taken into account when planning future dementia and osteoporosis clinical trials.

The article provides an analysis of underlying problems in diagnosing a cognitive decline and dementia in the early stages among older adults. The reasons for postponing the treatment of patients with cognitive impairment to specialized specialists examined. Indications given of the macrosocial (stigmatization of mental disorders in general and dementia in society particularly, costs of the period until the deinstitutionalization of psychiatry), microsocial (psychological structure in the family) aspects of postponing treatment to a psychiatrist. Using the experience of Moscow memory clinics the principles of psychoeducation implementation described as well as the mechanisms of interaction between psychiatrists and general practitioners analyzed.

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. The prevalence of the disease increases with age. Course of the disease, clinical manifestations, and treatment approaches at older ages have their own characteristics. Frequent predominance of persistent instability over classic episodes of positional vertigo as well as tendency to chronicity are among the main clinical features of BPPV at advanced age. BPPV in the older adults has a higher frequency of relapses, which is explained by the continuing degenerative processes in the otolith membrane and concomitant diseases that limit physical activity of older patients. The BPPV treatment in the older can be difficult due to the technical problems during canalith repositioning procedures, concomitant diseases and insufficient mobility of patients. Nevertheless, in most cases, the treatment of BPPV in the older adults remains highly effective, which makes early-stage disease detection of great value, even with atypical clinical manifestations. Therefore, it is especially important to perform positional tests in any cases with complaints of dizziness and instability.

A novel coronavirus infection was described in 2019 in Wuhan, China. From the first months of the spread of the infection around the world, evidence began to appear that patients after recovery had various symptoms. Duration, intensity, and variability of symptoms varies among patients and are often not associated with the severity of the most acute illness. Recently the concept of post-COVID syndrome (post-COVID or long-COVID in the English-language literature) has acquired increasingly clear diagnostic criteria. Persistent symptoms and / or the appearance of delayed complications after 4 weeks or more from the onset of symptoms of an acute illness are commonly called post-COVID syndrome. This review provides information on post-COVID syndrome, its pathophysiology and specific organ lesions. Relevant data on the interdisciplinary management of patients who have undergone a new coronavirus infection will be considered and an algorithm for identifying the diagnosis will be proposed.

Cognitive disorders are one of the most significant problems of older. Special attention should be paid to the diagnosis of early pre-dementia stages of cognitive impairment (CI): subjective, subtle and mild.
The aim of this study was to determine the criteria of pre-mild: subjective and subtle cognitive decline (SCD).
Material and methods. The study included 602 patients with pre-mild cognitive impairment with a mean age of 63.24±11.24 years and 515 patients with mild cognitive impairment aged 71.2±8.0 years. The indicators of patients were compared with those of 104 healthy people (average age 64.23±8.14 years) who did not complain of memory impairment and had no deviations during clinical and neuropsychological examination.
Results and discussion. Groups of patients with subjective and subtle cognitive decline were distinguished, which differed in most characteristics. At the same time, in both groups of patients, deviations in the results of neuropsychological tests did not exceed one standard deviation from the average results for healthy people, which, in fact, allowed them to be attributed to «pre-mild» cognitive decline. The data obtained confirmed the heterogeneity of the «pre-mild» cognitive decline. The study also shows the allocation limitation of pre-mild cognitive impairment only on the basis of a formal approach based on the quantitative characteristics of neuropsychological research with a difference from control groups necessarily exceeding one standard deviation.
Conclusion. The analysis showed the heterogeneity of pre-dementia and pre-mild cognitive impairments that are divided according to the degree of changes in objectively assessed cognitive functions with the similarity of subjective complaints. It is proposed to distinguish subjective cognitive decline with completely normal neuropsychological characteristics and subtle cognitive decline in the event of changes in individual indicators evaluating mainly the control functions and memory.

Overactive bladder (OAB) — is a clinical syndrome which includes urge urination with or without urge urinary incontinence which is usually accompanied by frequent urination and nocturia. In most cases, OAB does not pose a threat to the life of patients, but significantly worsens the quality of all spheres of human life. Urge urinary incontinence is one of the main causes of falls in older patients, which often leads to fractures of the proximal femur and is accompanied by severe complications. Drug therapy with M-cholinoblockers (cholinolytics) is the leading direction in the treatment of patients with OAB. However, this type of therapy remains poorly understood in older men and women. The choice of an effective and safe cholinolytic for older and senile patients is the subject of discussion and scientific research. The results obtained show trospium chloride as an effective drug for the treatment of urgent and frequent urination due to idiopathic OAB, as well as the lack of influence on cognitive function in older patients.

Using the clinical case of Waldenstrom's macroglobulinemia in an older patient, a research was carried out to find an algorithm for diagnosing the disease in patients of advance age, whose frequent polymorbid pathology makes it difficult to diagnose and detect the disease at an early stage. The study of Waldenstrom's macroglobulinemia has great relevance due to the dim clinical picture and high prevalence among the older population. This condition is relatively rare, but its timely detection is very important to prevent the development of complications. We analyzed the literature dedicated to study Waldenstrom's macroglobulinemia, as well as pathways of transformation a monoclonal gammopathy of undetermined significance into Waldenstrom's macroglobulinemia.