COMMON PATHOPHYSIOLOGICAL MECHANISMS UNDERLYING DEMENTIA AND PRESSURE ULCERS
Efraim Jaul
Hebrew University of Jerusalem, Israel
: J Regen Med
Abstract
Increased longevity, especially in frail elderly patients, there is a higher rate of dementia resulting in functional and cognitive impairment leading to disabilities, immobility and Pressure Ulcers (PU), representing a final pathological pathway. Our research goal was to elucidate common pathophysiological mechanisms underlying dementia and PU. Apparently, it looks as these are two separate conditions. Dementia is typically viewed as a neurodegenerative disease without peripheral implications. Pressure ulcers are manifested as a local skin problem particularly in frail, immobile elderly patient. Finding common etiological paths between pressure ulcers and dementia will produce new treatment strategies that could lead to the prevention of pressure ulcers, sensitized clinician awareness to PU in mild to moderate dementia could lead to the suppression of PU onset, ultimately decreasing suffering during the advanced stages of dementia. Studies consistently demonstrate a significant association between various comorbidities especially dementia and pressure ulcers in frail elderly patients. The precise physiological mechanisms that lead to dementia and pressure ulcers comorbidity versus other comorbidities are not clear. The potential hypothesized pathophysiological mechanism causing "peripheral" impact of dementia, particular in Alzheimer disease, is related to changes in fibroblast aggregation rates in the skin tissue, in conjunction with continuous deterioration of the neurophysiological subsystems associated with: motor, sensory, autonomic, cognitive, and behavioral pathways linking pressure ulcers with dementia progression.
Biography
Efraim Jaul is a specialist in Family Medicine and Geriatric Medicine, Clinical Senior Lecturer in the Hebrew University of Jerusalem, Faculty of Medicine-Jerusalem. Since 1991 served as Head Department of Geriatric Skilled Nursing department, Sarah Herzog Medical Center Jerusalem, Israel affiliated with Medical Faculty, Jerusalem. Published 44 scientific papers in national and international journals and five books on aging. Main interest is assisting the frail elderly confronted with Pressure Ulcers. In 2002, developed and established a pioneering inpatient unit at the Herzog Hospital specifically for the treatment of pressure ulcers. The vision for this approach in a published article entitled "Setting up a Dedicated Pressure Ulcer Unit", (Journal of Wound Care, 2003), concerning the need for a special unit specialized system and the resulting benefits for the immobile patients. This unit has elicited interest with concerns for patients with advanced dementia, chronic diseases and vegetative state. Currently, investigate comorbidities focusing on advanced dementia and pressure ulcers in an effort to understand the underlying pathogenesis.
