Are patients with cognitive impairment fit to fly? Current evidence and practical recommendations.

BACKGROUND: The worldwide prevalence of dementia is increasing and represents a major public health concern. In the last decades, air travel services have undergone an impressive expansion and one of ten passengers is aged 65 years and older. While air travel can be stressful at all ages and health conditions, older individuals with cognitive impairment carry a greater risk for air-travel-related complications. Consequently, demands to general practitioners for assessing their older patient's fitness to fly are increasing. METHODS: We conducted a search of the literature in PubMed on the impact of in-flight environmental changes on passengers with cognitive impairment and possible resulting complications. This set the base for a discussion on pharmacological and non-pharmacological interventions aimed at preventing in-flight complications in this vulnerable population. RESULTS: While our research strategy identified a total of 11 articles related to older age and air travel, only three focused on passengers with cognitive impairment. Our literature review showed that the airplane environment may lead to a large spectrum of symptoms in passengers of all age groups. However, passengers with cognitive impairment due to neurodegenerative diseases are at increased risk for experiencing the most extreme symptoms such as acute confusional state. Non-pharmacological and pharmacological interventions at different stages of the travel process (before, during and after) can help prevent complications in this vulnerable population. CONCLUSION: The decision to let a patient with cognitive impairment fly requires a solid understanding of the in-flight environmental changes and their impact on older patients with cognitive impairment. Moreover, a sound weighing of the risks and benefits while considering different aspects of the patient's history is demanded. In this regard, the role of the treating physicians and caregivers is essential along with the support of the medical department of the airline.

[CME: Jet Lag Jetlag]. / CME: Jetlag CME-Fragen.

CME: Jet Lag Jetlag Abstract. Crossing several time zones by air travel leads to a temporary desynchronization of the internal clock with the external light/dark cycle. In the following jet lag occurs typically including difficulties falling asleep or waking up early as well as day-time sleepiness and significant reduction of wellbeing and fitness. To provide optimal medical advice, it is necessary to understand the human circadian rhythm and sleep-wake regulation. In consideration with additional information on travel plans, an approach to alleviate jet lag symptoms can be developed. This article addresses different supportive measures and advice on how to adjust to a new time zone and reduce jet lag symptoms.

[Medical Problems in Air Travel from a General Practitioner's Perspective]. / Hausärztliche Probleme rund um Flugreisen.

As travel by air increases, so does the number of passengers with chronic or acute medical issues. To evaluate fitness for air travel, it is necessary to consider the impact of the altered atmospheric surroundings in an airplane on the current illness to avoid a worsening of health conditions or even an emergency. As first medical contact person, the general practitioner will define supportive measures together with the patient and discuss these with the Medical Service of the airline for implementation. After a thorough evaluation, most patients will be classified fit to fly. Furthermore, a pre-travel consultation should address necessary vaccinations and information on infectious diseases.

Convulsions and hypoglycemia due to tetramethyl succinonitrile intoxication in the polyvinyl chloride (PVC) industry: A 4-year follow-up.

OBJECTIVES: Exposure and clinical data concerning cases of toxic convulsions and hypoglycemia due to tetramethyl succinonitrile (TMSN) exposure are reported. MATERIAL AND METHODS: Forty-four workers exposed to TMSN in the PVC production plant participated in occupational health medical check-ups including medical history, clinical examination and clinical chemistry. A 4-year follow-up was performed. To evaluate occupational exposure, measurements of TMSN in the ambient air as well as personal air sampling were conducted. RESULTS: Four workers suffered from convulsions with reversible pathologic EEG and 16 other persons were hypoglycemic. Other frequent symptoms included headaches, dizziness and unpleasant taste sensations. TMSN levels had been clearly above the Swiss occupational exposure limit value (MAK). Occupational hygiene interventions resulted in a reduction of the TMSN concentration below the MAK value. TMSN related symptoms have not been observed anymore in the 4-year follow-up. CONCLUSION: TMSN is a convulsive substance which in humans has also a hypoglycemic effect.