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Louis R. Caplan, MD

JAMA. 2000;283:1479-1480.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Clinicians are always hoping to identify a single unifying diagnosis, but, in fact, many patients have more than one medical problem. Individuals seem to accumulate diseases (and different drug prescriptions) as they age. Physicians who care for elderly patients are well aware that multiple coexisting diagnoses are the rule rather than the exception.

Some risk factors predispose to multiple different pathogens and pathological processes and identifying them depends on the thoroughness and duration of the search. Genetic composition, lifestyle factors, and multiple exposures to potential pathogenetic elements over time help explain the coexistence of multiple different and often unrelated medical problems. Few problem-oriented lists in patients older than 70 years are short; probably none include single entries.

It should come as no surprise to physicians that patients with risk factors for atherosclerosis often have coronary artery disease, peripheral vascular occlusive disease, and strokes. The major risk . . . [Full Text of this Article]

Author Affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Mass.

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