(9-21-16)
Health challenges with aging
Neurological
A quick review of your brain
- brain stem (and spine)
- Ascending reticular systems (brain stem)
- arousal/(editing)
- Ascending reticular systems (brain stem)
- subcortical (limbic) structures
- Limbic systems (subcortical)
- arousal/attention/(editing)
- biological drives (basic instincts)
- emotional behavior/reinforcement
- temperament (?)
- consolidation of verbal learning/memory
- Limbic systems (subcortical)
- cerebellium: coordination of motor actions, efficiency of well learned/rehearsed responses (and perhaps some other things)
- cortex
- posterior — highest order sensory (input) processing
- sensory unit: processing input
- posterior: temporal, parietal, & occipital lobes
- sensory unit: processing input
- anterior — executive processing and output (motor) control
- motor unit: executive functions, “pause and plan”
- frontal: frontal lobe
- arousal/attention/(editing)
- forming plans
- executing plans
- verifying results
- frontal: frontal lobe
- motor unit: executive functions, “pause and plan”
- posterior — highest order sensory (input) processing
Dementing disorders
- dementia: literal — generalized loss of mental ability
- in contrast: “intellectual disability” (formally known as mental retardation) is a generalized failure to acquire mental ability
- clinical dementia: loss of multiple (e.g., two or more) mental abilities
- in DSM 5 dementia is now refered to as a Major Neurocognitive Disorder
- Dementia of the Alzheimer’s Type (DAT): progressive loss of ability in two or more areas of mental functioning (typically memory plus at least one other)
- Alzheimer’s disease: Alois Alzheimer, a German physician, met Ms. August Deter, a patient in the Frankfurt asylum, in 1901. She had severe memory loss and a number of behavioral problems. She told Dr. Alzheimer: “Ich bah mich verloren” (“I have lost myself”). When she passed away, a number of years later, at the age of 55 Dr. Alzheimer obtained her medical records and her brain. Examining the brain using Franz Nissal’s then new silver staining technique for visualizing neurons in postmortem brain samples, Dr. Alzheimer observed plaques and neurofibrillary tanges in sections of her brain. On November 3, 1906 he presented his findings at a medical meeting. Alzheimer’s findings would included in Emil Kraepelin’s influential textbook of psychiatry and by 1911 the term, “Alzheimer’s disease” was in common use. Ms. Deter today would be said to have “early on-set Alzheimer’s disease” because of the onset of symptoms prior to age 65.
- amyloid plaques: clumps of protein fragments
- neurofibrillary tangles: abnormal tau protein causes collapse of support structure maintaining microtubules in neurons–neurofibilary tangles form
- several gene alleles increase risk of Alzheimer’s disease
- DAT: a pattern of dementia defined by progress changes in mental status
- “early” (prior to 60-65) vs. “late” onset (after 60-65)
- presumptive Alzheimer’s dementia/DAT accounts for 15% of dementias (Pliszka, 2016)
- mild cognitive impairment (Minor Neurocognitive Disorder in DSM 5) vs. age-related cognitive decline
- Alzheimer’s disease: Alois Alzheimer, a German physician, met Ms. August Deter, a patient in the Frankfurt asylum, in 1901. She had severe memory loss and a number of behavioral problems. She told Dr. Alzheimer: “Ich bah mich verloren” (“I have lost myself”). When she passed away, a number of years later, at the age of 55 Dr. Alzheimer obtained her medical records and her brain. Examining the brain using Franz Nissal’s then new silver staining technique for visualizing neurons in postmortem brain samples, Dr. Alzheimer observed plaques and neurofibrillary tanges in sections of her brain. On November 3, 1906 he presented his findings at a medical meeting. Alzheimer’s findings would included in Emil Kraepelin’s influential textbook of psychiatry and by 1911 the term, “Alzheimer’s disease” was in common use. Ms. Deter today would be said to have “early on-set Alzheimer’s disease” because of the onset of symptoms prior to age 65.
- vascular dementias (multi-infarct dementia, MID): damage due to blockage or rupture (hemorrhage) of cerebral vessels
- transient ischemic attacks (TIA)
- stroke (cerebral vascular accident, CVA)
- “step-wise” pattern of loss; irreversible but (potentially) nonprogressive
- vascular dementia account for approximately 6% of dementias (Pliszka, 2016)
- frontaltemporal dementia account for approximately 6% of dementias (Pliszka, 2016)
- Parkinson’s disease and Parkinson’s dementia
- movement problems
- impaired cognition in 10-30% (Arciniegas & Beresford. 2001)
- subcortical pattern: decreased speed of thought, inefficiency of information processing, and impaired complex attention
- treatment with L-DOPA increases availability of dopamine (for a time)
- head injuries leading to acute and/or chronic dementia
- subdural hematoma
- actual destruction of tissue
- traumatic brain injury account for approximately 55% of dementias (Pliszka, 2016)
- HIV/AIDS complex dementia
- The majority of older adults reach their 80’s and 90’s without ever suffering dementia (Pliszka, 2016)
Delirium: acute confusion (change in level of alertness and mental orientation)
- delirium are medical emergencies (you’re going to get better [or die])
- Wernicke’s disease can lead to delirium
- Wernicke’s disease can lead to Korsakoff’s dementia (syndrome), “alcoholic dementia”
- dementia is a risk factor for delirium
- “sun downing” in dementia cases
- increased structure, re-oriention, environmental cues, and planning can decrease need for pharmacological interventions to deal with sun downing phenomena
“Pseudodementia”
- depression
- anxiety
- multiple drug effects (and side effects), (polypharmacy)
- other systemic illnesses
- however, some so called pseudodementias often show up again sometime later as “real” dementias, this is probably a very heterogeneous group
- other neruological health issues
- toxic exposures, metabolic difficulties, and medication effects
Other health concerns in later life
- movement, balance, activity, and pain
- arthritis is the most common chronic health difficulty in the elderly — this group of diseases affect the tissue of the joints and lead to stiffness, swelling, and pain
- the senses of taste, touch, temperature, and pain sensitivity remain largely intact in older adults
- changes in our sense of balance may make falls more likely, some activities promote better balance
- T’ai chi and stepping backwards
- maintaining activity promotes better health and adjustment; and decreasing excess weight can lead to symptomatic improvement
- breathing, energy, and fear
- normative changes in the respiratory system are difficulty to differentiate from the lifelong effects of air pollution
- a common form of incapacitating respiratory disease in older adults is Chronic Obstructive Pulmonary Disease (COPD), which refers to a group of breathing disorders, Emphysema is one of the most common form of COPD
- COPD can be extremely dibiliating, may contribute to anxiety and depression, and may result in need for continual oxygen support
- smoking is a major contributing factor to COPD
- the risk of cardiovascular disease increases with age
- “normal” changes in the cardiovascular system include a buildup of fat desposits in the heart and arteries, decrease in the amount of blood the heart can pump, decline in heart muscle tissue, and stiffening of the arteries
- most of these changes are affected by life style (diet, exercise)
- cancer risk increases significantly with age
- cancer screening is important in adults because early detection and treatment maximizes the survival statistics