2 - Clinical Hx and Ex in Older Patients Flashcards
What are the functions of the
- Frontal lobe
- Parietal lobe
- Temporal lobe
- Occipital lobe?
When does the most rapid acceleration of cerebral atrophy take place?
Which area is affected the most?
After 70
Hippocampus
What are enlarged ventricles in the brain called?
Venriculomegaly
How do ageing deficits in the
- frontal lobe
- parietal lobe
- temporal lobe
- occipital lobe
impact patients?
Frontal = decreased planning and working memory, abstract thinking and attention and reduced motor control
Parietal - increased reaction time, problems with sensory processing and balance
Temporal - problems with spatial awareness and episodic memory
Occipital - problems with visual processing
What neurovascular changes take place in the brain in older Ps?
What are the implications of this?
Reduced perfusion of the cerebrum (between 5-20%)
Narrowing of some arteries (artherosclerosis)
Fluctuating blood pressures
–> Inc risk of stroke, vascular dementia and syncope
What cellular changes can affect older brains?
Synaptic dysfunction = reduced neuroplasticity
Oxidative stress -> cellular ageing and neuron loss
Deposition of abnormally folded proteins
Which abnormally folded proteins are deposited intracellularly in elderly brains?
Amyloid plaques
Lewy bodies
Which abnormally folded proteins are deposited extracellularly in elderly brains?
Neurofibrillary tangles
Which monoclonal antibody treatment binds amyloid β protein, reducing burden in AD and was FDA approved in January 23?
Lecanemab
Which chemicals in the brain can reduce in older age? What is the implication of this?
ACh -> memory impairment
Serotonin -> mood disorders
Dopamine -> Parkinson’s disease
Are dementia and mild cognitive impairment normal?
No - they are diseases.
What can cause cognitive decline in older Ps?
Vascular changes
Tauopathy
Lewy body deposition
Amyloid plaques
How is peripheral sensation affected as we age?
Proprioception significantly reduces
Is 50% reduction in light touch and vibration (by 60) - due to reduction in Messiner’s and Pacinian corpuscles.
-> Inc postural sway, falls
How does vision change as we age?
Deterioration in acuity
Slower reactions to light changes
Reduced colour contrast and depth perception
Also - inc cataracts, glaucoma, retinal problems
What do changes in vision mean for older Ps in terms of risk?
They have an increased risk of falls.
How does reaction time change as we get older?
Reaction time = much increased.
Another RF for recurrent falls
How does myocardium change with age?
Can get increased LV wall thickness & stiffening. Can also get enlarged left atrium.
Inc size of myocytes, but reduction in number + deposition of collagen and amyloid in them = stiffening
How does condition in the heart change with age?
Get reduction in cells in the SAN by 50% at 50 yo
Fibrous tissue infiltrates the conduction system.
Means conduction happens slower = bradycardia, poss heart block
How can heart valves change with age?
They can become thickened & have calcium deposition = reduced flexibility
= Many older Ps have murmurs - without clinically significant disease
How can arteries change with age?
Get fibrosis & calcifications => stiffening
Less complaint and less efficient at dilating = hypertension
Can also get endothelial dysfunction => atherosclerosis
How can veins change as they age?
Can lose elastin = causing dilation of veins
How does
- SV
- Max HR
- CO change with age?
SV = relatively preserved
Max HR = decreases over time
CO = at rest can be ok, but
- can get ltd filling in diastole if stiffened LV wall
- can cause decreased CO when exercising
How can BP change with age?
Can get inc systolic and reduced diastolic
- due to loss of compliance of blood vessels
What causes HFpEF and what causes HFrEF?
HFpEF = Diastolic dysfunction (too stiff to fill)
HFrEF = Systolic dysfunction (too weak to squeeze properly)
Why can you get more arrhythmias in older Ps?
Dilated atria => AF
Fibrosis of conduction system = Brady and tachyarrythmias
What is the consequence of alveoli ageing?
They become larger = reduced SA:Vol for gas exchange
How does gas exchange change in older lungs?
It reduces = due to increasing areas that have reduced ventilation +/- perfusion
How does kyphosis affect breathing?
Changes the shape of the thorax
Thoracic cage = less compliant + weaker muscles
Diaphragm has to do more of the work
What is the clinical implication of changes to the respiratory system in ageing?
Can make older people less resilient to insults which can affect respiratory function E.g. pneumonia, rib fractures, stroke
=> respiratory failure
