פרק 28 The Neurology of Aging chapter 28

Question 1

Table 28-1
PHYSIOLOGIC AND ANATOMIC DETERIORATION AT 80 YEARS OF AGE

Answer 1

Question 2

Table 28-2
CRITERIA FOR FRAILTY (THE PRESENCE OF 3 OR MORE OF THE 5 FEATURES MAY BE USED TO DEFINE FRAILTY)

Answer 2

Question 3

Table 28-3
FREQUENCY OF NEUROLOGIC SIGNS IN UNCOMPLICATED AGING (IN PERCENT)

Answer 3

Question 4

מטופל בן80+ אלמן, לא נוטל תרופות. מגיע בתלונה של חוסר יציבות בהליכה. בבדיקתו הפרעה בתחושת רטט,פלמומנטל/גלבלר חיוביים, ללא הפרעה בתחושת מנח. הגבלה במבט מעלה. ללאתופעה על שם בל
Bell’s phenomena
בדיקתו ללא סימנים פירמידליים אואקסטראפירמידליים. הולך שפוף בצעדים קטנים. בהדמיה ללא הרחבת חדרים. איזה טיפול תיתן?
1. B12
2. Walking aid
3. LDOPA
4. אמנטדין

Answer 4

אתן לו רק אמצעי עזר בהליכה.
הפרעה בתחושת רטט, הגבלה במבט מעלה וכן פלמומנטל/גלבלר חיובי הם ממצאים שכיחים בגיל שלו שאינם מעידים על פתולוגיה מסוימת.

Normal findings in the elderly
* Neuro-ophthalmic: progressive smallness of pupils, decreased reactions to light, and near farsightedness (hyperopia) as a result of impairment of accommodation (presbyopia), insufficiency of convergence, restricted range of upward conjugate gaze, frequent loss of the Bell phenomenon, diminished dark adaptation, and increased sensitivity to glare.
* Progressive hearing loss (presbycusis), especially for high tones, and commensurate decline in speech discrimination. Mainly these changes are a result of a diminution in the number of hair cells in the organ of Corti.
* Diminution in the sense of smell and, to a lesser extent, of taste.
* Motor signs: reduced speed and amount of motor activity, slowed reaction time, impairment of fine coordination and agility, reduced muscular power (legs more than arms and proximal muscles more than distal ones) and thinness of muscles (sarcopenia), particularly the dorsal interossei, thenar, and anterior tibial muscles. A progressive decrease in the number of anterior horn cells is partially responsible for these changes.
* Changes in tendon and frontal reflexes: A depression of tendon reflexes at the ankles in comparison with those at the knees is observed frequently in persons older than 70 years of age, as is a loss of Achilles reflexes in those older than 80 years of age. The snout or palmomental reflexes, which can be detected in mild form in a small proportion of healthy adults, are frequent findings in the elderly (in as many as half of normal subjects older than 60 years of age, according to Olney). Other so-called cortical release signs, such as suck and grasp reflexes, when prominent, are indicative of frontal lobe disease but sometimes are expected simply as a result of aging.
* Impairment or loss of vibratory sense in the toes and ankles. Proprioception, however, is impaired very little or not at all. Thresholds for the perception of cutaneous stimuli increase with age but require the use of refined methods of testing for their detection. These changes correlate with a loss of sensory fibers on sural nerve biopsy, reduced amplitude of sensory nerve action potentials, probably as a result of loss of dorsal root ganglion cells.
* The most obvious neurologic aging changes—those of stance, posture, and gait.

Question 5

איזה שינוי בעיניים לא מצפים -Normal aging?
1.Hypperopia
2.ירידה באקומודציה
3.ירידה בתגובה לאור
4.מיוזיס
5.אנאיזוקוריה

Answer 5

לא נצפה לראות אניזוקוריה באופן תקין באדם מבוגר.

Neuro-ophthalmic: progressive smallness of pupils, decreased reactions to light, and near farsightedness (hyperopia) as a result of impairment of accommodation (presbyopia), insufficiency of convergence, restricted range of upward conjugate gaze, frequent loss of the Bell phenomenon, diminished dark adaptation, and increased sensitivity to glare.

Question 6

איזה נוירוטרנסמיטר לא יורד עם הגיל?
א. אצטילכולין
ב. נוראפינפרין
ג. דופמין
ד. GABA
ה. סרוטונין

Answer 6

סרוטונין לא יורד עם הגיל

Morphologic and Physiologic Changes in the Aging Nervous System
most studies point to a depletion of the neuronal population in the neocortex, especially evident in the seventh, eighth, and ninth decades.
* Cell loss in the limbic system (hippocampus, para­hippocampal, and cingulate gyri) is of special interest in regard to memory.

• Brain shrinkage is accounted for in part by the reduction in size of large neurons, not their disappearance. There is a more substantial reduction in neuronal number in the substantia nigra, locus ceruleus, and basal forebrain nuclei. In particular, hippocampal atrophy increases at the rate of less than 2 percent per year in healthy elderly people, in comparison to 4 to 8 percent a year in early Alzheimer disease.
• Among lumbosacral anterior horn cells, sensory ganglion cells, and putaminal and Purkinje cells, neuronal loss amounts to at most 25 percent between youth and old age. locus ceruleus and substantia nigra lose approximately 35 percent of their neurons,
• in normal aging, there is a gradual decline in memory and in some cognitive functions. caused, at least in part, by alterations in synaptic connectivity within critical cortical structures. loss of neuronal dendrites in the aging brain, particularly the horizontal dendrites of the third and fifth layers of the neocortex.
• increasing tendency for neuritic (amyloid and neurofibrillary) plaques to appear in the brains of nondemented individuals. At first in the hippocampus and parahippocam­pus, but later they become more widespread.
  By contrast, neurofibrillary tangles are far more abundant and diffusely distributed in patients with Alzheimer disease.
• One or more cerebral infarcts are found in approximately 25 percent of all individuals older than 70 years of age who were carefully examined postmortem. In addition to atherosclerotic disease, the basilar arteries become somewhat larger and more tortuous and opaque in the elderly.
  Cerebral blood flow declines with age and that the cerebral metabolic rate declines in parallel. There is also an age-related increase in cerebrovascular resistance.
• (EEG) to show a slowing of the alpha rhythm, an increase in beta activity, a decline in the percentage of slow-wave sleep, and an increasing intru­sion of theta rhythms, particularly over the temporal lobes, although there are large individual differences.
• neurotransmitters, it is generally agreed that the concentrations of acetylcholine, norepi­nephrine, and dopamine decline in the course of normal aging. Also, the concentration of gamma-aminobutyric acid (GABA) has been shown to decline with age,
  failed to demonstrate a decline with age in the concentration of serotonin.
  glutamate content of the brain and the number of N-methyl-d-aspartate (NMDA) receptors diminish with age,
  .

Question 7

.איזותחושהנפגעתראשונה בגילמבוגר?
א. טמפרטורה
ב.מגע
ג.מנח
ד.רטט

Answer 7

רטט!