AGE Flashcards
The Ageing Heart and Lungs by Dr Cheng
Ageing Heart Valves
*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)
Increased Thickness
Decreased Flexibility
Calcification
The Ageing Heart and Lungs by Dr Cheng
Ageing Heart Muscle
*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)
Increased Left Ventricular Wall Thickness
Increased Myocyte size
Fibrous Tissue deposits
Amyloid Desposits
Enlargement of Left Atrium
Slight enlargement/ hypertrophy of left ventricular cavity
The Ageing Heart and Lungs by Dr Cheng
Ageing Conduction Pathway
*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)
Reduced pacemaker cells (50-75% lost by ~50)
Fibrous tissue
AV node constant
The Ageing Heart and Lungs by Dr Cheng
Ageing Arteries
*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)
Lose elasticity and compliance
Lose stretch
More resistant to blood flow
Peripheral arteries less reilient
Calcifications in artery walls including aorta
Arteries stiffer and more difficult to dilate
The Ageing Heart and Lungs by Dr Cheng
Ageing Veins
*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)
Intima & muscular walls thicken and become less elastic
Dilate and stretch with less elasticity
The Ageing Heart and Lungs by Dr Cheng
Ageing Aorta
*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)
Dilated Elongated and rigid
Calcifications
May tortous
Reduced elastin, increased collagen
Increased stiffness, reduced compliance
The Ageing Heart and Lungs by Dr Cheng
Age Related Physiological Changes in CVS
*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)
- Heart rate
- Blood pressure
- Myocardial function
- Valvular function
- Conduction pathways
The Ageing Heart and Lungs by Dr Cheng
Ageing Myocardial Function
*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes
Reduced contractile strength & efficiency
Reduced cardiac output
Reduced cardiac reserve
The Ageing Heart and Lungs by Dr Cheng
Ageing Cardiac Function
PRELOAD
*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes
PRELOAD
Early diastolic left ventricular filling rate, slows with age
Compensation with increased atrial contraction
increasing late diatsole filling
RESULT End diastolic volume (Pre-load) at rest remains the same
The Ageing Heart and Lungs by Dr Cheng
Ageing Cardiac Function
AFTERLOAD
*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes
AFTERLOAD
Decrease in elasticity and lumen diamter within arterial tree
gradual increase systolic bp with age
Small arteries less responsive to vasodilator cues with age
increases peripheral resistance
INCREASED AFTERLOAD with age
The Ageing Heart and Lungs by Dr Cheng
Ageing Heart Rate
PRELOAD
*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes
Reduced cardiac responsiveness with exercise
Longer to return to baseline
Decrease in maximal HR in exercise
If healthy, resting heart rate (supine) does not change)
The Ageing Heart and Lungs by Dr Cheng
Ageing BP
*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes
SYSTOLIC may rise disproportionately higher than diastolic
why? Increase in pre-load due to cardiac changes
The Ageing Heart and Lungs by Dr Cheng
Ageing Left Ventricle
*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes
Weakened heart cant squeeze well, less blood pumped out = REDUCED Cardiac Output
Less blood fills ventricles, stiff heart cant relax= DIASTOLIC dysfunction
The Ageing Heart and Lungs by Dr Cheng
Ageing Ejection Fraction
*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes
Reduced due to
Increased vascular resistance
Increased end diastolic volume
Reduced maximal myocardial contractility
Reduced contractility by adrenergic stimulation
Ejection fraction = stroke volume divided by end diastolic volume
End diastolic volume on exertion is increased in older age, whereas it is unchanged at rest
The Ageing Heart and Lungs by Dr Cheng
Ageing Valves
*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes
Systolic and diastolic murmurs may result from thickened, calcified and malaligned valve leaflets
The Ageing Heart and Lungs by Dr Cheng
Ageing Conduction pathways
*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes
Irritability of the myocardium may result in extra systoles, along with sinus arrhythmias & sinus bradycardia
The Ageing Heart and Lungs by Dr Cheng
Functional Implications
QOL
*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes
Reduced response to stress
Activity intolerance
Orthostatic hypotension
INCREASED RISK FOR:
Hypertension
Ischaemic heart disease
Myocardial infarction
Heart failure
Arrhythmias
Stroke
The Ageing Heart and Lungs by Dr Cheng
Respiratory Ageing
*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)
Structural changes
Increase in size of alveolar space and air trapping
Loss of supporting structure of lung parenchyma
Decreased elasticity
Chest wall
Reduction in chest wall compliance
Reduced thickness of vertebral discs
Kyphosis
The Ageing Heart and Lungs by Dr Cheng
Respiratory Muscles
*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)
Generalised reduction in muscle strength with age
Diaphragm falls in height, thereby reducing its ability to generate force
Weakened cough reflex
The ventilatory response to lower oxygen tension or raised carbon dioxide tension is markedly impaired in older adults
The Ageing Heart and Lungs by Dr Cheng
Ageing Chest Wall
*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)
Chest wall compliance reduced
Stiffening of the thoracic cage from calcification of the rib cage
Age-related kyphosis
Arthritis of costovertebral joint
More muscular work is therefore required for ventilation (20% more at 60yrs vs 20yrs)- work of breathing
The Ageing Heart and Lungs by Dr Cheng
Ageing Respiratory Muscles
*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)
Muscle atrophy
Decrease in fast twitch fibers
Predisposes individuals to diaphragmatic fatigue and ventilatory failure with increased ventilatory load
Respiratory muscle performance is impaired by the age related increase in functional residual capacity
The Ageing Heart and Lungs by Dr Cheng
Respiratory Functional changes with age
*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes
The Ageing Heart and Lungs by Dr Cheng
Spirometry Changes
*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes
Decrease of FEV1 and FVC between 25 and 39, with more at over 65
The Ageing Heart and Lungs by Dr Cheng
Vascular Remodelling
*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes
Increased pulmonary vascular stiffness
Increased vascular pressures and resistance
Decreased pulmonary capillary blood volume
The Ageing Heart and Lungs by Dr Cheng
Immunological changes
*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes
Reduced Mucocillary transport
Blunted cough reflex
Increased swallowing error
Decreased no and funct T Cell, Mφ
Total exposure to pollutants over years
Therefore
chronic low-grade inflammation
Bronchoalveolar lavage has demonstrated increased levels of neutrophils, IL-1 and IL-8as well as neutrophil elastase
The Ageing Heart and Lungs by Dr Cheng
Respiratory Consequences
*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes
Increased work of breathing
Decreased exercise tolerance
Increased risk of infection
Subsequent increased risk of a variety of respiratory diseases
VO2Mac decreases (quicker if sedentary)
Disease presentation in the older adult by Dr Hetherington
Events in Ageing
*LOB: Explain why disease presentations may be atypical in the older adult
Physiological decline happens across all body systems
Expending reserves to compensate for primary age changes
Reduced ability to maintain homeostasis when disturbed by physiological insult
(Also known as… frailty)
Disease presentation in the older adult by Dr Hetherington
What is Frailty?
*LOB: Explain why disease presentations may be atypical in the older adult
Dysregulation in multiple physiological systems (e.g. cardiac, respiratory, metabolic, renal, musculoskeletal etc etc) results in reduced reserve
Older age ≠ frailty
Disease presentation in the older adult by Dr Hetherington
What is Clinical Frailty Scale?
*LOB: Explain why disease presentations may be atypical in the older adult
1-9, scores slightly differently in dementia
Depends on active disease and activity
Includes terminal illness
Disease presentation in the older adult by Dr Hetherington
Homeostenosis
*LOB: Explain why disease presentations may be atypical in the older adult
Homeostasis + Stenosis
Homeostasis has a physiological limit
Physiologic reserve decreases with time
Stress (biologic) can overwhelm the reserve
Disease presentation in the older adult by Dr Hetherington
Pathology vs Ageing
*LOB: Explain why disease presentations may be atypical in the older adult
Pathology may be mistaken for ‘normal ageing’ (by patients, relatives or healthcare staff)
Fatigue, memory problems, incontinence et.c
Symptoms are often multifactorial in origin
Same symptoms can be caused by different disease processes
E.g. dyspnoea – COPD/ heart failure / anaemia
The same disease process can cause different symptoms in different patients.
Disease presentation in the older adult by Dr Hetherington
System Overlap
*LOB: Explain why disease presentations may be atypical in the older adult
Disease presentation in the older adult by Dr Hetherington
Atypical Presentation
*LOB: Describe the five most common atypical disease presentations
An older person may have the same presentation for varied underlying causes
* Dyspnoea (pneumonia, COPD, heart failure)
* Falls (infection, postural hypotension, arrhythmia)
* Fatigue (infection, anaemia, malignancy, MS)
* Delirium (almost anything you can think of)
Or the same disease may present in different ways in differnet patients
ATYPICAL is typical in older patients
Disease presentation in the older adult by Dr Hetherington
Geriatric Giants - the 5 Is
*LOB: Describe the five most common atypical disease presentations
Immobility
Instability
Intellectual impairment
Incontinence
(Iatrogenesis)
Disease presentation in the older adult by Dr Hetherington
Immobility
*LOB: Describe the five most common atypical disease presentations
Causes
Acute or chronic illness
Medication side effects
Pain
Delirium or dementia
Sarcopenia
Mood
Lack of mobility aid
Consequences
Pressure ulcers
Pneumonia
Increased dependence
Death
Disease presentation in the older adult by Dr Hetherington
Instability
*LOB: Describe the five most common atypical disease presentations
Causes
Age-related changes:
Gait, Sarcopenia, Visual impairment etc
Medical conditions
Environmental causes
Medications
Alcohol
Consequences
Fractures
Immobility
Fear of falling (FFF) and reduced confidence
Traumatic intracranial haemorrhage
Dependence
Death
Disease presentation in the older adult by Dr Hetherington
Iatrogenesis
*LOB: Describe the five most common atypical disease presentations
illness caused by medication
Polypharmacy
More than half of >65 take 3 medications
Increases ADR risk
Changes in pharmacokinetics/dynamis with age
Disease presentation in the older adult by Dr Hetherington
Atypical presentation in Covid
*LOB: Describe the five most common atypical disease presentations
Fever, cough, and dyspnoea may be absent despite respiratory disease
Only 20-30% of geriatric patients with infection present with fever
Delirium, falls, malaise, functional decline, conjunctivitis, dizziness, headache, rhinorrhoea, chest pain, haemoptysis, diarrhoea, nausea/vomiting, abdominal pain
May be covid positive when other plausible explanation for presentation (remember – often >1 cause for syndromes)
Older adults may present with mild symptoms that are disproportionate to the severity of their illness
Regional Geriatric Program of Toronto
Disease presentation in the older adult by Dr Hetherington
Reversible Causes of Incontinence
*LOB: Describe the five most common atypical disease presentations
DIAPPERS think diapers
Delirium
Infection - urinary (symptomatic)
Atrophic urethritis and vaginitis
Pharmaceuticals
Psychiatric disorders, especially depression
Excessive urine output (eg, from heart failure or hyperglycemia)
Restricted mobility
Stool impaction
Disease presentation in the older adult by Dr Hetherington
Incontinence
*LOB: Describe the five most common atypical disease presentations
Not a normal part of ageing
Urge, stress, mixed, functional
Consequence
Damage to skin
Infection
Embarrassment
Instability
Social isolation
Disease presentation in the older adult by Dr Hetherington
Precipitants of Delirium
*LOB: Describe the five most common atypical disease presentations
PINCH ME
Predisposing factors
Polypharmacy
Acute illness
Constipation
Electrolyte or fluid imbalance
Change in environment
Pain
Disease presentation in the older adult by Dr Hetherington
Instability
*LOB: Describe the five most common atypical disease presentations
Causes
Age-related changes:
Gait, Sarcopenia, Visual impairment etc
Medical conditions
Environmental causes
Medications
Alcohol
Consequences
Fractures
Immobility
Fear of falling (FFF) and reduced confidence
Traumatic intracranial haemorrhage
Dependence
Death
Disease presentation in the older adult by Dr Hetherington
Intellectual Impairment
*LOB: Describe the five most common atypical disease presentations
Causes
delirium
Delirium affects >25% of people in hospital
Disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course
Consequences
Significant mortality (> cancer, #NOF, STEMI)
Instability
Immobility
Longer stay
Increased level of dependence (e.g. nursing home)
Poor PO intake
Death
Disease Presentations in the Older Adult
Skin
*LOB: Describe the age-related changes to the structure and function of the skin and the functional consequences
Changes:
Thinning of the epidermis (outer layer)
Decreased collagen and elastin in the dermis (middle layer)
Reduction in subcutaneous fat (bottom layer)
Reduced sweat and oil gland activity
Structure:
Thinner, less elastic skin
Less cushioning from fat
Reduced moisture
Function:
Weaker barrier against external damage
Lower ability to retain moisture
Decreased temperature regulation
Consequence:
Increased risk of skin injuries and infections
Dry, itchy skin
Slower wound healing
Greater susceptibility to temperature extremes
Disease Presentations in the Older Adult
Pituitary Gland
*LOB: Describe the age-related functional changes to the pituitary, thyroid, and adrenal glands and how these may alter disease presentations
Changes:
Reduced hormone production (e.g., growth hormone)
Altered hormone release patterns
Structure:
Degeneration of gland tissue
Reduced cell function
Function:
Lowered growth hormone levels affect muscle mass and fat distribution
Altered hormone levels influence overall metabolism and stress response
Consequence:
Decreased muscle mass and strength
Increased body fat
Slower metabolism
Potential for disrupted sleep and energy levels
Disease Presentations in the Older Adult
Thyroid Gland
*LOB:Describe the age-related functional changes to the pituitary, thyroid, and adrenal glands and how these may alter disease presentations
Changes:
Decreased production of thyroid hormones (T3 and T4)
Increased incidence of thyroid nodules
Structure:
Gland may become nodular or atrophic
Function:
Slowed metabolism
Altered body temperature regulation
Consequence:
Increased risk of hypothyroidism (fatigue, weight gain, cold intolerance)
Potential for hyperthyroidism if nodules produce excess hormones
Disease Presentations in the Older Adult
Adrenal Gland
*LOB: Describe the age-related functional changes to the pituitary, thyroid, and adrenal glands and how these may alter disease presentations
Changes:
Decreased production of adrenal hormones (e.g., cortisol, aldosterone)
Altered response to stress
Structure:
Degeneration of adrenal cortex
Reduced gland size
Function:
Lowered ability to respond to physical and emotional stress
Reduced blood pressure regulation
Consequence:
Increased susceptibility to stress-related disorders
Potential for low blood pressure and electrolyte imbalances
Disease Presentations in the Older Adult
Increased Susceptibility to Infection in Older Adults
Explain why older people are more prone to infection
Changes:
Decline in immune system function (immunosenescence)
Reduced production of immune cells
Structure:
Thinner skin and mucous membranes
Weakened barriers against pathogens
Function:
Slower immune response
Reduced ability to recognize and attack pathogens
Consequence:
Higher risk of infections (e.g., pneumonia, urinary tract infections)
Slower recovery from illnesses
Increased severity of infections
Falls and Their Consequences by Dr Godfrey
Risk for Falls
*LOB Identify common risk factors for falls in the older population
Syncope
Stroke
STEMI
Trip Stumble
Difficulty raising foot
Foot catching furniture/ other foot
Tripped by another person
Loss of external support
Hit or bump
Loss of Conciousness
Falls and Their Consequences by Dr Godfrey
Why Falls?
*LOB Identify common risk factors for falls in the older population
Ageing Neurological BALANCE BRADYKINESIA
Brain atrophy, neurone loss, reduced synaptic transmission leading to slower processing speed, loss of proprioception, impaired vestibular system
Ageing Muscles
Sarcopenia, and asymmetrical changes
Ageing posture
Gait
Reduced stride, speed, fleion and extension, less strength in “pushing off”
Co Mobidities
Extrinsic
Lighting, pets, headroom, clothing, shoes
Falls and Their Consequences by Dr Godfrey
Comorbidities effecting Falls
*LOB Identify common risk factors for falls in the older population
Ageing Hearing/ Presbycusis
With each 10dB of hearing loss, risk increases by 140%
Less Spatially Aware, less resource for balance
Ageing Sight
Deterioration in acuity, opaque lens, pupil rigid, slower light reaction, reduced sensitivity
Medications
Exposure to anticholinergic associated in 60% increase
Falls and Their Consequences by Dr Godfrey
Posture and Gait Changes
*LOB Identify the changes to posture and gait in normal ageing
Posture Changes:
Increased thoracic kyphosis
Decreased lumbar lordosis
Height loss
Forward head position
Shoulders more rounded and stooped
Functional Consequences of Posture Changes:
Balance issues
Back pain
Breathing difficulties
Gait Changes:
Decrease in stride length
Reduction in walking speed
Widening of the stance
Decreased arm swing
Joint stiffness
Functional Consequences of Gait Changes:
Increased fall risk
Reduced mobility
Fatigue
Falls and Their Consequences by Dr Godfrey
Hip Fracture Management
*LOB: Briefly describe key steps in the management of hip fracture in the elderly, appreciating both surgical and non-surgical aspects
Initial Assessment and Stabilization:
Pain Management
Imaging
Medical Stabilization
Surgical Management:
Type of Surgery
Internal Fixation
Hemiarthroplasty
Total Hip Arthroplasty
Timing
Post-Surgical Care:
Pain Management
Antibiotics
Anticoagulation
Non-Surgical Management:
Rehabilitation
Weight-Bearing
Assistive Devices
Comprehensive Care:
Nutritional Support
Bone Health
Multidisciplinary Approach
Follow-Up:
Monitoring
Adjustments
Frailty and Multiple Morbidity
Caveats to Frailty
*LOB: Outline the concepts of frailty and multiple morbidity
Not living with multiple long-term health conditions.
Someone living with frailty may have no other diagnosed health conditions
Not a disability
Frailty and Multiple Morbidity
Frailty
*LOB: Outline the concepts of frailty and multiple morbidity
“a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves”
Frailty and Multiple Morbidity
Pathogenesis of Frailty
*LOB: Describe the pathogenesis of frailty
Aetiology, Mechanisms, Phenotype and Outcome
Frailty and Multiple Morbidity
Screeing Frailty: Rockwood
*LOB: Identify the screening tools to detect frailty
Frailty and Multiple Morbidity
Screening Frailty: Edmonton
*LOB: Identify the screening tools to detect frailty
Frailty and Multiple Morbidity
Management
*LOB: Describe the management of the frailty syndrome
Comprehensive Geriatric Assessment (CGA)
Interdisciplinary, multi-component process, focused on medical, psychological and functional capabilities to develop an integrated plan for treatment and long term follow up
NNT is only 17
Can be used in hospitals or in the community
Introduction to Ageing and Disease
Ageing is….
*LOB: Define ageing
the time-related deterioration of the physiological functions necessary for survival and fertility.
Pharmacology and Older People by Dr Cheng
Distribtution in Age
*LOB: Describe how pharmacokinetics and pharmacodynamics can be affected in old age
Increased Body fat
Decreased body water, lean body mass, plasma albumin
Can increase Vd for lipophilic drugs, increasing halflife
Decreases Vd for hydrophilic
Less albumin = unbound drug = toxicity risk
Pharmacology and Older People by Dr Cheng
Metabolism in Age
*LOB: Describe how pharmacokinetics and pharmacodynamics can be affected in old age
Decreased hepatic blood flow and volume with age
Decreased activity of Hepatic enzymes
first-pass metabolism are most likely to be affected
Phase 1 reactions (oxidation, reduction & hydrolysis) are more significantly affected than Phase 2 reactions (conjugation & glucorinidation)
Pharmacology and Older People by Dr Cheng
Excretion in Age
*LOB: Describe how pharmacokinetics and pharmacodynamics can be affected in old age
Decreased renal blood flow, kidney size and functioning nephrons
Reduced eGFR (calculation may not show change)
Poor renal blood flow 2’ to arterial disease (+ RF of diabetes, HTN)
Loss of nephrons by focal glomerular sclerosis
Most important for medications with a narrow therapeutic range which rely on renal clearance – digoxin, gentamicin, lithium
May stay in body longer = longer affects, higher risk of toxicity
Pharmacology and Older People by Dr Cheng
Prescribing in Ageing
*LOB: Describe principles for safe prescribing in the older patient
Polypharmacy
Typically defined as a taking 5 or more medications
Increasing prevalence in part due to increasing rates of multimorbidity and treatment options
Prescribing cascade -> HTN -> Amlodipine -> Ankle swelling -> Furosemide -> incontinence -> Tamsulosin -> Constipation -> Laxatives
Anticholinergic Burden calculator
https://www.acbcalc.com/
What is this patient’s anticholinergic burden? (Answer: 7)
(3+ is associated with increased mortality)
Chlorphenamine (3)
Prednisolone (1)
Amitriptyline (3)
Aspirin (0)
ADR
A: adverse reaction from an exaggeration of a drug’s expected actions
Pharmacology and Older People by Dr Cheng
Adherence
*LOB: Explain what factors can affect medication compliance in the older person including polypharmacy
Complex regimens
Multiple prescribers
Medication storage / formulation issues
Multimorbidity
Cognitive impairment
Increased risk of ADRs
Start low and go slow
Introduction to Ageing and Disease
Consequences of Ageing
*LOB: Consider the changing age demographics in the UK over the past 150 years and explain the possible consequences of these changes in the context of healthcare
Increased Demand for Geriatric Care:
More elderly individuals require specialized medical services, long-term care, and management of chronic conditions.
Strain on Healthcare Resources:
Higher healthcare costs and resource allocation challenges due to the rising number of older patients with complex needs.
Expansion of Healthcare Workforce:
Need for more healthcare professionals trained in geriatric medicine, nursing, and allied health services to cater to the aging population.
Growth in Preventive and Community-Based Services:
Emphasis on preventive healthcare, home care services, and community-based support to manage aging in place and reduce hospital admissions.
Policy and Infrastructure Changes:
Development of policies and healthcare infrastructure to support aging populations, including increased funding, age-friendly facilities, and integrated care models.
Introduction to Ageing and Disease
Squaring the circle
The geriatrician’s profession de foi
*LOB: Define ageing
By delaying the onset of disabling diseases to later ages when intrinsic ageing has raised fatality by reducing adaptability, the average duration of disability before death will be shortened. In brief, we will spend a longer time living and a shorter time dying
J Grimley Evans 1997
The Ageing Brain
Macroscopic Anatomical Brain Ageing
*LOB: Differentiate between age-related and pathological anatomical changes (macroscopic and microscopic) which can be identified in the ageing brain
Brain Shrinking
Neurodegeneration
Ventricular Enlargement
Volume loss
Sulcal Swelling
Hippocampal Atrophy
Cortical Thinning
The Ageing Brain
Macroscopic Anatomical Brain Ageing
*LOB: Differentiate between age-related and pathological anatomical changes (macroscopic and microscopic) which can be identified in the ageing brain
Brain Shrinking
Neurodegeneration
Ventricular Enlargement
Volume loss
Sulcal Swelling
Hippocampal Atrophy
Cortical Thinning
The Ageing Brain
Vascular Anatomical Brain Ageing
*LOB: Differentiate between age-related and pathological anatomical changes (macroscopic and microscopic) which can be identified in the ageing brain
Large vessel disease
Ischaemic and haemorrhagic strokes
Small vessel disease
Cerebral arteriosclerosis and atherosclerosis
Cerebral amyloid angiopathy
Lacunar infarcts
The Ageing Brain
Chemical Changes Brain
*LOB: Describe the age-related changes in the function of the neurological system
The Ageing Brain
Normal Ageing Brain
*LOB: Differentiate between age-related and pathological anatomical changes (macroscopic and microscopic) which can be identified in the ageing brain
The Ageing Brain
Macroscopic Anatomical Brain Ageing
*LOB: Differentiate between delirium and dementia in relation to the clinical presentation
Syndrome caused by a number of brain disorders which cause memory loss, decline aspects of cognition, and difficulties with activities of daily living.
Cognitive impairment
Psychiatric or behavioural disturbances
Difficulties with activities of daily living
The Ageing Brain
Ageing vs Mild Cognitive Impairment vs Dementia
*LOB: Differentiate between delirium and dementia in relation to the clinical presentation
Healthy Ageing: some impairment, doesnt affect daily living
MCI: memory loss, difficulty speaking, disorientation, but does not interfere with normal daily functions and routines
Dementia: severe cognitive dysfunction affecting daily life, completing tasks or learning new things
The Ageing Brain
Alzheimer’s Dementia
*LOB: Differentiate between delirium and dementia in relation to the clinical presentation
Risk Factors: Apolipoprotein E4
Aetiology: Extracellular beta-amyloid plaques, intracellular neurofibrillary tangles (Tau)
Clinical Evolution: Progressive decline
Neuropsychological changes: Short-term memory
Imaging: Medial temporal lobe atrophy
Management: Acetylcholinesterase inhibitors, NMDA receptor antagonistis
The Ageing Brain
Vascular Dementia
*LOB: Differentiate between delirium and dementia in relation to the clinical presentation
Risk Factors: HTN, DM, Stroke, TIA, AF, smoking
Aetiology: Infarction, leukoaraiosis, haemorrhage
Clinical Evolution: Step-wise decline
Neuropsychological changes: Executive function
Imaging: infarcts, small vessel disease, white matter changes
Management: Reduce cardiac risk factors
The Ageing Brain
Microscopic Anatomical Brain Ageing
*LOB: Differentiate between age-related and pathological anatomical changes (macroscopic and microscopic) which can be identified in the ageing brain
NeuroneDecreased synaptic function
Microglia Accumulation of insoluble material, pro inflammatory, decreased surveilling
Oligodendrocyte Decreased myelination, release myelin debris, shorter internodes
Astrocyte Reactivity features, decreased neuronal synaptic suport, enhanced immune response
The Ageing Brain
Macroscopic Anatomical Brain Ageing
*LOB: Differentiate between age-related and pathological anatomical changes (macroscopic and microscopic) which can be identified in the ageing brain
Brain Shrinking
Neurodegeneration
Ventricular Enlargement
Volume loss
Sulcal Swelling
Hippocampal Atrophy
Cortical Thinning
Causes of Delirium
Infection
Constipation
Urinary retention
Medications (e.g. anticholinergics, opiates, benzodiazepines)
Medication/drug withdrawal
Pain
Post-operative
Hypoxia
Electrolyte abnormalities
Hormonal imabalances (e.g. thyroid)
Thiamine deficiency
B12 deficiency
Trauma
Post-ictal
Delirium Dementia
Delirium
Delirium is an acute, fluctuating syndrome characterized by disturbed consciousness, attention, cognition, and perception
Subtypes:
Hypoactive
Hyperactive
Mixed
Theories of Ageing by Dr Mark Cottee
Wear and Tear
*LOB: Outline the following theories of why we age: wear and tear, evolutionary, non-adaptive evolutionary, disposable soma theories
View organisms as machines that wear out over time.
Example: Elephant’s teeth wear down, leading to difficulties in feeding.
Limitation: Some animals, like sea anemones, do not exhibit ageing.
Theories of Ageing by Dr Mark Cottee
Adaptive Evolution
*LOB: Outline the following theories of why we age: wear and tear, evolutionary, non-adaptive evolutionary, disposable soma theories
Ageing is a result of evolution and natural selection, advantageous for species but not for individuals.
Prevents old and worn-out individuals from competing with younger, more vital individuals.
Limitation: Ageing is rarely observed in natural populations.
Theories of Ageing by Dr Mark Cottee
Non-Adaptive Evolution
*LOB: Outline the following theories of why we age: wear and tear, evolutionary, non-adaptive evolutionary, disposable soma theories
Mutation Accumulation
Natural selection weakens with age, allowing deleterious mutations to accumulate.
Ageing is due to a collection of late-acting, harmful genes.
Limitation: Lacks experimental support.
Antagonistic Pleiotropic Genes
Genes beneficial early in life can have adverse effects later, contributing to ageing.
Example: Drosophila studies showing increased early fecundity but reduced longevity.
Theories of Ageing by Dr Mark Cottee
Disposable Soma Theory
*LOB: Outline the following theories of why we age: wear and tear, evolutionary, non-adaptive evolutionary, disposable soma theories
Organisms allocate resources between reproduction and body maintenance.
Limited investment in maintenance leads to ageing as repair mechanisms eventually fail.
Theories of Ageing by Dr Mark Cottee
Genetic Ageing
*LOB: Describe, with examples, how ageing may occur at the following levels i) genetic, ii) genomic stability, iii) cellular, including cell senescence and iv) systems
specific genes that either promote longevity or contribute to the ageing process.
“geronto-genes”
longevity assurance genes in various organisms.
Example:
Telomeres and Telomerase: ends of chromosomes that protect them from deterioration. Each time a cell divides, telomeres shorten. When they reach a critical length, the cell can no longer divide
Theories of Ageing by Dr Mark Cottee
Genomic Stability Ageing
*LOB: Describe, with examples, how ageing may occur at the following levels i) genetic, ii) genomic stability, iii) cellular, including cell senescence and iv) systems
maintenance of DNA integrity over time.
As organisms age, the ability to repair DNA damage declines, leading to an accumulation of genetic errors that contribute to the ageing process.
Example:
Free Radical Theory:
reactive oxygen species (ROS) produced during cellular metabolism can damage DNA, proteins, and lipids. Over time, the accumulation of such damage leads to genomic instability and contributes to ageing. Enzymes like superoxide dismutase (SOD) and catalase help mitigate this damage, but their efficacy decreases with age.
Theories of Ageing by Dr Mark Cottee
Cellular Level Ageing
*LOB: Describe, with examples, how ageing may occur at the following levels i) genetic, ii) genomic stability, iii) cellular, including cell senescence and iv) systems
At the cellular level, ageing manifests through processes such as cell senescence, where cells lose their ability to divide and function properly, contributing to tissue dysfunction.
Examples:
Cell Senescence: Senescent cells cease to divide and can secrete inflammatory cytokines, growth factors, and proteases, collectively known as the senescence-associated secretory phenotype (SASP). This can disrupt tissue structure and function and promote age-related diseases. For instance, increased senescent cell numbers are observed in osteoarthritis and pancreatic dysfunction.
Hayflick Phenomenon: Normal somatic cells have a limited capacity for division, known as the Hayflick limit. After a certain number of divisions, cells enter a state of senescence due to telomere shortening.
Theories of Ageing by Dr Mark Cottee
Systems Level Ageing
*LOB: Describe, with examples, how ageing may occur at the following levels i) genetic, ii) genomic stability, iii) cellular, including cell senescence and iv) systems
At the systems level, ageing can be viewed through the decline in the function of entire organ systems and the interactions between them.
Examples:
Neuroendocrine Theory: This theory suggests that ageing is regulated by the decline in neuroendocrine function, particularly involving the hypothalamic-pituitary-adrenal axis. For instance, decreased pulsatile secretion of growth hormone and gonadotropin-releasing hormone (GnRH) is associated with ageing. Experimental interventions such as hypothalamectomy followed by hormone replacement have shown increased lifespan in rats.
Immune System Decline: The efficiency of the immune system decreases with age, a process known as immunosenescence. This contributes to increased susceptibility to infections, reduced response to vaccination, and a higher incidence of autoimmune diseases in the elderly.
