The ageing brain Flashcards
What is the importance of the ageing brain in the NHS and in clinical practice?
- Ageing population with finite NHS resources
- Social care funding for dependent older adults
- Impact of neurological disease incl stroke
- Increasing prevelance + consequence of dementia
- Influence of delirium on inpatients in hospital
What anatomical changes are associated with an ageing brain?
- Cerebral atrophy
- Cerebral white matter lesions (leukoaraiosis)
- Cerebral microhaemorrhages
In whom will cerebral atrophy be most prominent in?
- More severe in those w dementia esp Alzheimer’s
- More pronounced in hypertensive individuals
Cerebral white matter lesions are a common incidental radiological finding. They are small vessel infarcts/episodes of hypoperfusion. When are they common and what other things are they associated with in patients?
- Diffuse lesions common in hypertension
- Associated with vascular risk factors
- Associated with increased risk of falls, hip fracture, urinary dysfunction, physical functional decline + cognitive impairment.
What is the reason for cerebral microhaemorrhages occurring?
- Cerebral amyloid angiopathy
- Amyloid deposition in the blood vessels - weakens vessels and gives tendency for bleeding in brain, seen more with advancing age
What microscopic changes occur in an ageing brain?
- Loss of neurons (fewer dendrites + demyelination)
- Lipofuscin pigment deposition
- Beta-amyloid plaque
- Amyloid deposition in blood vessels
- Neurofibrillary tangles
In terms of functional changes in an ageing brain, what cognitive changes occur?
- Reduced new memory learning
- Reduced new problem solving + psychomotor speed
- Reduced verbal fluency
- Diminished performance of complex visuospatial tasks
- Bradyphenia (slow cognition)
- More cautious pattern of behaviour
What are neurological signs of ageing?
- Long nerve tract reflexes diminished/lost
- Minor sensory loss distally
Also increased susceptibility to some neuromodulating drugs
What is the difference between a stroke and a TIA?
- Definition of Stroke: “Sudden onset of focal neurological deficit or reduced consciousness that is most likely caused by vascular aetiology and of duration greater than 24 hours (or resulting in death)”.
- Definition of TIA: “Sudden onset of a focal neurological deficit or monocular dysfunction that is most likely due to vascular aetiology and of symptoms duration less than 24 hours”.
What is the epidemiology of stroke?
- Incidence is 200-250 / 100,000 per year
- Mean age UK = 74
- Second commonest cause of death worldwide
What are the two main types of stroke?
- Ischaemic 85%
- Haemorrhagic 15%
- > 10% primary intracerebral haem
- > 5% subarachnoid haem
What are symptoms and signs of stroke?
- Contralateral weakness (limbs, face)
- Contralateral sensory loss
- Contralateral visual field defect
- Dysphasia
- Dysarthria (slurred speech)
- Ataxia
- Dysphagia
- Reduced level of consciousness
Which cerebral arteries supply which part of the brain?
List the relevant stroke syndromes
- LACS (Lacunar Stroke Syn) - lenticulostriate arteries, affect basal ganglia
- TACS (Total Anterior Circulation Syn) - middle cerebral artery, worst one
- PACS (Partial Anterior Circulation Syn)
- POCS (Posterior Circulation Syn) - posterior cerebral artery/vertebral/basilar artery
- Weber’s and Wallenberg’s syndromes
Describe the prognosis of each of the stroke syndromes
- TACS - 60% 1 year mortality, 35% dependent
- PACS - 15% 1 year mortality, 30% dependent
- LACS - 10% 1 year mortality, 30% dependent
- POCS - 20% 1 year mortality, 20% dependent
What is the most commonly used form of imaging for stroke diagnosis?
CT - quick and easy, tells whether it’s a haemorrhage.
CT scan in very early stages of stroke might be normal so may not show it.
What are risk factors for an ischaemic stroke?
- Smoking
- Hypertension
- Diabetes Mellitus
- Hypercholesterolaemia
What is the best form of treatment for stroke?
Primary and secondary prevention
What are non-cognitive symptoms of Alzheimer’s dementia?
