The Ageing Brain

Question 1

Whats the function of the Frontal Lobe?

Whats the function of the Parietal Lobe?

Whats the function of the Temporal Lobe?

Whats the function of the Occipital Lobe?

Answer 1

• Executive behaviour, Impulsivity, Emotion
• Sensory processing, Reading, Writing
• Combines Auditory and Visual information, Memory
• Visual processing

Question 2

STRUCTURAL CHANGES:
Cerebral Atrophy:
What is it?

Which type of brain matter is lost quicker?

Which parts of the brain are most affected?

Amyloid Plaques & Neurofibrillary Tangles:
What are Neurofibrillary Tangles?

What are Amyloid Plaques?

When are these present?

Cerebral Small Vessel Disease:
What is Small Vessel Disease (Leukoaraiosis)?
→ What is it commonly related to?

What is Oxidative Stress? How does it affect an ageing brain?
→ What type of changes is it associated with?

How is Cerebral blood flow affected with age?

Answer 2

• Shrinkage and loss of neurons and synapses
• White matter loss&raquo_space;> Grey matter loss
• Frontal, Temporal, Hippocampus, Cerebellum (Non-global)

• Collections of hyperphosphorylated tau protein inside neurons
• Deposition of Beta-Amyloid between neurons
• Present in normal ageing, but there’s a lot more
  in abnormal ageing

• Changes in small perforating vessels
  → Age and HTN
• Accumulation of oxidation of DNA, lipids, and protein by free radicals, causing a functional decrease in the ageing brain - Brain is very sensitive to oxidative stress
  → Inflammatory and Microvascular changes
• Reduced, Narrowed arteries, Fluctuating BP

Question 3

CHEMICAL CHANGES:
Which 3 Neurotransmitters are reduced with age? What does this cause?

How is the BBB affected with age?

Answer 3

• • Ach - Cognitive impairment
  • Dopamine - Parkinsonian symptoms
  • Serotonin - Depression
• • Increased permeability
  • Reduced transport of glucose, proteins and hormones = More susceptible to hypoglycaemia

Question 4

DELIRIUM:
What is it also known as?

What is it?

What are the 3 types?
→ Which is the most common type?
→ What is Hypoactive easily mistaken for?

What are its Risk factors?

What is used to assess it?

What is the Delirium screen?

What is it caused by?

How is it managed?

Answer 4

• ‘Acute Confusion State’ or ‘Acute Brain Failure’
• ACUTE ONSET AND FLUCTUATING COURSE of changes in Consciousness, Cognitive function, Perception, Physical function and Social behaviour
• Hyperactive, Mixed, Hypoactive
  → Hypoactive
  → Depression or Dementia
• > 65yrs, Severe illness, Fractured femoral neck, Dementia
• Cognitive screening tests - 4AT, AMTS, MOCA
• Blood Calcium, Vitamin B12, Folate, TSH, Glucose, MSU, CT head
• • Acute Reduction in Ach and Increase in Dopamine
  • Infection, Pain, Post-surgery, Medication, Neurological, Environment, Metabolic (Dehydration etc.)
• Treat underlying cause and manage symptoms

Question 5

DELIRIUM VS DEMENTIA:
Onset?

Course?

Consciousness?

Psychomotor?

Attention?

Reversibility?

Answer 5

• Hours to Days Vs Months to Years
• Fluctuating Vs Progressive
• Changed Vs No change
• Increased/Decreased Vs Normal
• Altered Vs Normal (except when advanced)
• Hopefully Vs Irreversible