Geriatrics -Neurologic System

Neuro system: overall ___% decline per year starting at age 30

1

ACH decrease leads to

typical age related memory changes

NE decrease leads to

cognitive decline

Dopamine decrease lead to

motor and cognitive decline

serotonin decrease leads to

mood and cognitive changes

GABA decrease leads to

cognitive decline

loss of dendritic spines lead to ______________ loss

synapses

true or false: total number of neurons decline over time

true

areas in the CNS that are impacted by typical aging are _____________

variable!

substantia nigra and locus ceruleus lose _______%

35

lumbosacral anterior horn cells, sensory ganglion cells, putamen, and purkinje lose at most _________%

25

vestibular nuclei and inferior oliver lose __________%

HARDLY ANY

white matter changes with age found in _____-_____% of community dwelling elderly

50-98

white matter changes related to decrease in ______________ density over time

myeline

white matter changes can lead to age-related changes in _____________ and ______________

gait, cognition

grey matter changes thought to be driven by decline in circulating serum ____________ levels

BDNF

grey matter changes more prevalent in what areas?

frontal lobe, temporal lobe, cingulate gyrus, hippocampus, and insula

atherosclerosis

Pesence is highly variable and seems to be more related to BP control, lipid levels, and genetics than a product of aging

basilar arteries become ______________ and more TORTUOUS

larger

cerebral blood flow and cerebral metabolic rate ____________

decline

blood flow to brain declines by _____% by age 80

20

true or false: ventricles get smaller with age and sulci become less pronounced

FALSE, opposite

true or false: 10-15% decline in brain weight by age 80

true

true or false: our view on typical cognitive changes can impact how neurological events (TBI, stroke) are recognized

true

nerve conduction speeds decrease with aging, starting between age _____ and _____

30-40

nerve conduction changes are driven by what two things?

loss of myelinated and unmyelinated nerve fibers, decrease in myelin with maintained nerve fibers

true or false: motor and sensory nerves decrease in number

true

which is more effected by peripheral nerve loss? UE or LE?

LE

_____% decline in number of fibers in nerves by age 80

37

do older adults become hyporeflexic or hyperreflexic?

hypo

LE or UE more effected by hyporeflexia?

LE

t or f: with age, decreased vibratory sense, joint position, and response to tactile input

true

t or f: older adults are more impacted by extremes of hot and cold

true

pain perception?

we dont really know

t or false: 40% have smell enhancement by age 80

no (loss)

what causes smell loss?

meds, smoking, cancer tx, alzheimers, PD

decreases sense of taste due to what?

decreased number/size taste buds, decreased saliva production

what can decreased taste lead to:

malnutrition, excess salt and sugar intake

____% decline in number of taste buds by age 80

64

presbycusis=

age related hearing loss

why are their hearing changes: due to decreased number of _______________ cells in the organ of ___________

hair, Corti

what is speech discrimination?

ability to tell if two sounds are the same or different

uncorrected hearing loss is correlated to ____________ decline

cognitive

how should you speak to a patient with hearing loss?

lower, slower

lens becomes more ___________, begins around age 40

rigid

rigid lens: leads to _________________ deficits

accomodation

impact of rigid lens:

need bifocals, readers

presbyopia

impaired vision as a result of aging

glare

causes problem

increased/decreased? tear production

decreased (dry eye)

causes of vestibular changes

vestibular, medication, cardiogenic

vestibular deconditioning

you tend to stop spinning in circles, cartwheels, etc. as you get older

presence of _________________ increases risk of falls

BPPV

when doing testing with BPPV: testing should be _______________

slower

agility?

declines starting in 30s

typical gait changes w/age:

wider BOS, slower, stoops, less arm swing, more time in double limb stance, less confidence

gait changes mean what?

increased work in walking, increased risk for falls

sleep cycle ___________

shortens

sleep schedule:

early morning waking, more frequent night-time waking

why are there sleep changes?

changes in circadian rhythms, decreased sleep homeostasis, social engagement, lifestyle, environment, medical co-morbities, medications, sleep disorders

stage 1 and 2 sleep

non-REM

SWS = slow wave sleep

deep non-REM sleep important for MEMORY consolidation

REM=

rapid eye movement

WASO

wake after sleep onset

sleep latency

how long until you fall asleep

t or f: significant mood changes are typical with aging

FALSE

exception to mood changes with aging?

perimenopause and menopause

if notable changes in mood or mood swings are noted, look for underlying cause like:

mental health, dementia, medications, underlying condition

1/4 of people over the age of 65 are considered to by socially ______________

isolated :(

social isolation significantly increases chances of _________ ____________

premature death

social isolation: _________% increased risk of dementia

50%

t or f: loneliness and social isolation are the same

false

definition of meaning

"psychological concept linked to the feeling we get when our thoughts, emotions, and actions make a difference and matter to others. Significance in our lives."

definition of purpose

"Journey we embark on, what we perceive as our calling, or the potential we believe we have for our lives."

t or f: unsuccessful or non-attempts at finding meaning and purpose tend to lead to higher rates of depressive symptoms

true

how to find meaning in later life:

•Meaning reflectivity

•Finding and constructing

•Mindset

•Viewing aging as a strength and source of wisdom

•Creative pursuits

•Exploring new activities

•Family life

•Volunteering or continued employment

•Learning something new (or many things)

•Setting new goals

______________ attention remains intact, ___________________ gradually decline

selective, divide attention

___________________ memory shortens

working

long term memory:

general concept remain, but context, dates, and people involved tend to be lost

semantic memory (facts):

preserved

procedural memory:

preserved

prospective memory:

requires use of calendars and lists, without these impairment is noted

perception

intact ,deficits related to sensory impairments

speech and language

preserved and MAY IMPROVE

with decision making, rely heavily on __________________________________ rather than new info

prior knowledge

with decision making, rely heavily on ______________ opinion

expert

executive control (planning, organization, coordination, implementation):

decline w age

t or f: intelligence remain with age

true

crystallized intelligence

improves w age

fluid intelligence

Analyze novel problems, identify patterns and relationships that may cause problems, extrapolate using logic, decline with age

recommendations for preventing abnormal cognitive decline w aging:

aerobic ex, crossword, socially active, cognitively active, stop smoking, minimize alcohol, minimize risk of head injury

is neuroplasticity possible in older age?

yes, but takes more time, work, and practice

cataracts

clouding of the lens

glaucoma

increased intraocular pressure

macular degeneration

loss of central vision

t or f: any visual issue puts people at higher risk for falls

true

risk factors for cataracts

age, DM, smoking, alochol, fam hx, eye injury, no sunglasses, steroids

symptoms of cataracts

develop over time, cloudy vision, colors faded, problems seeing at night, halo around lights, diplopia

leading cause of blindness in developing countries?

cataracts

t or f: in the US and developed nations, surgery removes clouded lens and replaces it

true