Dr. ISNANIAH, Sp.SDr. ISNANIAH, Sp.S

AGEING PROCESS OF AGEING PROCESS OF NEURONAL SYSTEMSNEURONAL SYSTEMS

Definition: Memory refers to the storage, retention and recall of information including past experiences, knowledge and thoughts

Only some types of memory loss are associated with normal aging

Other types are typical of disease states

Memory Decline in Normal Aging

Working (intermediate term) – loss occurs with normal aging

Episodic- especially impaired in normal aging e.g. ability to process recent information

Semantic (e.g. vocabulary) – Improves with age; lost in dementias

Procedural (long-term memory of skills) - shows No Decline with age; affected by diseases

Types of Memory and Loss

Very long-term memory (months to years)- increases upto age 50; maintained until well after 70

Short-term memory- shows little decline; loss associated with diseases

Older adults tend to be worse at remembering the source of their information

Types of Memory and Loss

Forgetting things much more often than you used to Forgetting how to do things you've done many times

before Trouble learning new things Repeating phrases or stories in the same

conversation Trouble making choices or handling money Not being able to keep track of what happens each

day

Abnormal Memory Loss in Aging

High blood pressure, diabetes, poor nutrition, and social isolation

Heart disease Family history of dementia Psychological factors like stress and

depression

Risk Factors for Cognitive Decline

Executive Functioning include: Organization: attention, decision-making,

planning, sequencing, problem solving Regulation: initiation of action, self-control, self-

regulation Language- coherent, sensible Working (immediate) Memory Spatial Memory

Verbal Memory

Normal Cognition

The word dementia is used to describe the condition where one has a progressive decline in memory and other cognitive functions that results in a change in the ability to conduct one's usual activities

Dementias are neurodegenerative diseases which cannot be cured

Each type characterized by specific effects on cognitive and motor function

Dementia

Diagnosis of dementia is not generally given in absence of impairment in social functioning and independent living.

Dementia seriously affects a person’s ability to carry out daily activities

People with dementia lose their abilities at different rates

Eventually, patients may need total care

Dementia ( con’t )

Dementia symptoms may include: asking the same questions repeatedly, becoming lost in familiar places, being unable to follow directions, getting disoriented about time, people, and

places, and neglect of personal safety, hygiene, and

nutrition.

Symptoms of Dementia

Definition: Is a progressive, neurodegenerative disease characterized in the brain by abnormal clumps (amyloid plaques) and tangled bundles of fibers (neurofibrillary tangles) composed of misplaced proteins

AD is the most common dementia in older adults Incidence expected to more than double by 2050-

from 377,000 in 1995 to 959,000

Alzheimer's Disease (AD)

The proportion of new cases >85 will increase from 40% in 1995 to 62% in 2050

The annual incidence expected to shoot up by 2030 (baby boomers [persons born between 1946 and 1964] will be over age 65)

Most of the increase will occur among people age 85 or older

Early symptoms of AD, which include forgetfulness and loss of concentration, are often missed because they resemble natural signs of aging

Alzheimer's Disease (AD)

Caused by a series of strokes in the brain Infarcts result in irreversible death of brain tissue Location/severity of compromised area governs severity

of symptoms/loss of function Symptoms – abrupt onset; progress step-wise as strokes

recur Treatment to prevent further strokes is very important

Multi-infarct dementia

Anxiety Anxiety disorders- commoner as we get older as

medical, psychological, and social problems build up One in five older adults suffers anxiety symptoms

severe enough to necessitate treatment Persistent or extreme anxiety can seriously decrease

QOL Can be a sign of other problems like depression,

dementia, physical illness

Other Mental Conditions

Anxiety is often associated with over-arousal Specific anxiety disorders include the following:

General Anxiety Disorder –Most Common Panic Attacks –Previous History Present Phobias- E.G. Unable To Urinate In Public

Bathrooms; Inability To Eat In Public Obsessive Compulsive Disorder –Usually Present

At Younger Age Post-Traumatic Stress Disorder

Other Mental Conditions

Delirium, or acute confusion, is a sudden change in mental function

Delirium is usually a short-term, temporary problem May persist for weeks to months in a substantial

number of people Is a common complication of medical illness in

elderly

Delirium

One-third of older adults arrive at hospital emergency departments in delirious state

Is strongly associated with poor outcomes among hospitalized patients

Can be mistaken for dementia or schizophrenia Delirium common in people with dementia

Delirium ( con’t )

Parkinson's disease is a slowly progressive degenerative disease of the nervous system

About 50,000 Americans are diagnosed with PD each year

Many more undiagnosed as attribute symptoms to old age

Average age of onset is 60; commoner as we grow older

Parkinson's Disease

Caused by loss of nerve cells in brain that produce dopamine

Usually familial Exposure to high levels of manganese, carbon

disulfide or certain pesticides increases risk An increased risk in people who live in rural areas in

advanced countries (unproved)

Parkinson's Disease ( con’t )

Depression is a serious medical illness characterized by: Persistent sad, anxious, or "empty" mood Feelings of hopelessness, pessimism Feelings of guilt, worthlessness, helplessness Loss of interest or pleasure in hobbies and

activities that were once enjoyed

Depression

1%—2% of older women, and < 1% of older men have major depression

Is a continuation of problem from earlier life in 30%—50% of cases

Major depression may accompany disorders that result in dementia

Many older adults face cancer or grief that promote depression

There is a strong link between major depression and increased risk of dying from heart disease.

Alcohol abuse causes depressed mood

Depression ( con’t )

Aging has profound effects on mental faculties Brain tissue is irreparable – changes are permanent Speed of communication between nervous tissues is

decreased Transmission of messages within nerve cells

becomes slower The brain and spinal cord lose nerve cells and weight Waste products collect in brain, causing plaques and

tangles

Nervous Tissue and Aging

Changes result in: Lost or reduced reflexes → problems with movement

and safety Slight slowing of thought, memory, and thinking- a

normal part of aging A change in thinking/memory/behavior are

important indicators of disease ALL ELDERLY PEOPLE DO NOT BECOME ‘SENILE’

Delirium, dementia, and severe memory loss are NOT normal processes of aging

Caused by degenerative brain disorders such as Alzheimer's disease

Illnesses unrelated to brain can cause changes in thinking/ behavior

Severe infections can lead to confused states Diabetes- fluctuations in glucose levels can cause thinking/behavioral disorders

CHANGES IN SENSES

TOUCH-Gradual reduction after 50- injuries,

hypothermia

SMELL- Decreases after

70 yrs- may affect hygiene

TASTE- Minimal changes

VISION-Usually need glasses by 55-Only 15-20% have ↓ driving

ability

HEARING30% people over

age 65 have impairment

SENSES

Normal acuity ↓ with age

All senses are controlled totally by the brain Aging increases minimum amount of stimulation before

a sensation is perceived Any compromise in senses has tremendous impact on

lifestyle Hearing and vision changes- dramatic effect on QOL Many changes can be improved with glasses, hearing

aids, and lifestyle modifications Communication problems common- lead to social

isolation and loneliness

SENSES

Ears perform two functions – 1. Hearing 2. Maintaining body balance (equilibrium)

Equilibrium (controlled by the inner ear) Hearing is ruled by the outer ear– disorders respond

better Aging adversely affects both structures Acuity of hearing declines slightly after age 50 30% people > 65 have significant hearing impairment Impacted ear wax commoner with increasing age →

deafness, easy to treat Persistent, abnormal ear noise (tinnitus) - common in

older adults

HEARING

Visual acuity may gradually decline- not universal After age 55, most people need glasses at least part of

the time Driving ability is impaired in 15% to 20% due to bad

vision 5% become unable to read Trouble adapting to darkness or bright light Significant difficulty with night driving may be the first

sign of a cataract

VISION

Color Perceptions Change As we age, it is harder to distinguish blues and greens

than reds and yellows Elderly should use yellow, orange, and red contrasts

at home- improves ability to locate things Using a red nightlight is better than a conventional

bulb

"Floaters" in vision- harmless; sudden ↑ needs consultation

Reduced peripheral vision occurs- cannot see adjacent people- may cause offense to friends

Blindness- usually caused by diseases like diabetes and high BP

TASTE AND SMELL

Taste does not seem to decrease until after age 60, if at all

Sense of smell may diminish, especially after age 70- leads to poor hygiene, and unawareness of gas leaks etc

Touch, Vibration, And Pain

Aging can reduce sensations of pain, vibration, cold, heat, pressure, and touch

Decreased temperature sensitivity increases the risk of frostbite, hypothermia, and burns

After age 50, many people have reduced sensitivity to pain.

Reduced feel of vibrations- loss of stability in motion