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Flashcards in Neuro of Aging Deck (19)
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1

cognitive: intelligence, performance IQ, verbal IQ

- intelligence peaks in young adulthood
- performance IQ: declines more than 40% b/c of decline in motor skills not as much b/c of actual intelligence decline
- verbal IQ: stable prior to age 60; up to 10% loss through 8th decade

2

cognitive: speed of central processing and learning

- speed of central processing gradually and continually declines from 3rd through 8th decade
- impaired learning related to recent memory impairment

3

impaired vision

- decline in contrast sensitivity (shades) and VA (presbyopia)
- increasing lens and vitreous opacification
- lens becomes more rigid = impaired accommodation
- pupil becomes smaller and less reactive

4

restricted vertical eye movements

- young adults have 35-45 degrees of upgaze
- adults in 8th decade have only 15-20 degrees of upgaze
- limited neck motion: decrease in upgaze happens more b/c of disuse v. actual degeneration of the vertical gaze

5

presbycusis

- elevation of auditory threshold, especially for higher frequencies
- difficulty w/ speech discrimination
- degeneration of hair cells in organ of Corti

6

motor system changes

- decreased m. mass, strength and speed
- anterior horn cell degeneration
- mild decline in coordination

7

sensory system changes

- decreased vibratory sensation in legs
- only feeling vibrations in UE is a normal finding in the elderly
- position sense should be intact everywhere

8

reflex changes

- generally reflexes are depressed
- depressed reflexes is a normal elderly finding but absent reflexes is not - absence indicates some underlying issue
- could be due to loss of large fiber function

9

gait changes

- postural righting reflexes are preserved but increased postural sway
- stable gait relies on sensory input, motor response and integration of both --> remember Romberg's test and its implications

10

frontal release signs

- the frontal lobe suppresses these reflexes as children develop and they can return in the elderly
1. palmomental refles: stroke palm and + if you see chin flinch; 20-27% in 20-50yo; 20-60% in 60-93yo
2. snout reflex: tongue blade over lips and tap - pt will purse lips in response; 13% v. 54% >60yo
3. suck reflex: rarely seen even in elderly - more pathologic; only 5% in >65yo
4. grasp reflex: very rare in normal population; most pathologic

11

peripheral neuropathy

- normal changes in the elderly do not produce:
1. + symptoms (paresthesias) or
2. significant - symptoms (weakness)

12

orthostatic hypotension

- decreased baroreceptor sensitivity
- blunted increase in heart rate
- reduction in response to pressor drugs
- tendency for volume depletion (nutritional deficits and medications can be cause)

13

hypothermia

- defined as core temp <35 degrees C
- decreased ability to maintain thermal homeostasis
- impaired heat conservation: less fat and decreased vasoconstriction
- impaired heat production: decreased metabolic rate

14

hyperthermia

- defined as core temp >41C or >40.7C w/ anhidrosis or altered mental status
- impaired heat loss b/c of inadequate sweating and reduced peripheral vasodilation

15

sleep disturbances

- elderly require less sleep --> only 5-6h
- decreased sleep duration, frequent arousals, early awakening, frequent napping, reduction of Stage IV and REM sleep
- evaluation includes enforced sleep cycle, assess for sleep apnea and be cautious w/ use of sleeping pills (can contribute to falls)

16

Falls: epidemiology

- 30% of people 65+ fall each year
- accidents (includes falls) = 6th leading cause of death
- falls can result in fx, serious soft tissue injuries, joint dislocations, closed head injuries
- 1% of falls cause hip fx and 20% of these people die in 6 months

17

falls: etiology

1. cognitive: dementia can cause apraxia, normal pressure hydrocephalus, multi-infarct; dementia is treatable not curable
2. sensory: vision (cataract, macular degeneration, glaucoma), auditory, vestibular (drugs, trauma, previous surgery, vertigo), proprioception (neuropathy, myelopathy, spinal stenosis)
3. motor: stroke, spinal stenosis, myelopathy, Parkinson ds
4. continence

18

falls: consequences

- result in injury, pain, restricted activity, anxiety, fear, depression, loss of confidence
- the more falls = higher chance for nursing home placement

19

falls: prevention methods

1. assess meds: pts w/ 4+ meds at higher risk; in particular benzodiazepines, sedatives and antidepressants are high risk b/c they dull sensations and slow rxn times
2. assess home; check footwear, lighting, stairs, flooring, wires, clutter, bathroom
3. assess diet: calcium & vitamin D, bone density, folate/B12, alcohol use
4. assess physical well-being: strengthening, exercise and ROM programs (tai chi, weights, resistance training, flexibility); balance programs
5. assess mental well-being: psychological support, mini-mental status eval