Neurologic and Gait Changes

Question 1

What are common cognitive changes with aging?

Answer 1

Slowed processing speed, decreased cognitive flexibility, decreased sustained/divided attention, and decreased working memory.

Question 2

Which type of memory remains intact with aging?

Answer 2

Semantic memory (crystallized intelligence), including vocabulary and recall of facts.

Question 3

What brain structures are most affected by aging?

Answer 3

Frontal lobe (executive functions), basal ganglia (motor control, learning, behaviors), and cerebellum (coordination, postural control).

Question 4

How does myelin change with aging?

Answer 4

Myelin degeneration, decreased myelin repair, and shortening of myelinated nerve fibers contribute to reduced nerve conduction speed.

Question 5

How does aging affect motor units?

Answer 5

Fewer motor units with increased size, leading to reduced coordination and impaired timing of muscle activation.

Question 6

What changes occur in the autonomic nervous system with aging?

Answer 6

Altered balance between sympathetic and parasympathetic systems, affecting gastric motility, bladder control, blood pressure regulation, and peripheral blood flow.

Question 7

What are normal visual changes with aging?

Answer 7

Decreased visual field, acuity, contrast sensitivity, depth perception, and dark adaptation.

Question 8

What is presbycusis?

Answer 8

Age-related sensorineural hearing loss characterized by decreased sound sensitivity, speech discrimination, and difficulty localizing sound.

Question 9

How does peripheral neuropathy affect aging?

Answer 9

Reduced sensory and motor nerve conduction, loss of Achilles reflex, impaired proprioception, and increased fall risk.

Question 10

What happens to taste and smell with aging?

Answer 10

Loss of taste buds (especially sweet/salty), blunted thirst mechanism, and reduced olfactory sensitivity.

Question 11

How does vestibular function change with aging?

Answer 11

Decreased number of vestibular hair cells, nerve fibers, and degradation of otoconia, contributing to balance deficits.

Question 12

What is postural control?

Answer 12

The ability to maintain stability by managing the body’s center of mass within the base of support.

Question 13

What is the difference between anticipatory and compensatory postural adjustments?

Answer 13

Anticipatory: Pre-planned responses based on experience. Compensatory: Reflexive responses to unexpected perturbations.

Question 14

What postural control strategies do older adults rely on more?

Answer 14

Hip strategy over ankle strategy due to decreased lower extremity strength and flexibility.

Question 15

What environmental factors increase fall risk?

Answer 15

Poor lighting, slippery floors, clutter, improper footwear, and obstacles like area rugs.

Question 16

What psychological factors contribute to falls?

Answer 16

Fear of falling, anxiety, depression, and reduced confidence in mobility.

Question 17

What are intrinsic fall risk factors?

Answer 17

Muscle weakness, sensory impairments, vestibular deficits, postural hypotension, cognitive impairment, polypharmacy.

Question 18

What are extrinsic fall risk factors?

Answer 18

Poor lighting, uneven terrain, lack of handrails, clutter, and unsafe footwear.

Question 19

How does fear of falling impact function?

Answer 19

Leads to reduced mobility, increased sedentary behavior, muscle weakness, and higher fall risk.

Question 20

What is the impact of sarcopenia on fall risk?

Answer 20

Reduced strength, balance, and coordination, leading to slower gait speed and impaired postural control.

Question 21

What screening tools are used to assess fall risk?

Answer 21

Timed Up and Go (TUG), Berg Balance Scale, Functional Gait Assessment (FGA).

Question 22

What are common gait changes associated with aging?

Answer 22

Decreased stride length, velocity, pelvic rotation; increased stance time, cadence, and base of support.

Question 23

What is considered a normal gait speed in healthy older adults?

Answer 23

0.75-1.24 m/s.

Question 24

What is the significance of gait speed in older adults?

Answer 24

Predictor of functional mobility, fall risk, hospitalization, and mortality.

Question 25

What gait speed is needed for safe community ambulation?

Answer 25

At least 1.0 m/s; <0.8 m/s indicates limited community mobility and fall risk.

Question 26

What are major neuromuscular contributors to gait decline?

Answer 26

Loss of motor units, reduced proprioception, impaired vestibular function, and decreased flexibility.

Question 27

What outcome measures assess gait and balance in older adults?

Answer 27

TUG, 6 Minute Walk Test, Functional Gait Assessment, Dynamic Gait Index.

Question 28

What is considered a 'slow walker' based on gait speed?

Answer 28

<0.6 m/s, indicating increased fall risk, hospitalization, and disability.

Question 29

What is the importance of gait variability in fall prevention?

Answer 29

Increased gait variability, especially with mediolateral perturbations, is associated with higher fall risk.

Question 30

What interventions can improve gait and reduce fall risk?

Answer 30

LE strengthening, balance training, proprioceptive training, postural education, and dual-task training.

Question 31

How does cognitive load impact gait?

Answer 31

Divided attention (e.g., walking while talking) increases fall risk due to reduced executive function and motor planning.

Question 32

What is the concept of 'life space' in older adults?

Answer 32

The geographic area an individual moves through daily, with a shrinking life space indicating reduced mobility and independence.

Question 33

What is the average gait speed required to cross a street safely?

Answer 33

1.2-1.4 m/s.

Question 34

What is physiological reserve, and why is it important?

Answer 34

The body's ability to withstand stressors; reduced reserve leads to greater vulnerability to functional decline and falls.

Question 35

How does energy reserve affect walking ability?

Answer 35

Older adults have reduced VO2 max, requiring more effort for daily activities, leading to fatigue and reduced mobility.

Question 36

What is the best predictor of functional decline in older adults?

Answer 36

Decreased gait speed over 12 months is strongly associated with increased fall risk and mortality.