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Neurologic Signs of Aging
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Critchley, in 1931 and 1934, drew attention to a number of neurologic abnormalities that he had observed in octogenarians and for which no cause could be discerned other than the effects of aging itself Several reviews of this subject have appeared subsequently (see especially those of Jenkyn, of Benassi, and of Kokmen and their associates) The most consistent of the neurologic signs of aging are the following: 1 Neuro-ophthalmic signs: progressive smallness of pupils, decreased reactions to light and on accommodation, farsightedness (hyperopia) due to impairment of accommodation (presbyopia), insuf ciency of convergence, restricted range of upward conjugate gaze, frequent loss of Bell s phenomenon, diminished dark adaptation, and increased sensitivity to glare Progressive perceptive hearing loss (presbycusis), especially for high tones, and commensurate decline in speech discrimination Mainly these changes are due to a diminution in the number of hair cells in the organ of Corti Diminution in the sense of smell and, to a lesser extent, of taste (see Chap 12) Motor signs: reduced speed and amount of motor activity, slowed reaction time, impairment of ne coordination and agility, reduced muscular power (legs more than arms and proximal muscles more than distal ones) and thinness of muscles, particularly the dorsal interossei, thenar, and anterior tibial muscles A progressive decrease in the number of anterior horn cells is responsible for these changes, as described further on Changes in tendon re exes: A depression of tendon re exes at the ankles in comparison with those at the knees is observed frequently in persons more than 70 years of age, as is a loss of Achilles re exes in those above 80 years The snout or palmomental re exes, which can be detected in mild form in a small proportion of healthy adults, is a frequent nding in the elderly (in as many as half of normal subjects over 60 years of age, according to Olney) However, other so-called cortical release signs, such as suck and grasp re exes, are indicative of frontal lobe disease and are not to be expected simply as a result of aging Impairment or loss of vibratory sense in the toes and ankles Proprioception, however, is impaired very little or not at all Thresholds for the perception of cutaneous stimuli increase
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Effects of Aging on the Nervous System
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Of all the age-related changes, those in the nervous system are of paramount importance Actors portray old people as being feeble, Table 29-1 Physiologic and anatomic deterioration at 80 years of age
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Brain weight Blood ow to brain Speed of return of blood acidity to equilibrium after exercise Cardiac output at rest Number of glomeruli in kidney Glomerular ltration rate Number of bers in nerves Nerve conduction velocity Number of taste buds Maximum O2 utilization with exercise Maximum ventilation volume Maximum breathing capacity Power of hand grip Maximum work rate Basal metabolic rate Body water content Body weight (males)
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520 PART 3
with age but require the use of re ned methods of testing for their detection These changes correlate with a loss of sensory bers on sural nerve biopsy, reduced amplitude of sensory nerve action potentials, and probably loss of dorsal root ganglion cells The most obvious neurologic aging changes those of stance, posture, and gait are fully described in Chap 7 and further on in this chapter
The incidence of certain neurologic signs of aging has been determined by Jenkyn and colleagues, based on their examinations of 2029 individuals aged 50 to 93 years Notable again is the high frequency of snout and glabellar responses, but also limited downgaze and upgaze in approximately one-third of persons older than 80 These data are summarized in Table 29-2 With regard to the interesting population of the oldest old, over 85 years of age, Kaye and colleagues have reported that deficits in balance, olfaction, and visual pursuit are distinctly worse than in younger elderly persons Also of interest is the observation by van Exel and colleagues that women in this age group perform better than men on cognitive tests
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