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Aging Changes in Muscles and Nerves
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With advancing age, skeletal muscles lose cells ( bers) and undergo a gradual reduction in their weight more or less parallel to that of the brain Atrophy of muscles and diminution in peak power and endurance are clinical expressions of these changes Many processes contribute to this age-dependent loss of lean muscle mass, described as sarcopenia These include decreased physical activity; diminished appetite associated with loss of smell and elevated levels of cholcystokinin, a satiety hormone; other endocrine changes such as diminished levels of growth hormone and androgens; and (as in the brain) the accumulation of subcellular defects such as nuclear and mitochondrial DNA mutations alluded to earlier Moreover, with aging, the slow loss of motor neurons contributes to a component of denervation atrophy Our own observations of neuropathologic material indicate that the wasting involves several processes, some principally myopathic and others relating to disuse or denervation, from loss of motor neurons In this material, denervation atrophy of the gastrocnemius muscles was found in 80 percent of individuals over 70 years of age The lost muscle bers are gradually replaced by endomysial connective tissue and fat cells The surviving bers are generally thinner than normal (pos-
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sibly due to disuse atrophy), but some enlarge, resulting in a wider than normal range of ber size Groups of bers all at the same stage of atrophy undoubtedly relate to loss of motor innervation The reduction in conduction velocity and decrease in amplitude of motor nerve potentials and, to a greater extent, of sensory nerves in the aged may be taken as other indices of loss of motor and sensory axons All these changes are more marked in the legs than elsewhere However, when Roos and colleagues examined the contractile speed and ring rates of the quadriceps muscle in young men and compared them to those of men close to 80 years old, they found little difference despite a 50 percent reduction in the maximum voluntary contraction force developed by the muscle in the older men It has been repeatedly observed that age is an important prognostic factor in a large number of human diseases This effect is very evident, for example, in the markedly slower and less complete recovery from Guillain-Barre polyneuropathy in older age groups compared with younger ones One presumes that the structural changes of aging in peripheral nerves limit the degree of myelin regeneration and lower the threshold for failure of electrical transmission
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Gerontology is de ned as the study of aging and gerontologic neurology as the study of the effects of aging both of aging itself and of the age-related diseases on the nervous system In comparison to pediatric neurology, these disciplines have not aroused much interest The young physician is more excited by acute disease than by the seemingly immutable changes due to aging and is inclined to question whether medicine has a signi cant role to play
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in treating the neurologic disorders of the elderly The authors would answer this question af rmatively for the simple reason that a majority of all neurologic patients seen in practice are elderly, especially if one includes those with vascular diseases of the brain Furthermore, many of their diseases are preventable or therapeutically controllable Some of the age-related chemical de ciencies (ie, vitamin B de ciencies, diabetes mellitus) and many of the common restricted involutional changes (presbyopia, etc) can be corrected Others can even be turned into assets; the forgetfulness of the aged and their deafness may serve to excuse many of their shortcomings and to spare them effort and annoyance And always, there is the need to counsel the elderly patient on matters pertaining to health and daily activities This was appreciated even in the time of Cicero, who, in his De Senectute, urged the practice of moderation in exercise and giving due attention to the mind, which must be kept active or, like a lamp that is not supplied with oil, it will grow dim As medical science and public health measures have brought diseases of aging and other diseases under control, the number of elderly persons has increased and will continue to do so The US Census Bureau has estimated that in the year 2000 there were 31 million persons over the age of 65 in the United States and that 13 million of them were more than 75 years old As the number of elderly increases, the need to look after them will occupy more and more of the energies of physicians and the resources of society at large Once an old person declines physically and mentally to a vegetative state, the issue of euthanasia and all the ethical problems it entails will arise from time to time The authors reject this solution while committing themselves to measures that prevent pain and suffering
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