NEUROPSYCHIATRIC ASPECTS OF AGING

  OVERVIEW

The process of aging produces important physiologic changes in the central nervous system including neuroanatomical, neurotransmitter, and neurophysiologic changes.

 These processes result in age-related symptoms and manifestations for many older persons. These physiologic changes develop at dramatically variable rates in different older persons, however, the decline being modified by factors such as diet, environment, lifestyle, genetic predisposition, disability, disease, and side effects of drugs.

 These changes can result in the common age-related symptoms of benign senescence, slowed reaction time, postural hypotension, vertigo or giddiness, presbyopia, presbycusis, stiffened gait, and sleep difficulties. In the absence of disease, these physiologic changes usually result in relatively modest symptoms and little restriction in activities of daily living.

These changes decrease physiologic reserve, however, and increase the susceptibility to challenges posed by disease-related, pharmacologic, and environmental stressors

PHYSIOLOGICAL CHANGES

·         Neuroatomic changes

Brain atrophy

Decreased neuron count

Increased neurotic plaques

Increased lipofuscin and melanin

·         Neurotransmitter changes

Decline in cholinergic transmission

Decreased dopaminergic synthesis

Decrease catecholamine synthesis

·         Neurophysiological changes

Decreased cerebral blood flow

Electrophysiological changes (slowing rhythm, active evoked responses etc

NEUROPYCHIATRIC MANIFESTATIONS

These affects cognition, reflex, sensory, gait and sleep and includes the following

Forgetfulness

Decline in visual capacity

Loss of stretch reflex

Decrease or absence of ankle reflex

Postural instability

Depression

Decreased sleep in stage 3 and 4

Gait stiffer, slowed and forward movement

COMMON CONDITIONS ASSOCIATED WITH NEUROPSYCHIATRIC AGING

·         Alzheimer’s disease and related dementias

·         Delirium

·         Severe depression

·         Anxiety disorders

·         Parkinson's disease

·         Peripheral neuropathies

·         Degenerative myelopathies

·         Spinal stenosis and disc disease

·         Seizure disorders

·         Sleep apnea

·         Falls

·         Incontinence

·         Impotence

DIAGNOSIS AND MANAGEMENTS

  To diagnose these conditions, physicians must understand and perform a mental status examination and an assessment of functional capacity and know the uses and side effects of psychoactive drugs in geriatric patients used for symptomatic treatments.