Effects of Aging on Impairment Ratings: Part 3: Neurological and Associated Issues

2019 ◽  
Vol 24 (1) ◽  
pp. 3-14
Author(s):  
Stephen L. Demeter
Keyword(s):  
Nervous System ◽  
Medical Records ◽  
Age Related ◽  
Visual Status ◽  
The Central Nervous System ◽  
Tunnel Syndrome ◽  
Visual Problems ◽  
Impairment Ratings ◽  
Specific Disorders ◽  
Effects Of Aging

Abstract This article is the third in a series of four that explore the effects of age-related changes in impairments as defined by the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth and Sixth Editions. Specifically, this article focuses on evaluation of disturbances of the nervous system, divided for discussion here into four parts—the central nervous system (CNS), the peripheral nervous system, vision, and hearing—and offers guidance in using the AMA Guides, Fifth and Sixth Editions, in a variety of specific disorders within each group. For example, the CNS discussions address disorders of consciousness and awareness; sleep and arousal disorders; alterations in metal status, cognition, and highest integrative function; aphasia or dysphagia; emotional or behavioral disorders resulting from CNS causation (fifth edition only); chronic pain; and others. One of the most challenging issues in evaluating peripheral neuropathy regards carpal tunnel syndrome, and rating physicians should provide references in their reports to justify their position. Rating visual problems usually requires attention to the medical records to document preinjury visual status. The AMA Guides, Fifth and Sixth Editions, do not use age-adjusted corrections in assessing age-related diminished hearing, but local jurisdictions and circumstances may apply apportionment. In apportioning impairment due to aging, the examiner must understand both the science and the specific legal processes involved.

Bladder Problems

2013 ◽  
Author(s):  
J. Eric Ahlskog
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Neurogenic Bladder ◽  
Soft Tissues ◽  
Bladder Wall ◽  
Bladder Function ◽  
System Control ◽  
Autonomic Nervous ◽  
Age Related ◽  
The Central Nervous System

Urinary problems occur with normal aging. In women they often relate to the changes in female anatomy due to the delivering of babies. With superimposed age-related changes in soft tissues, laxity may result in incontinence (loss of urinary control), especially with coughing, laughing, or straining. In men the opposite symptom tends to occur: urinary hesitancy (inability to evacuate the bladder). This is due to constriction of the bladder outlet by an enlarging prostate; the prostate normally surrounds the urethra, through which urine passes. DLB and PDD are often associated with additional bladder problems. Recall that the autonomic nervous system regulates bladder function and that this system tends to malfunction in Lewy disorders. Hence, reduced bladder control is frequent among those with DLB, PDD, and Parkinson’s disease. This condition is termed neurogenic bladder, which implies that the autonomic nervous system control of bladder reflexes is not working properly. This may manifest as urgency with incontinence or hesitancy. Neurogenic bladder problems require different strategies than those used for treating the simple age-related problems that develop in mid-life and beyond. Moreover, there are certain caveats to treatment once a neurogenic bladder is recognized. The bladder is simply a reservoir that holds urine. It is located in the lower pelvis and is distant from the kidneys. The kidneys essentially filter the circulating blood and make the urine. The urine flows down from the kidneys into the bladder, as shown in Figure 14.1. Normally, as the bladder slowly fills with urine, a reflex is triggered when it is nearly full. This results in conscious awareness of the need to urinate, plus it primes the reflexive tendency of the bladder to contract in order to expel the urinary contents. The bladder is able to contract because of muscles in the bladder walls. Normally, nerves activate these muscles at the appropriate time, which forcefully squeeze the bladder, expelling the urine. Nerve sensors in the bladder wall are activated by bladder filling and transmit this information to the central nervous system, ramping up bladder wall muscle activity.

Effects of Aging on Impairment Ratings: Part 4: Musculoskeletal Issues

2019 ◽  
Vol 24 (6) ◽  
pp. 3-11
Author(s):  
Stephen L. Demeter ◽  
Charles N. Brooks ◽  
J. Mark Melhorn
Keyword(s):  
Medical Literature ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Older Individuals ◽  
Repetitive Motion ◽  
Age Related ◽  
Spinal Ligaments ◽  
Impairment Ratings ◽  
Effects Of Aging ◽  
Causation Analysis ◽  
Injury Causation

Abstract This article is the fourth of five in a series on the effects of age-related changes in impairment evaluations as defined by the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth and Sixth Editions. The present article addresses the musculoskeletal system and differs from the first three articles, which focused on apportionment of an impairment rating between aging and other causes. The medical literature supports the notion that age-related osteoarthritis (OA) changes in the hand and digits frequently are associated with injury and/or repetitive motion. Thus, apportionment is indicated, but deciding which came first, the imaging abnormality or the injury, requires consummate skill on behalf of the rating physician. OA also occurs in the knees and hips of older individuals. Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory disorder characterized by calcification and ossification of spinal ligaments and entheses and is unique, in the authors’ opinion, because of a positive correlation between aging and back pain caused by this condition. The article also addresses the association—or the lack thereof—between pathology and aging, as well as degenerative changes and symptoms, to facilitate causation analysis. For a fuller discussion of causation analysis for the spine, readers can consult the AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition.

scholarly journals Elastin-Derived Peptides in the Central Nervous System: Friend or Foe

2021 ◽  
Author(s):  
Konrad A. Szychowski ◽  
Bartosz Skóra ◽  
Anna K. Wójtowicz
Keyword(s):  
Nervous System ◽  
Matrix Proteins ◽  
Brain Vessels ◽  
Current State ◽  
Model Of Alzheimer’S Disease ◽  
Elastin Degradation ◽  
Age Related ◽  
The Central Nervous System ◽  
Structural Matrix

AbstractElastin is one of the main structural matrix proteins of the arteries, lung, cartilage, elastic ligaments, brain vessels, and skin. These elastin fibers display incredible resilience and structural stability with long half-life. However, during some physiological and pathophysiological conditions, elastin is prone to proteolytic degradation and, due to the extremely low turnover rate, its degradation is practically an irreversible and irreparable phenomenon. As a result of elastin degradation, new peptides called elastin-derived peptides (EDPs) are formed. A growing body of evidence suggests that these peptides play an important role in the development of age-related vascular disease. They are also detected in the cerebrospinal fluid of healthy people, and their amount increases in patients after ischemic stroke. Recently, elastin-like polypeptides have been reported to induce overproduction of beta-amyloid in a model of Alzheimer's disease. Nevertheless, the role and mechanism of action of EDPs in the nervous system is largely unknown and limited to only a few studies. The article summarizes the current state of knowledge on the role of EDPs in the nervous system.

scholarly journals Antioxidant Defense Mechanisms in Erythrocytes and in the Central Nervous System

Antioxidants ◽  
2019 ◽  
Vol 8 (2) ◽  
pp. 46 ◽  
Author(s):  
Rafael Franco ◽  
Gemma Navarro ◽  
Eva Martínez-Pinilla
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Defense Mechanisms ◽  
Antioxidant Defense ◽  
Circulatory System ◽  
Reducing Power ◽  
Antioxidant Defense System ◽  
Age Related ◽  
The Central Nervous System ◽  
High Level

Differential antioxidant action is found upon comparison of organ/tissue systems in the human body. In erythrocytes (red blood cells), which transport oxygen and carbon dioxide through the circulatory system, the most important issue is to keep hemoglobin in a functional state that requires maintaining the haem group in ferrous (Fe2+) state. Conversion of oxidized Fe3+ back into Fe2+ in hemoglobin needs a special mechanism involving a tripeptide glutathione, glucose-6-phosphate dehydrogenase, and glucose and NADPH as suppliers of reducing power. Fava beans are probably a good resource to make the detox innate system more robust as the pro-oxidant molecules in this food likely induce the upregulation of members of such mechanisms. The central nervous system consumes more oxygen than the majority of human tissues, i.e., 20% of the body’s total oxygen consumption and, therefore, it is exposed to a high level of oxidative stress. This fact, together with the progressive age-related decline in the efficiency of the antioxidant defense system, leads to neuronal death and disease. The innate mechanism operating in the central nervous system is not well known and seems different to that of the erythrocytes. The strategies of antioxidant intervention in brain will be reviewed here.

Effects of Age and Practice on Attention and Stages of Information Processing Using CRT with Fixed and Variable Foreperiods

1988 ◽  
Vol 32 (3) ◽  
pp. 208-212 ◽  
Author(s):  
Barbara L. Carlton ◽  
Max Vercruyssen ◽  
Joan M. McDowd ◽  
James E. Birren
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Reaction Time ◽  
Response Selection ◽  
Stimulus Interval ◽  
Response Stimulus Interval ◽  
Age Related ◽  
Response Stimulus ◽  
Effects Of Aging ◽  
Selection Stage

The results of previous investigations have found conflicting results on the locus of age-related slowing of reaction time using Additive Factors Method (Sternberg, 1969). This experiment was conducted to examine the differential effects of Additive Factors Method task manipulations using both fixed and variable foreperiod conditions with practice preceding a second day replication to quantify the interaction of these effects with skill. The results show that (1) practice is a major confounding for research involving RT tasks, (2) the locus of age effects may lie in the later response selection stage of processing, and (3) the effects of aging, practice and intra-task factors depend on the response-stimulus interval characterizing the RT task. This research has implications for improving research methodologies and understanding the nature of age-related slowing in central nervous system functions.

Age-related Degradation in the Central Nervous System: Assessment with Diffusion-Tensor Imaging and Quantitative Fiber Tracking

Radiology ◽  
2008 ◽  
Vol 247 (1) ◽  
pp. 179-188 ◽  
Author(s):  
Andreas Stadlbauer ◽  
Erich Salomonowitz ◽  
Guido Strunk ◽  
Thilo Hammen ◽  
Oliver Ganslandt
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Diffusion Tensor Imaging ◽  
Diffusion Tensor ◽  
Fiber Tracking ◽  
Age Related ◽  
The Central Nervous System ◽  
System Assessment

I. Age-related changes in the enteric nervous system

2002 ◽  
Vol 283 (3) ◽  
pp. G489-G495 ◽  
Author(s):  
Paul R. Wade
Keyword(s):  
Nervous System ◽  
Enteric Nervous System ◽  
The Elderly ◽  
Future Directions ◽  
Age Related ◽  
Clinical Literature ◽  
Pharmacological Studies ◽  
The Central Nervous System ◽  
Irritable Bowel ◽  
Age Related Changes

As we enter the 21st century, the segment of the population that is the most rapidly expanding is that comprised of individuals 85 yr of age and older. Dysfunctions of the gastrointestinal (GI) system, including dysphagia, constipation, diarrhea, and irritable bowel syndrome are more common complaints of the elderly, yet our knowledge of the aging GI tract is incomplete. Compared with the rapid advances in the neurobiology of aging in the central nervous system, the understanding of age-related changes in the enteric nervous system (ENS) is poor. In this brief review, I recap experiments that reveal neurodegenerative changes and their functional correlates in the ENS of mice, rats, and guinea pigs. Clinical literature seems indicative of similar structural and functional age-related changes in the human ENS. Current studies that address the mechanisms underlying age-related changes in the ENS are introduced. The future directions for this field include physiological and pharmacological studies, especially at cellular and molecular levels. Research in the aging ENS is poised to make major advances, and this new knowledge will be useful for clinicians seeking to better understand and treat GI dysfunction in the elderly.

Sign in / Sign up

Export Citation Format

Share Document