Functional MRI Studies of Cognitive Evaluation in the Elderly

2018 ◽  
pp. 119-139
Keyword(s):  
The Elderly ◽  
The United States ◽  
Global Perspective ◽  
Major Surgery ◽  
Medical Illness ◽  
Mental Function ◽  
Cognitive Changes ◽  
Compensatory Response ◽  
Age Related ◽  
The Brain

Over the last century, life expectancy has improved significantly in the United States—from 47 years for men and 49 years for women in 1900 to 76 years and 81 years, respectively, in 2017. Older people have altered mental function that can vary from subtle cognitive changes to dementia. Additionally in elderly patients cognitive function seems to worsen after a medical illness, hospital admission or major surgery. The cognitive neuroscience of aging is an emerging field of research. Clinically, older patients can show alteration in working memory, executive function, multitasking, speed of response, etc. Anatomically, age-related changes in the brain are primarily in the frontal lobe. However, in neuropathological diseases affecting cognition in elderly (Alzheimer’s disease, Huntington’s disease, etc.), the changes are primarily in the temporal lobe. fMRI activation studies have revealed consistent changes in activation pattern with age. In younger persons, many activation-induced responses are lateralized—verbal activation is lateralized to the left and spatial memory activation is right lateralized. In the elderly, these activations induce a bilateral response. This is an age-related compensatory response. fMRI connectivity studies give a global perspective on mental function. The default mode network (DMN) is active in the resting “no task” state of the brain; with a task, activity decreases in the DMN. The elderly have less resting DMN activity than younger people, and their ability to decrease DMN activity during a task (which is essential for shifting attention and focusing on a task) is also less.

Cognition in Ageing

2018 ◽  
pp. 118-133 ◽  
Author(s):  
Susmita Halder ◽  
Akash Kumar Mahato
Keyword(s):  
Cognitive Functions ◽  
The Elderly ◽  
Daily Functioning ◽  
Cognitive Changes ◽  
Geriatric Population ◽  
Medical Issues ◽  
Age Related ◽  
Growing Age ◽  
The Common ◽  
The Brain

This chapter focuses on cognitive functions and impairment in the elderly; its implications in daily functioning with inputs on differences in the existing literature. The chapter further focuses on the diagnostic and assessment issues and intervention strategies. Ageing is an inevitable phase of life and encompasses changes in physical, psychological and social realms of an individual. Concern with the dwindling health and presence of any medical issues make the geriatric population prone to develop mental health conditions. Poor memory and reduced functional ability is one of the common complaints from older adults coming to psychiatric or neurology clinics. Cognitive functions have been well documented regarding their role in daily functioning of an individual. With growing age of the brain; while some cognitive functions do slow down; some of the functions do evolve better with experience. In this context, it is important to differentiate between normal age related cognitive changes and symptoms of any degenerative disease.

scholarly journals Considerations for a Respiratory Syncytial Virus Vaccine Targeting an Elderly Population

Vaccines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 624
Author(s):  
Laura M. Stephens ◽  
Steven M. Varga
Keyword(s):  
Respiratory Syncytial Virus ◽  
Disease Burden ◽  
Elderly Population ◽  
Vaccine Development ◽  
The Elderly ◽  
The United States ◽  
Susceptible Population ◽  
Age Related ◽  
Syncytial Virus ◽  
Tract Infections

Respiratory syncytial virus (RSV) is most commonly associated with acute lower respiratory tract infections in infants and children. However, RSV also causes a high disease burden in the elderly that is often under recognized. Adults >65 years of age account for an estimated 80,000 RSV-associated hospitalizations and 14,000 deaths in the United States annually. RSV infection in aged individuals can result in more severe disease symptoms including pneumonia and bronchiolitis. Given the large disease burden caused by RSV in the aged, this population remains an important target for vaccine development. Aging results in lowered immune responsiveness characterized by impairments in both innate and adaptive immunity. This immune senescence poses a challenge when developing a vaccine targeting elderly individuals. An RSV vaccine tailored towards an elderly population will need to maximize the immune response elicited in order to overcome age-related defects in the immune system. In this article, we review the hurdles that must be overcome to successfully develop an RSV vaccine for use in the elderly, and discuss the vaccine candidates currently being tested in this highly susceptible population.

Pharmacotherapy of Chronic Heart Failure in the Elderly: A Review of the Evidence

2010 ◽  
Vol 2 ◽  
pp. CMT.S2794
Author(s):  
Toni L. Ripley ◽  
Thomas A. Hennebry
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Older Patients ◽  
The Elderly ◽  
The United States ◽  
Response To Therapy ◽  
Clinical Endpoints ◽  
Age Related ◽  
Prevalent Disease ◽  
To Receive

Heart failure (HF) is a very prevalent disease in the United States and in Europe, with the highest prevalence among older patients. Population estimates suggest substantial growth among the elderly over the next four decades. However, older patients are underrepresented in clinical trials evaluating HF therapies and are less likely to receive the medications shown in these trials to reduce the morbidity and mortality associated with HF. Age-related differences exist in cardiovascular function that may affect disease progression, clinical presentation, and/or response to therapy. Further, medication use in older patients is complicated by physiologic changes in pharmacokinetics and the presence of multiple co-morbidities, which leads to polypharmacy and the related complications. We reviewed the pharmacotherapy clinical trials in HF to review the results specifically in older patients. Trials were included in this review if clinical endpoints were evaluated, if data regarding the participants’ age was reported, and if the intervention studied was in a medication class that is generally recommended for patients with HF by published guidelines. Although some non-randomized data shows benefits of standard therapies may be maintained among patients with HF ≥ 60 years old, the randomized controlled trials that have been published to date showed no benefit and no harm in this group. Cautious HF management among older patients is critical as additional evidence is pursued.

Role of positive pressure therapy on sleep disordered breathing and cognition in the elderly

2017 ◽  
Author(s):  
Molly E. Zimmerman ◽  
Mark S. Aloia
Keyword(s):  
Older Adults ◽  
Sleep Disordered Breathing ◽  
Randomized Clinical Trials ◽  
The Elderly ◽  
Positive Pressure ◽  
Cognitive Changes ◽  
Pressure Therapy ◽  
Age Related ◽  
Disordered Breathing

Efforts aimed toward alleviating senescence have intensified as older adults occupy an increasing proportion of the population. Cognitive abilities become compromised with advancing age, with a vast heterogeneity of presentations, ranging from occasional word-finding difficulties to dementia. The role of sleep disordered breathing (SDB) in moderating or mediating age-related cognitive decline is particularly relevant given its potential reversibility in response to positive airway pressure (PAP) therapies. Establishment of SDB as a significant contributor to the development of dementia and cognitive dysfunction among the elderly has immense public health relevance, underscoring the importance of its early identification and treatment. Although several studies have examined the effect of PAP on cognitive function in older adults with SDB, additional prospective randomized clinical trials are needed. This chapter reviews the literature on SDB and cognition among the elderly as well as cognitive changes in response to PAP. Considerations for future research are also discussed.

Pharmacologic Considerations in the Elderly Surgical Patient

2016 ◽  
Author(s):  
Linda Sohn ◽  
Joe C. Hong ◽  
Michael W. Yeh ◽  
Tara A. Russell ◽  
Marcia M. Russell
Keyword(s):  
Older Adults ◽  
Surgical Procedures ◽  
Postoperative Delirium ◽  
Medication Management ◽  
The Elderly ◽  
The United States ◽  
Surgical Patient ◽  
Age Related ◽  
The Impact ◽  
Preoperative Medication

The most rapidly growing segment of the elderly population corresponds to persons age 85 and over. As of 2006, elderly patients accounted for 35.3% of the inpatient and 32.1% of the outpatient surgical procedures occurring in the United States. Because age-related changes occur in each organ system in all elderly individuals, this population merits special consideration when undergoing surgical procedures. Furthermore, there is a high probability that older adults will have multiple chronic medical problems, which may present a complex medication management challenge. This review covers the pharmacologic impact of physiologic changes associated with aging, preoperative assessment, preoperative medication management, delirium and the impact of perioperative medications in the elderly, anesthesia and related medications, and specific drug classes and their use in the elderly surgical patient. Figures show an overview of the management of the elderly surgical patient, and preoperative medication management. Tables list medications that should be avoided in older patients with reduced renal function, drugs that exhibit additive adverse effects, medications with high anticholinergic activity, medications that inhibit and induce the CYP450 system, herbal supplements, 2015 Beers Criteria summary of potentially inappropriate medication use in older adults, drugs associated with postoperative delirium, risk factors for postoperative delirium, and clinical pharmacology of commonly used anesthetic agents.   This review contains 2 highly rendered figures, 9 tables, and 61 references

Pharmacologic Considerations in the Elderly Surgical Patient

2017 ◽  
Author(s):  
Linda Sohn ◽  
Joe C. Hong ◽  
Michael W. Yeh ◽  
Tara A. Russell ◽  
Marcia M. Russell
Keyword(s):  
Older Adults ◽  
Surgical Procedures ◽  
Postoperative Delirium ◽  
Medication Management ◽  
The Elderly ◽  
The United States ◽  
Surgical Patient ◽  
Age Related ◽  
The Impact ◽  
Preoperative Medication

The most rapidly growing segment of the elderly population corresponds to persons age 85 and over. As of 2006, elderly patients accounted for 35.3% of the inpatient and 32.1% of the outpatient surgical procedures occurring in the United States. Because age-related changes occur in each organ system in all elderly individuals, this population merits special consideration when undergoing surgical procedures. Furthermore, there is a high probability that older adults will have multiple chronic medical problems, which may present a complex medication management challenge. This review covers the pharmacologic impact of physiologic changes associated with aging, preoperative assessment, preoperative medication management, delirium and the impact of perioperative medications in the elderly, anesthesia and related medications, and specific drug classes and their use in the elderly surgical patient. Figures show an overview of the management of the elderly surgical patient, and preoperative medication management. Tables list medications that should be avoided in older patients with reduced renal function, drugs that exhibit additive adverse effects, medications with high anticholinergic activity, medications that inhibit and induce the CYP450 system, herbal supplements, 2015 Beers Criteria summary of potentially inappropriate medication use in older adults, drugs associated with postoperative delirium, risk factors for postoperative delirium, and clinical pharmacology of commonly used anesthetic agents.   This review contains 2 highly rendered figures, 9 tables, and 61 references

scholarly journals Micronutrients - a Global Perspective on Intake, Health Benefits and Economics

2012 ◽  
Vol 82 (5) ◽  
pp. 316-320 ◽  
Author(s):  
Birgit Hoeft ◽  
Peter Weber ◽  
Manfred Eggersdorfer
Keyword(s):  
Low Income ◽  
Health Care Systems ◽  
The Elderly ◽  
The United States ◽  
Global Perspective ◽  
Low Income Countries ◽  
Micronutrient Deficiencies ◽  
Micronutrient Status ◽  
Care Systems ◽  
Development And Aging

The link between a sufficient intake of vitamins and long term health, cognition, healthy development and aging is increasingly supported by experimental animal, human and epidemiology studies. In low income countries billions of people still suffer from the burden of malnutrition and micronutrient deficiencies. However, inadequate micronutrient status might also be an issue in industrialized countries. Recent results from nutritional surveys in countries like the United States, Germany, and Great Britain indicate that the recommended intake of micronutrients is not reached. This notably concerns certain vulnerable population groups, such as pregnant women, young children and the elderly, but also greatly influences the general healthcare costs. An overview is provided on the gap that exists between current vitamin intakes and requirements, even in countries where diverse foods are plentiful. Folic acid and vitamin D intake and status are evaluated in more detail, providing insight on health and potential impact on health care systems.

Gamma Knife: An Alternative Treatment for Acoustic Neurinomas

1988 ◽  
Vol 97 (6) ◽  
pp. 631-635 ◽  
Author(s):  
Donald B. Kamerer ◽  
L. Dade Lunsford ◽  
Margareta Møller
Keyword(s):  
Gamma Knife ◽  
The Elderly ◽  
The United States ◽  
Alternative Methods ◽  
Long Term Results ◽  
Major Surgery ◽  
Karolinska Institute ◽  
University Of Pittsburgh ◽  
Early Results ◽  
World Center

Despite surgical advances and technologic means of better monitoring seventh and eighth nerve function intraoperatively, there remains a group of patients for whom alternative methods of treatment are desirable. These include the elderly, those with bilateral tumors or tumors in only hearing ears, individuals with medical contraindications to major surgery, and those who refuse surgical resection. The University of Pittsburgh became the fifth world center and the first in the United States to install the “gamma knife” for stereotactic radiosurgery. On the basis of the pioneering work done at the Karolinska Institute in Stockholm, acoustic tumor patients who fulfill the above criteria are being treated. A tumoricidal single treatment closed-skull radiation dose is given through 201 sharply focused cobalt 60 sources, minimizing the effects on surrounding brain or other tissues. Our early results are discussed and compared to those from more than 200 cases in Stockholm. Complications and expected long-term results are presented.

scholarly journals A review of creatine supplementation in age-related diseases: more than a supplement for athletes

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 222 ◽  
Author(s):  
Rachel N. Smith ◽  
Amruta S. Agharkar ◽  
Eric B. Gonzales
Keyword(s):  
Skeletal Muscle ◽  
Brain Aging ◽  
Antioxidant Properties ◽  
Creatine Supplementation ◽  
The Elderly ◽  
Food Sources ◽  
Long Term Memory ◽  
Gyrate Atrophy ◽  
Age Related ◽  
The Brain

Creatine is an endogenous compound synthesized from arginine, glycine and methionine. This dietary supplement can be acquired from food sources such as meat and fish, along with athlete supplement powders. Since the majority of creatine is stored in skeletal muscle, dietary creatine supplementation has traditionally been important for athletes and bodybuilders to increase the power, strength, and mass of the skeletal muscle. However, new uses for creatine have emerged suggesting that it may be important in preventing or delaying the onset of neurodegenerative diseases associated with aging. On average, 30% of muscle mass is lost by age 80, while muscular weakness remains a vital cause for loss of independence in the elderly population. In light of these new roles of creatine, the dietary supplement’s usage has been studied to determine its efficacy in treating congestive heart failure, gyrate atrophy, insulin insensitivity, cancer, and high cholesterol. In relation to the brain, creatine has been shown to have antioxidant properties, reduce mental fatigue, protect the brain from neurotoxicity, and improve facets/components of neurological disorders like depression and bipolar disorder. The combination of these benefits has made creatine a leading candidate in the fight against age-related diseases, such as Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis, long-term memory impairments associated with the progression of Alzheimer’s disease, and stroke. In this review, we explore the normal mechanisms by which creatine is produced and its necessary physiology, while paying special attention to the importance of creatine supplementation in improving diseases and disorders associated with brain aging and outlining the clinical trials involving creatine to treat these diseases.

scholarly journals Age-Related Deficits of Dual-Task Walking: A Review

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Rainer Beurskens ◽  
Otmar Bock
Keyword(s):  
Dual Task ◽  
Visual Information ◽  
The Elderly ◽  
Present Knowledge ◽  
The Other ◽  
Age Related ◽  
Plastic Changes ◽  
The Brain ◽  
Partial Compensation

This review summarizes our present knowledge about elderly people's problems with walking. We highlight the plastic changes in the brain that allow a partial compensation of these age-related deficits and discuss the associated costs and limitations. Experimental evidence for the crucial role of executive functions and working memory is presented, leading us to the hypothesis that it is difficult for seniors to coordinate two streams of visual information, one related to navigation through visually defined space, and the other to a visually demanding second task. This hypothesis predicts that interventions aimed at the efficiency of visuovisual coordination in the elderly will ameliorate their deficits in dual-task walking.

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