The Neuroscience of aging

Dr Vimala Christina Colaco K

MD, DM
Assistant Professor of Neurology
FMMCH
• An overview of the Neurological System.
• Early Neurological Changes in the elderly. ( signs and symptoms)
- Causes
• Brief note on Alzheimer’s & Parkinson’s and Dementia
• Facts & Myths about the same.
• Aging is a nearly universal biological process associated with gradual
deterioration in physiological and biochemical functions, including
cognitive decline.
• Aging is also a major risk factor for many neurodegenerative
diseases, including Alzheimer’s disease and Parkinson’s disease
• Aging is characterized by progressive and broadly predictable changes
associated with increased susceptibility to many diseases.
• Aging is not a homogenous process.
• Rather, organs in the same person age at different rates influenced by
multiple factors, including genetic makeup, lifestyle choices, and
environmental exposures
• From maturity to senescence, diminishing physiologic reserves are
available to meet challenges to homeostasis.
• The endpoint of this process is frailty, where even the smallest
challenge overwhelms the available reserves and results in disaster.
Understanding the social, cultural, psychological, cognitive,
cognitive, and
and biological aspects of aging
biological of the
aspects nervous system
of aging.
AN OVERVIEW OF THE CENTRAL NERVOUS SYSTEM
• The aging nervous system encompasses two related research areas.
• One is the effect of aging itself on nervous system function, also
referred to as “normal” aging.
• A second area of consideration is that of neurodegenerative diseases
with aging-associated onset, which are not representative of normal
nervous system aging
• Both normal and pathological nervous system aging involve elevated
oxidative stress, perturbed energy metabolism and the accumulation
of protein aggregates.
• Changes in pathways for cell replacement, regeneration and repair
are also important factors that are altered in the aging nervous
system.
activation of astrocytes (marker GFAP) by inflammation,
ROS and neuronal injury regulating uptake and release of
neurotransmitters responsible for synaptic transmission.
• The loss of brain mass occurs primarily in the cerebral cortex, especially in the prefrontal gray matter
associated with planning and decision-making.
• However, neural atrophy may also impact areas such as the somatic motor cortex, which manages gait and
body movement.

• Another consequence of the loss of neurons is memory loss.

• Even older adults who retain good cognitive function may experience the inability to recall details of past
events.
• The neurology of healthy aging is characterized by the appearance of specific
neurologic signs, a very gradual decline in some cognitive functions, and minimal
loss of brain volume.
• With increasing age, even in the healthiest elderly, there is an increased incidence
of dementia, which is characterized by increased rates of cognitive decline and
brain volume loss.
• The pathology associated with this dementia is classical Alzheimer disease
pathology. It is possible for elderly subjects to be spared cognitive decline, brain
volume loss, and Alzheimer pathology, even into the eleventh decade.
• Although this phenotype represents the exception rather than the rule,
additional investigations of healthy aging hold promise for elucidating the
mechanisms responsible for both pathologic and successful brain aging.
Neurodegenerative Diseases

• Alzheimer’s disease (AD) and PD are the most common

neurodegenerative diseases in the world .
• These diseases are age-associated and most often have a long
prodromic phase preceding the clinical manifestation with a
subsequent stage of progression leading to signs of dementia with
similar symptoms such as memory impairment, orientation problems,
and difficulties in performing service functions among others.
• AD and PD are referred to as “protein misfolding” diseases because
deposits of improperly folded modified proteins are detected in
specific areas of the brain
• "Dementia" is a general term for when a person has
developed difficulties with reasoning, judgment, and
memory. People who have dementia usually have some
memory loss as well as difficulty in at least one other area,
such as:
●Speaking or writing coherently (or understanding what is
said or written)
●Recognizing familiar surroundings
●Planning and carrying out complex or multi-step tasks
• The most common cause is Alzheimer disease.
• Alzheimer disease is present in approximately 60 to 80 percent of all
cases of dementia; other degenerative and/or vascular diseases may
be present as well, particularly as a person gets older.
• Lifestyle factors have also been implicated in dementia. For instance,
people who remain physically active, socially connected, and mentally
engaged seem less likely to develop dementia than people who do
not.
• These activities may produce more cognitive (mental) reserve or
resilience, delaying the emergence of symptoms until an older age.
• Each form of dementia can cause
difficulty with memory,
language, reasoning, and
judgment, but the symptoms are
often very different from person
to person.
• Symptoms also change over
time.
•Is memory loss normal? — Many people worry that memory problems
are related to early Alzheimer disease.
• However, some problems are normal and just related to aging, and do not signify a
progressive dementia.
• Normal age-related changes often cause minor difficulties with immediate
memory, for example, remembering a phone number or a set of directions for a
short time.
• Temporary difficulty recalling proper names, even very familiar ones, is also
common with aging.
• As people age normally, it is common to complain of less efficient and slower
processing and learning of new information.
• Memory changes due to normal aging are usually mild and do not worsen greatly
over time, nor should they interfere with a person's day-to-day functioning.
• When symptoms of memory difficulty are associated with minor
functional effects at work or home, and a person shows mild
impairments on specific memory tests, this is referred to as mild
cognitive impairment (MCI).
• Because MCI may progress to dementia over time, people with this
condition should have a more careful assessment and closer
monitoring for signs of a decline in their ability to function.
• Some people with MCI may have a transient or treatable disorder that
remains unchanged for long periods, has a fluctuating course, or
actually improves over time, all depending on the specific cause.
• Early changes — The earliest symptoms of Alzheimer disease are
gradual and often subtle.
• Many people and their families first notice difficulty recalling recent
events or information.
• This often emerges as a tendency to repeat stories or questions or to
request or require repetition of material to be able to remember.
• If you find yourself telling an older family member or friend "I told you
that earlier" or "You have told me that more than once," you might
begin to suspect Alzheimer disease. Other changes can include one or
more of the following:
●Difficulties with language (eg, not being able to find the right words
for things)

●Difficulty with concentration and reasoning

●Problems with complex tasks like paying bills, cooking, or balancing a

checkbook

●Getting lost in a familiar plac

• Late changes — As Alzheimer disease progresses, a person's ability to think clearly continues to decline, and
any or all of the changes listed above may be more disruptive. In addition, personality and behavioral
symptoms can become quite troublesome. These can include:

●Increased anger or hostility, sometimes aggressive behavior; alternatively, some people become depressed or
exhibit little interest in their surroundings (called "apathy")

●Sleep problems

●Hallucinations and/or delusions

●Disorientation

●Needing help with basic tasks (such as eating, bathing, and dressing)

●Incontinence (difficulty controlling the bladder and/or bowels)

• The number of symptoms, the functions that are impaired, and the
speed with which symptoms progress can vary widely from one
person to the next.
• In some people, severe dementia occurs within five years of the
diagnosis; for others, the progression can take more than 10 years.
• Most people with Alzheimer disease do not die from the disease
itself, but rather from a secondary illness such as pneumonia, bladder
infection, or complications of a fall.
• Reliable bystander account
SAFETY AND LIFESTYLE ISSUES FOR PEOPLE
WITH DEMENTIA
• Medications
• Driving
• Cooking
• Wandering
• Falls
For caregivers
●Make a daily plan and prepare to be flexible if needed.
●Try to be patient when responding to repetitive questions, behaviors, or statements.
●Try not to argue or confront the person with dementia when they express mistaken
ideas or facts. Change the subject or gently remind the person of an inaccuracy. Arguing
or trying to convince a person of "the truth" is a natural reaction but it can be frustrating
to all and can trigger unwanted behavior and feelings.
●Use memory aids such as writing out a list of daily activities, phone numbers, and
instructions for usual tasks (ie, the telephone, microwave, etc). It may help if these are
posted and easily visible so that the person need not remember to look for the aids.
●Establish calm and consistent nighttime routines to manage behavioral problems,
which are often worst at night. Leave a night light on in the person's bedroom.
●Avoid major changes to the home environment (for example, rearranging furniture).
●Employ safety measures in the home, such as putting locks on medicine cabinets, keeping
furniture in the same place to prevent falls, reducing clutter, removing electrical appliances from
the bathroom, installing grab bars in the bathroom, and setting the water heater below 120°F.
●Help the person with personal care tasks as needed. It is not necessary to bathe every day,
although a health care provider should be notified if the person develops sores in the mouth or
genitals related to hygiene problems (eg, ill-fitting dentures, urine leakage).
●Speak slowly, present only one idea at a time, and be patient when waiting for responses.
●Encourage physical activity and exercise. Even a daily walk can help prevent physical decline and
improve behavioral problems.
●Consider respite care. Respite care can provide a needed break and give you a chance to
recharge. This is offered in many communities in the form of in-home care or adult day care.
Caregiving can be an all-consuming experience, and it's essential to take time for yourself, take
care of your own medical problems, and arrange for breaks when you need them.
●See if your area has a support group for people caring for loved ones with dementia. It can help
to talk with other people who understand what you are going through.
• The cause of PD is not known. Normally, certain nerve cells (neurons)
in the brain make a chemical called dopamine, which helps to control
movement.
• In people with PD, these neurons slowly degenerate and lose their
ability to produce dopamine.
• As a result, the symptoms of PD develop gradually and tend to
become more severe over time.
• It is not clear how or why these neurons stop working correctly.
• Symptoms typically start on one side of the body and spread to the other
side over a few years.
• As symptoms worsen, a person may have difficulty with walking, talking,
and performing other normal daily tasks.
• While symptoms typically progress slowly, this varies from one person to
another.
• It is important to discuss any bothersome or worsening symptoms with a
healthcare provider so that the optimal type of treatment can be given.
• The symptoms of PD can be managed effectively for a significant period of
time.
• In most cases, medication for Parkinson disease is recommended
once the symptoms are severe enough to interfere with quality of life.
• All decisions regarding the use of antiparkinson medications should
be made jointly by the patient, caregivers, family, and healthcare
provider
• Exercise can also help patients feel better, both physically
and mentally.
• Aerobic exercise, such as biking, may have a positive effect
on disease status while improving quality of life and
socialization.
• Favorable studies have appeared in the medical literature on
exercises to improve balance, flexibility, and strength
(including dance and tai chi).
• However, these reports will need to be confirmed in larger
groups of people followed for longer periods of time.
• Exercise can help to prevent some of the complications of
Parkinson disease caused by rigidity and flexed (or bent)
posture, such as shoulder, hip, and back pain.
• The benefits of exercise will persist as long as exercise
continues.
• Falls prevention (https://www.cdc.gov/falls/ )
• Driving safety
• Installing shower or tub grab-bars, nonslip tape on floors, and
elevated toilet seats with handles.

• Having adequate lighting in the house, especially at night. Use of

light-sensitive night lights or lamps on a timer may be helpful.

• Securing loose rugs, which can increase the risk of tripping.

• MIND diet (Mediterranean-DASH Intervention for Neurodegenerative
Delay) reduces the risk of dementia in people at risk for or with early
signs of Parkinson disease, and reduces the risk of Alzheimer disease.
Myths about neurodegenerative disease
• There is no treatment for the above disease
• Once treatment is initiated , progression of the disease is accelerated
• PD affects only motor activities
Alzheimer's - Myths and facts

Myth 1: It's purely genetic

Fact: While genetics play an important role in determining the risk of Alzheimer's in people, it does not ensure it. A variety of factors such as head trauma, lifestyle, and more can
put people at risk of developing Alzheimer's.

Myth 2: Only people over 60 fall prey to it

Fact: Due to the progression of the disease, the symptoms begin to get more visible after the age of 60. However, the development of the disease can take place in ages as early as
30. Due to the disease being in an initial stage, it might not be easy to identify the symptoms.

Myth 3: Memory loss in early life is a definitive sign

Fact: If you keep forgetting where you kept your glasses, keys, or phone, it is not always an early sign of Alzheimer's onset. Forgetfulness is not healthy but it is a normal part of
ageing. That being said, any signs must not be ignored and for better understanding, consult a doctor immediately.

Myth 4: Treatment can stop worsening of the disease

Fact: So far, there is no cure for Alzheimer's disease. While treatment can slow the progression of the disease, it cannot stop it. It is important to understand that it is a progressive
condition and will worsen with time and age however, one can always go for treatment and therapy to lessen the burden of the symptoms.

Myth 5: Once diagnosed, there's no hope

Fact: Diagnosis of the disease is not the end of the world. People can survive up to 10 to 20 years after being diagnosed with the disease. With proper care and support, there is
always hope for a better life.
• Repeated use of "compensatory scaffolding" by engaging in social,
leisure, and cognitive activities (learning a new language, pursuing
higher education) may decrease the risk of Alzheimer disease or delay
its onset and slow the progress of normal aging changes.
• Specifically designed cognitive training activities for older adults have
also been shown to decrease decline in ability to perform
instrumental activities of daily living, per subject self-reports
compared with controls.
USEFUL LINKS
• https://www.nia.nih.gov/health/alzheimers-and-dementia
• https://www.ninds.nih.gov/health-information/disorders/alzheimers-
disease
• https://ardsi.org/
THANK YOU