Manifestation of Novel Social Challenges of the European Unionin the Teaching Material ofMedical Biotechnology Master’s Programmesat the University of Pécs and at the University of DebrecenIdentification number: TÁMOP-4.1.2-08/1/A-2009-0011
NEUROLOGICAL DISORDERS IN THE ELERLYPART II
Márta Balaskó and Gyula Bakó Molecular and Clinical Basics of Gerontology – Lecture 17
Manifestation of Novel Social Challenges of the European Unionin the Teaching Material ofMedical Biotechnology Master’s Programmesat the University of Pécs and at the University of DebrecenIdentification number: TÁMOP-4.1.2-08/1/A-2009-0011
TÁMOP-4.1.2-08/1/A-2009-0011The most common aging-associated neurological disorders (outline) • Disorders of cerebral blood flow (stroke)• Neurodegenerative diseases
affecting motor (and later cognitive) functions(e.g. Parkinson’s diasease)
• Other, more frequent neurological disorders also present in old individuals with high prevalence:
- myasthenia gravis- headache- dizziness (vertigo) in the elderly• Peripheral neuropathies
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Earlier definitions: extrapyramidal disease, diseases of the basal gangliaTypes:• Hypokinetic syndromes
- Parkinson’s disease- Symptomatic parkinson syndromes- Multiple system atrophy• Hyperkinetic syndromes
- Huntington chorea- Creutzfeldt-Jakob disease
Neurodegenerative diseases affecting motor functions: classification
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Neurodegenerative diseases affecting motor functionsParkinson’s diasease Movement-related disease of unknown origin including shaking, rigidity, slowness of movement and difficulty with walking with dementia in the later phases.Huntington-choreaA neurodegenerative autosomal dominant genetic disorder that affects muscle coordination (with abnormal involuntary writhing movements = chorea) with cognitive decline and dementia. Creutzfeldt-Jakob diseaseA rare, degenerative, invariably fatal brain
disorder
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Parkinson’s disease: etiology prevalence• A disease with progressive movement disorder• Special progressive cell death of the substantia nigra
– with consequent dopamine deficiency• The origin of the cellular damage is unknownRisk factors: • AGE• Noxious effects (CO poisoning, infections, pesticides)• Mutations of the tau-gene Prevalence: • 100-200/100,000 population• It is more frequent in males (1.5 : 1)
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Neurotransmitter imbalance in Parkinson’s diseaseBalance between dopamine
and glutamate/acetylcholine
Imbalance as a result ofdopamine deficiency
GlutamateAcetylcholin
eDopamine Glutamate
Acetylcholine
Dopamine
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Parkinson’s disease: early symptomsSymptoms:• Asymmetry: one-sided motor symptoms
- tremor (at rest and aggravated by sustained effort),
- rigidity of muscles (cogwheel phenomenon upon passive movement of limbs),
- hypo- and bradykinesis (difficulty in initiating movement and getting frozen during the course of it),
- lack of expression in the face (mask-like face, diminished eye blinking)
- postural abnormalities- slow and monotonous speech
• Upon levodopa administration symptoms improve• Long-term (levodopa) treatment itself also leads to
dyskinesis
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Parkinson’s disease: late symptomsMotor functions• postural instability (after 8-10 years)Autonomic functions• seborrheic oily skin• orthostatic hypotension• gastrointestinal disorders (dysphagia,
constipation)• sphincter disturbances• impotence• enhanced sweatingCognitive decline• intellectual impairment occurs invariably
(mechanism unknown)
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Secondary (symptomatic) parkinsonismDifferent types of secondary Parkinsonism show somewhat similar symptoms as Parkinson’s disease, but they do not react to levodopa. The progression is frequently more rapid.• Infections: complications of viral encephalitis• Atherosclerosis of cerebral vessels: vascular
Parkinsonism • Toxins: Carbon monoxide, Manganese • Drugs: neuroleptic drugs, reserpine, metoclopramide,
methyldopa • Metabolic disorders: parathyroid disorders, cerebral
hypoxia• Tumors• Head trauma• Other degenerative disorders: e.g. striatonigral
degeneration, Olivopontocerebellar atrophies, Shy-Drager syndrome
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Huntington disease (chorea)Characteristics: • 5-10/100,000 population• Autosomal dominant inheritance (huntingtin,
chromosome 4) • Onset: 40-50 years of age • Mean survival does not exceed 15 years• Main symptom: involuntary abnormal choreiform
writhing movements• Psychiatric symptoms are present from the beginning
(affective disorders, schizoform symptoms)• No available treatment
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Creutzfeldt-Jakob diseaseCharacteristics:• Prevalence: rare: 1 / 1,000,000 population• Cause: prion (infectious agent composed of protein in
a misfolded form)• Onset is usually about the age of 60 years (50-70)• Triade of symptoms:
- dementia (starts with failing memory, mental deterioration)
- characteristic EEG findings- myoclonus
• Other symptoms occur during progression: involuntary movements and muscle weakness, blindness, coma.
• Progression: 0.5-1 year survival
TÁMOP-4.1.2-08/1/A-2009-0011The most common aging-associated neurological disorders (outline) • Disorders of cerebral blood flow (stroke)• Neurodegenerative diseases
affecting motor functions (e.g. Parkinson’s disease)
• Other, more frequent neurological disorders also present in old individuals with high prevalence:- myasthenia gravis- headache- dizziness (vertigo) in the elderly
• Peripheral neuropathies
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Myasthenia gravisGeneral characteristics • An autoimmune neuromuscular disease
affecting acetylcholine receptors • Leading symptoms: fluctuating muscle
weakness and fatiguability that ameliorates upon rest
• The disease affect predominantly:- ocular (ptosis), - bulbar (swallowing, chewing, speech)- facial muscles (lack of facial expression)- Neck- skeletal muscles- respiratory muscles (diaphragm), respiratory
failure
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Pathomechanism of myasthenia gravis
A nerve ending
Acetylcholine is released from nerve
endingNeuromuscular junction (gap
between nerve and muscle)
Some receptors are blocked or damaged by antibodies
Some receptors are stimulated by acetylcholine
Surface of muscle fiber
Antibody
Muscle
Nerve
Nerve endings spread along
muscle
Receptor on surface of muscle
fiber
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Myasthenia gravis in the elderlySpecial characteristics in the elderly• It progresses to a severe, fatal disease more
frequently sooner• Complete remission occurs rarely• Crises presents higher risk for lethal outcome• Immunosuppressive treatment is more
frequently needed• More frequent drug side-effects • Comorbidities (e.g. hypothyroidism 15%)
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Head-aches in the elderlyPrimary (60-70% of all head-aches)• Migraine (much less prevalent than in the young)• Tension head-ache (frequent)• Cluster head-ache (predominantly in males, above 60
years)Secondary (they are more prevalent in the elderly)• Intracranial vascular diseases• Intracranial tumor, inflammation• Other disease-associated forms (e.g. ear-throat and
nose, diseases of the locomotor system)• Drug-induced (e.g. nitrate)• Immune disease-associated (arteritis temporalis)• Trauma-associated (chronic subdural hematoma)
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Dizziness in the elderlyCharacteristics: • Very frequent complaint in the elderly• 30% of people older than 65 years
experience dizziness in some form, increasing to 50% in the very old (older than 85 years)
• Above 80 years of age: females 66%, males 33%
• It is often associated with depression, • Anxiety increases the prevalence• 45-70% of the elderly suffer a fall at least
once a year (dizziness is often found in the background)
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Dizziness in the elderly: causes• Vertebrobasilar circulatory disorders (the
most frequent cause among the elderly)• Degenerative diseases or ischemia affecting
the vestibular organ• Degeneration of mechanoreceptors in the
neck region• Diminished physical activity due to some
other disease, immobilization• Oscillations of blood pressure• Exsiccosis (hypovolemia)
TÁMOP-4.1.2-08/1/A-2009-0011The most common aging-associated neurological disorders (outline) • Disorders of cerebral blood flow (stroke)• Neurodegenerative diseases affecting motor
(and later cognitive) functions (e.g. Parkinson’s disease)
• Other, more frequent neurological disorders also present in old individuals with high prevalence:- myasthenia gravis- headache- dizziness (vertigo) in the elderly
• Peripheral neuropathies
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Peripheral neuropathy in the elderlyPeripheral neuropathy is a widespread damage of the peripheral nervous system. Prevalence: 2400/100,000 (2.4%), rising with age to 8000/100,000 (8%). In the elderly, losses of vibratory sensation in the lower extremities and ankle reflexes are common.Causes: (40-70% idiopathic or autoimmune): • diabetes mellitus (most frequent known cause in
Europe)• aging, alcoholism, HIV, toxin exposure, metabolic
abnormalities, vitamin B12, B1 deficiencies, side effects of drugs
Consequences: sensory, motor, autonomic deficitsSymptoms include also paresthesia, pain, weakness , paralysis, distortion of the feet, orthostatic hypotension, disorders of sweating, gastric dysmotility, impotence, incontinence, etc.
