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Disorders of the Autonomic Nervous System

This chapter focuses on the consequences of aging on autonomic cardiovascular control. The neurobiology of aging and the effects of aging on gastrointestinal and urinary tract function are detailed in other sections in this book. The chapter first provides a brief summary of autonomic pathways involved in cardiovascular control, and the methods used to assess their function. The chapter then reviews the effect of aging on…

Long-Term Stroke Care

Stroke is an ancient disease, recognized since the time of Hippocrates, when the term apoplexy was used to describe someone being suddenly struck down. The lay term stroke emerged in the seventeenth century, and this term has only more recently replaced apoplexy in the medical literature. Despite centuries of reports of this condition and early understanding of its cause, rigorous scientific exploration was slow to gain…

Stroke : Clinical Presentation, Management, and Organization of Services

Introduction Stroke and transient ischemic attacks (TIAs) are the most common clinical manifestations of disease of cerebral blood vessels. Other manifestations of cerebrovascular disease are subclinical and include cerebral white matter lesions, “silent” brain infarcts, and cerebral microbleeds. This chapter focuses mainly on stroke and TIA, with less emphasis on subclinical cerebrovascular disease. In terms of therapy, the chapter does not deal with primary prevention but,…

Stroke : Epidemiology and Pathology

Stroke Epidemiology This chapter is concerned with the study of patterns and risk factors associated with stroke and the pathologic changes observed in stroke. The major types of stroke are ischemic stroke (due to cerebral vessel occlusion) and hemorrhagic stroke (due to bleeding from cerebral vessel). In epidemiologic tradition, stroke has been defined as “rapidly developing clinical signs of focal disturbance of cerebral function lasting more…

Headache and Facial Pain

Introduction Worldwide, headache disorders are one of the most prevalent medical complaints. This will continue because of the changing demographic of aging populations and because people experience headaches more commonly in their later years. Headaches are often more severe in older people, and secondary causes occur with increased incidence. Primary headache disorders (migraine, tension-type headache, and cluster headache) may persist into old age, although incidence and…

Intellectual Disability in Older Adults

Definition and Causes Intellectual disability (ID) is the current term used to describe what in the United Kingdom has been known as learning disability and in the United States as mental retardation. The World Health Organization's International Classification of Diseases (ICD-10) still uses the term mental retardation , and its report on healthy aging in this population uses the term intellectual disabilities . In Australia the…

Mental Illness in Older Adults

Introduction Mental illness is common in older adults, and those who have a concurrent physical illness are particularly vulnerable. Although these conditions tend to be underdetected and undertreated, their outcome with appropriate management is often excellent. This chapter reviews the main mental health disorders aside from dementia. Depression and Anxiety in Older Adults Despite the commonly held negative stereotypes of aging as mainly loss and decrepitude,…

Delirium

Introduction Delirium represents an acute disorder of consciousness. Serially time-ordered, organized, and with reflective awareness of self and the environment, consciousness also represents an experience of graded complexity and quality. It follows that disturbance of consciousness as part of delirium is accompanied by impairments in arousal, attention, thinking, perception, and memory. A temporary dissolution of the mind poses grave vulnerability through impaired communication of personal needs…

Frontotemporal Lobar Degeneration

Introduction Frontotemporal lobar degeneration (FTLD) is a neurodegenerative condition that selectively affects the frontal and anterior temporal lobes of the brain, resulting in progressive shortfalls in behavior and language. More than a century ago Arnold Pick, a Czechoslovakian neurologist and psychiatrist, first published a report on FTLD. He described a 71-year-old man who developed dementia with sensory aphasia and behavioral symptoms. Autopsy demonstrated severe atrophy of…

Vascular Cognitive Disorders

The term vascular cognitive disorder (VCD) refers to a hetero­geneous group of disorders in which the salient feature is the presence of cognitive impairment primarily attributable to cerebrovascular disease (CVD). The conceptualization of this disorder has had a checkered history, with a variety of terms used to describe overlapping conditions. VCD is used not only for vascular dementia, including poststroke and multi-infarct dementia, but also for…

Alzheimer Disease

Alzheimer disease (AD) is the most common cause for dementia affecting older adults. The illness was first described by Alois Alzheimer in 1906 in a 51-year-old woman with well-described features of dementia. After death, her brain was examined and found to have numerous cortical plaques and tangles, characteristic of the illness. The disease was thought to be rare for 6 decades until its clinical and neuropathologic…

Neuropsychology in the Diagnosis and Treatment of Dementia

Introduction The aging of the U.S. baby boomer population has given rise to a significant increase in the prevalence of Alzheimer disease, the most common form of dementia in adults older than 65 years. One in three Americans aged 85 and older has Alzheimer disease, and by 2050, up to 16 million are predicted to have Alzheimer disease. Dementia is defined as significant impairment in cog­nitive…

Classification of the Dementias

Overview Dementia is a critical public health problem worldwide, especially as populations age. As a consequence, physicians dealing with a range of other age-associated problems can expect to see such problems in patients with dementia. Dementia diagnosis is evolving. Here, we review recent developments in the syndromic approach to dementia, and then highlight aspects of its differential diagnosis. Dementia generally has been defined in terms of…

Nonobstructive Lung Disease and Thoracic Tumors

Respiratory disease is a major cause of morbidity and mortality, affecting 1 in 10 of the population older than 65 years. The presentation and management of respiratory disease often differs in older adults. This chapter provides some insight into these differences while reviewing current evidence. Respiratory Infections Respiratory infection is common in older adults. Age-related factors include declining lung function and structural changes to the chest…

Asthma and Chronic Obstructive Pulmonary Disease

Diseases of Airflow Obstruction Two common chronic lung diseases found in older adults are characterized by expiratory airflow obstruction on lung function testing: asthma and chronic obstructive pulmonary disease (COPD). In most cases, it is possible to distinguish asthma from COPD on the basis of a thorough clinical assessment ( Table 48-1 ). This discrimination is important, as certain aspects of management of the two conditions…

Venous Thromboembolism in Older Adults

Introduction Venous thromboembolism (VTE) is the third most common cardiovascular disease and an important cause of morbidity and mortality. Older people account for nearly two thirds of episodes. Between 65 and 69 years of age, annual incidence rates per 1000 for deep vein thrombosis (DVT) and pulmonary embolism (PE) are 1.3 and 1.8, respectively, and rise to 2.8 and 3.1 in individuals aged between 85 and…

Vascular Surgery

Introduction As the prevalence of atherosclerosis increases with advancing age, it is hardly surprising that specialists in geriatric medicine frequently find vascular disease in their patients. For many, their overall degree of frailty is such that neither detailed investigation nor vascular surgery will be indicated. However, vascular surgeons now routinely perform procedures in octogenarians and will increasingly do so as the population ages. Older adults suffer…

Syncope

Introduction Definition Syncope is a transient loss of consciousness (TLOC) due to transient global cerebral hypoperfusion and is characterized by rapid onset, short duration, and spontaneous complete recovery. TLOC is a term that encompasses all disorders characterized by self-limited loss of consciousness, irrespective of mechanism. By including the mechanism of unconsciousness—transient global cerebral hypoperfusion—the current syncope definition excludes other causes of TLOC such as epileptic seizures…

Cardiac Arrhythmias

Ventricular Arrhythmias The prevalence of complex ventricular arrhythmia (VA) in older adult patients without cardiovascular disease detected by 24-hour ambulatory electrocardiogram (ECG) was 50% in men and women, 31% in men and women, 30% in men and women, 20% in men and women, 16% in women and 28% in men, and 33% in men and women. The prevalence of complex VA detected by 24-hour ambulatory ECG…

Hypertension

Introduction Demographic changes in most Westernized societies have highlighted the increasing number of older and very old (80+ years) adults in the global population, of whom over two thirds will have raised blood pressure (BP) levels. These elevated BP levels cannot be regarded as benign, only reflecting the effects of the natural aging process on the cardiovascular system, because they are associated with significant rates of…