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Manifestation of Novel Social Challenges of the European Union
in the Teaching Material of
Medical Biotechnology Master’s Programmes
at the University of Pécs and at the University of Debrecen Identification number: TÁMOP-4.1.2-08/1/A-2009-0011
NEUROLOGICAL
DISORDERS IN THE
ELERLY
PART II
Márta Balaskó and Gyula Bakó
Molecular and Clinical Basics of Gerontology – Lecture 17
Manifestation of Novel Social Challenges of the European Union
in the Teaching Material of
Medical Biotechnology Master’s Programmes
at the University of Pécs and at the University of Debrecen Identification number: TÁMOP-4.1.2-08/1/A-2009-0011
TÁMOP-4.1.2-08/1/A-2009-0011
The 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
TÁMOP-4.1.2-08/1/A-2009-0011
Earlier definitions: extrapyramidal disease, diseases
of the basal ganglia
Types:
• Hypokinetic syndromes
- Parkinson’s disease
- Symptomatic parkinson syndromes
- Multiple system atrophy
• Hyperkinetic syndromes
- Huntington chorea
- Creutzfeldt-Jakob disease
Neurodegenerative diseases affecting
motor functions: classification
TÁMOP-4.1.2-08/1/A-2009-0011
Neurodegenerative diseases
affecting motor functions
Parkinson’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-chorea
A neurodegenerative autosomal dominant genetic
disorder that affects muscle coordination (with
abnormal involuntary writhing movements = chorea)
with cognitive decline and dementia.
Creutzfeldt-Jakob disease
A rare, degenerative, invariably fatal brain disorder
TÁMOP-4.1.2-08/1/A-2009-0011
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 unknown
Risk 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)
TÁMOP-4.1.2-08/1/A-2009-0011
Neurotransmitter imbalance in
Parkinson’s disease
Balance between dopamine
and glutamate/acetylcholine
Imbalance as a result of
dopamine deficiency
Glutamate
Acetylcholine Dopamine
Glutamate
Acetylcholine Dopamine
TÁMOP-4.1.2-08/1/A-2009-0011
Parkinson’s disease: early symptoms
Symptoms:
• 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
TÁMOP-4.1.2-08/1/A-2009-0011
Parkinson’s disease: late symptoms
Motor functions
• postural instability (after 8-10 years)
Autonomic functions
• seborrheic oily skin
• orthostatic hypotension
• gastrointestinal disorders (dysphagia, constipation)
• sphincter disturbances
• impotence
• enhanced sweating
Cognitive decline
• intellectual impairment occurs invariably (mechanism
unknown)
TÁMOP-4.1.2-08/1/A-2009-0011
Secondary (symptomatic)
parkinsonism
Different 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
TÁMOP-4.1.2-08/1/A-2009-0011
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
TÁMOP-4.1.2-08/1/A-2009-0011
Creutzfeldt-Jakob disease
Characteristics:
• 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-2009-0011
The 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
TÁMOP-4.1.2-08/1/A-2009-0011
Myasthenia gravis
General 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
TÁMOP-4.1.2-08/1/A-2009-0011
Pathomechanism of myasthenia
gravis
A nerve ending
Acetylcholine is
released from
nerve ending
Neuromuscular
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
TÁMOP-4.1.2-08/1/A-2009-0011
Myasthenia gravis in the elderly
Special 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%)
TÁMOP-4.1.2-08/1/A-2009-0011
Head-aches in the elderly
Primary (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)
TÁMOP-4.1.2-08/1/A-2009-0011
Dizziness in the elderly
Characteristics:
• 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)
TÁMOP-4.1.2-08/1/A-2009-0011
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-2009-0011
The 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
TÁMOP-4.1.2-08/1/A-2009-0011
Peripheral neuropathy in the elderly
Peripheral 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 deficits
Symptoms include also paresthesia, pain, weakness , paralysis,
distortion of the feet, orthostatic hypotension, disorders of
sweating, gastric dysmotility, impotence, incontinence, etc.