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.