Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 157

Age‐related changes involving both the central and peripheral nervous system may result in clinical abnormalities that can be detected during a neurological examination (Table 6.2).^40,41 Typically, such neurological signs and deficits do not occur in the context of overt diseases and can be considered normal manifestations of the ageing process.⁴⁰ On one hand, they should not be overestimated, to avoid the risk of overdiagnosis and overmedicalization. On the other hand, these age‐related changes should not be overlooked, as they may contribute to functional loss and poor perceived well‐being. In this regard, even when a finding is considered within the normal limits for age, targeted interventions should be considered to optimize daily function (e.g. correction of vision and hearing loss). Moreover, it is noteworthy that some of these impairments may represent the phenotypic expressions of long prodromal phases preceding the onset of full‐blown pathological conditions. For example, olfactory dysfunction and constipation are regarded among the earliest nonmotor features of PD and can anticipate the onset of motor symptoms by years.^42,43 Finally, it should be acknowledged that the detection of neurological abnormalities might be hampered by the concomitant decline of cognitive functioning, potentially limiting the clinical assessment’s reliability.

Table 6.2 Changes in the neurological examination with ageing.

Sources: Schott⁴⁰; Seraji‐Bzorgzad, Paulson, and Heidebrink⁴¹.

Function	Most commonly observed changes
Sensation	Impaired vibration sense in distal lower extremities Reduced pain perception Reduced joint position sense
Reflexes	Loss of ankle jerk reflexes Presence of ‘primitive’ reflexes (palmomental, snout, grasping, sustained glabellar)
Vision	Decreased near vision (presbyopia) Reduced pupillary size and reactivity Increase of saccadic latency and decrease of saccade frequency, amplitude, and velocity Breakdown of smooth eye pursuit movements with saccadic intrusions Deceased upward gaze and convergence
Hearing	Hearing loss (presbycusis), especially at higher frequencies
Smell	Diminished smell sense
Taste	Reduced taste
Gait	Decline in walking speed Decreased stride length Reduced tandem ability
Muscle	Mild increase in muscle tone Mild decrease in muscle bulk and strength
Posture	Increasingly stooped posture
Balance	Reduced ability to stand on one leg