The neurology of aging

Is aging normal or abnormal/pathological? No one quite knows the answer to that question. What we do know is that as we age, neurological disorders become increasingly common. These may range from well defined neurodegenerative diseases like Alzheimers dementia, Parkinson disease and amyotophic lateral sclerosis to other less well defined conditions like gait disorders, “balance problems”, “forgetfulness and senior moments” and increased propensity to falls. Strokes become more common in the aged brain vessels.

As life expectancy increases and more and more people live past the eight decade, neurological conditions become common and account for substantial morbidity and mortality in the oldest old (above 85). Earlier when the life expectancy was in the 60s, we did not see so much Alzheimers dementia, Parkinson’s disease or brain tumors. People died of other “natural” and “unnatural”  causes before the brain showed clinical manifestations of neurodegeneration.

Is it the norm that as we age, a substantial majority of us are destined to develop dementia?  Clinical studies have clearly shown that Alzhemier disease pathology increases with age and the incidence of the disease becomes increasingly common as one goes past 85 (the oldest old). Other studies suggest that though not all the oldest old show clinical dementia, a substantial majority have cognitive difficulties if carefully tested for at the bedside.

Why do neurological conditions become more “common” as we age and can we do anything to alter this? Many theories have been propounded. Increased amyloid deposition in the brain has causal association with Alzheimers dementia, in the same vein deposition of iron in the basal ganglia has been postulated to cause various basal ganglia pathology. There is increased oxidative stress in the “aged” brain which leads to free radical formation and damage to the cellular DNA. Genes get switched off or on triggering the disease process. A lot still needs to be learned about the neurology of aging.

While the mechanisms are still been elucidated, is there anything which we can do to change our “risks”. In the absence of good studies most of the data is open to interpretation. Aspirin prophylaxis, modification of microvascular and macrovascular risk factors like hypertension, diabetes mellitis and dyslipidemia (high “bad” cholesterol) all seem to be reasonable interventions. Obesity and sedentary life styles are bad for the brain too. Regular physical as well as brain exercises (neurobics) keeps the brain healthy and increases neuronal reserve. The role of anti-oxidants like coenzyme Q10 and alpha lipoic acid is still been defined. As they are relatively innocuous and free from side-effects, I would recommend them on a case by case basis. Episodes of major depression “hurt” the brain and aggressive treatment with anti-depressants should be initiated early rather than late.

The neurology of aging remains an uncharted territory but there is hope yet.

Nitin Sethi, MD

Successful aging and living with adversity

                             Successful aging and living with adversity

Nitin K Sethi, MD

 

        Comprehensive Epilepsy Center, Department of Neurology, NYP-Weill Cornell Medical Center, New York, NY (U.S.A.)

Address for Correspondence:

NK Sethi, MD

Comprehensive Epilepsy Center

Department of Neurology

NYP-Weill Cornell Medical Center

525 East 68th Street, York Avenue

New York, NY 10021

Fax: 212-746-8984

Email: sethinitinmd@hotmail.com

I read a very fascinating article recently in the Journal of Neurology Neurosurgery and Psychiatry about successful aging in adversity. We all want to age successfully . Successful aging though is just not about escaping illness as the authors (Livingston et.al) point out but also of having a positive attitude towards one’s life despite poor health. In their study they interviewed patients with dementia to find out how they view their aging. To my pleasant surprise they found that many people with dementia feel that they are aging successfully and rate their quality of life as good. This may be against what their caregivers feel. I should add these were people with mild to moderate and not severe dementia.

So how can we age successfully both in health and disease? Well if you are healthy, good then the odds are with you. Your quality of life is good, you have no physical or mental impairments due to disease and if you maintain a positive attitude and avoid depression and anxiety successful aging can be readily achieved. Exercise regulary, keep your mind occupied (read books, watch television, read the newspaper), maintain good and healthy social interactions (surround yourself with family and friends, date if you are single) and hey you are on your way to aging successfully.

But what if you are sick?  Is successful aging possible in adversity. YES as the study points out. It is very much so. What is needed is good mental health and social relationships. Have a positive frame of mind. The study points out that an individual’s underlying resilience plays a big role in successful aging and even though the disease may progress as time goes by, the individual shall still continue to feel he is aging well. Again the importance of mental health is stressed. Avoiding depression and anxiety is the key to successful aging in the face of adversity. The importance of social relationships and support of family and friends cannot be stressed more.

Well there you have it, maybe a small piece to the puzzle of successful aging and at least to some of us in the face of adversity.