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NERVOUS SYSTEM

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CENTRAL NERVOUS SYSTEM

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 Decreased brain weight.

 17% lighter than brains of young adults over 60

years of age

 Parietal and occipital-no shrinkage

 >15% atrophy in extrapyramidal and orbital

cortex
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 Decreases in cerebral hemisphere volume

 Irreversible changes

 Increased lateral ventricle and third ventricle

volumes

 Gyri-narrower,Sulci-wider

 Progressive dehydration of brain

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 Cortex is thinner,more space between brain and
meninges

 Loss of white matter,dendrites

 Neurons show signs of slower metabolism

 Neurofibrillary tangles and lipofuscin pigment

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 Myelin sheath degenerates,changes in
oligodendrocytes

 Fewer synapses

 Fewer receptor proteins

 Less efficient signal conduction and

transmission
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 Neurotransmitters:
Acetylcholine
Dopamine
Norepinephrine
Serotonin
GABA
Glutamate

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 No neuronal loss but an increase in neuronal
density

 Cerebral blood flow and cerebral oxygen

consumption decrease

 Cortical atrophy reduces threshold for

neurodegeneration.

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A, D, G, a 25-year-old
man; B, E, H, a 55-year-
old man; and, C, F, I, an
81-year-old woman and
depicted on sagittal
sections. Association
fibers are divided into
superior longitudinal
(yellow),
inferior fronto-occipital
(orange), and inferior
longitudinal (red)
fasciculi. D–F, Callosal
fibers (purple) and,
G–I, projection fibers
(blue)
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 Decline in function of attention (working
memory)

 Decline in episodic memory (memory of

events)

 Decline in speed of processing

 Decline in multitasking capability

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 Procedural memory does not decline

 Capacity to recognize familiar routes, places

and people does not decline

 Capacity to solve problem, think abstractly

(executive function) does not change.

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Cognitive changes

 Effect on intelligence

 Effect on learning & memory

Personality changes

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PERIPHERAL NERVOUS SYSTEM
 Decreased mechanoreceptor density and
sensitivity

 Dereased Nerve Conduction Velocity

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 Reflex signs
 Ankle jerk

 Biceps,Knee,Triceps

 Abdominal reflex

 Babinski’s sign

 Primitive reflexes 16
AUTONOMIC NERVOUS SYSTEM

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 Efficiency of ANS declines in old age

 Fewer receptor proteins for NT

 Less responsive

 Dry Eyes, Poorer Night Vision, Slower

Adapting to Intensity,less Efficient Control Of
BP, Thermoregulation
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 Sensory changes
 Diminished Vibratory sense
distally,legs>>arms

 Possible change in Proprioception

 Mildly increased threshold for Light

Touch,Pain & Temperature

 Impaired Double Simultaneous Stimulation 19

CARDIOVASCULAR SYSTEM

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 HEART
 Increase in the size

 Deposits of the lipofuscin.

 Heart muscle cells degenerate slightly.

 Valves thicken,calcified & become stiffer.

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 Absolute number of myocytes decreases

 Altered local collagen concentration

 Increased myocyte size(Hypertrophy rather

than Hyperplasia)

 Increase in myocardial stiffness & decrease in

compliance
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BLOOD VESSELS:

 Decreased baroreceptor sensitivity

 The capillary walls thicken slightly. This may

cause a slightly slower rate of exchange of
nutrients and wastes.

 Aorta & other arteries becomes thicker, stiffer,

and less flexible. 24
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 Moderate increase in blood pressure

 MHR decreases even among the most fit

athlete.

 Resting heart rate & CO do not change.

 Takes longer for the HR & BP to return to

resting levels following stress.

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 Maximum LV Ejection Fraction decreases

 Maximum CO decreases

 Overall decreased cardiac reserve

 Dysfuction of sympathetic modulation of CVS

System

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 Reduced blood flow results in reduced
stamina,reduced renal & hepatic function &
less cell nourishment

 Impaired response to standing,volume

depletion & heart blocks

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 CONDUCTING SYSTEM

 Fibrous tissue & fat deposits

 SA node loses some cells

 Results in slightly slower heart rate.

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BLOOD:
 The blood itself changes slightly with age.

 Reduction in total body water.

 Blood volume decreases.

 The number of red blood cells (and

correspondingly, hemoglobin & hematocrit
levels) are reduced.
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 Slower
Healing rate

Reduced
Poor
Brain, Liver
Response to
and Kidney
Stress
Function
CVD Changes
↓
Poorer Cell
Oxygen

↑ Risk of HBP,
Vulnerable to Heart Attack,
Drug Toxicity Stroke, Heart
Failure
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 IMMUNE SYSTEM
 Functional impairment of T-lymphocyte
mediated immunity

 Reduces the ability to resist infection.

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RESPIRATORY SYSTEM

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 At age 60,the residual air
volume increases to about 35%

 Alveolar surface area

decreases by up to 20%

 Alveoli tend to collapse

sooner on expiration.

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 Diminished Pulmonary Elastic Recoil Pressure

 Fusion of adjacent Alveoli

 Decreased Surface tension forces

 Decreased Gas-diffusing capability

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 Increase in mucus production

 Decrease in the activity and number of cilia.

 The body becomes less efficient in monitoring

and controlling breathing.

 Decreased oxygen uptake and exchange.

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 PO2 decreases

 V/Q mismatch

 Diminished ventilatory response to

hypercapnia & hypoxia

 Respi.bronchioles & alveolar ducts increase in

size significantly after 60 years of age.
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 Muscles of the rib cage atrophy

 Decreased forced expiratory volume

 Costovertebral calcification

 Costovertebral ossification
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 Decreased FEV1( 8-10% decline each decade)

 Decreased expiratory flow rates

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SPEECH

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 Lower-pitched,soft,low volume

 A shortened controlled expiration rate with

speech production.

 Voice with breathiness, hoarseness, or vocal

tremor

 Sentences may shorten to accommodate a

reduced, controlled expiration rate.
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MUSCULOSKELETAL SYSTEM

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 Bone mass gradually begins to decline.

 Bones become thin and more sponge-like.

 More rapidly in women, usually within 5 years

of menopause.

 Bones become fragile,easy to fracture

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 When the bones are weak and do not support
the body’s structure, there is an increased risk
for fractures, falls, and gait problems.

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Bones: anatomical changes:

  Mineral content

  Mass

 > Viscous synovial fluid & Fibrotic synovial

membranes.
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 Muscles: anatomical changes
  Mass :From age 40-80, there is a 30-40%
decrease in muscle mass,fat deposits

 Decrease in no. & size of fibers

  Tendon size & Elasticity – sclerosis

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  Myosin ATP activity

 Sarcopenia

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 Decrease in motor units

 Muscle fibers also decreased

 Slow twitch type I- higher %

 Fast twitch type II- selectively lost

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 CONNECTIVE TISSUES
 Ligaments lose elasticity

 Decreased water content of cartilage

 Decreased tensile strength of collagen

 Reduction in amount of elastin

 Reduced secretion of hyaluronic acid 52

 Joint Mobility

 There is a  in extremes of joint ROM even

without pathology

 PROM  with age

 Jt. Flexibility is inversely related to age.

 Women lose ROM at a slower rate than men

 UE joints remain more flexible then LE

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 SENSORYMOTOR CHANGES
  Reaction time

 Altered Neurotransmitter production

 ed Perception of Vibration, Temperature,

Touch, Proprioception and Pressure

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 Postural changes
 Progressive anterior thrust of the head & extension
of the cervical spine

 Dorsal kyphosis

 Decreased lumbar lordosis

 Increased arm extension,scapular protraction

associated with flexion of the elbows,ulnar
deviation at the wrists & finger flexion.
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 Increase in hip-knee flexion & decrease in
ankle dorsiflexion

 Widening of the bony pelvis

 Angle of inclination of femur increases

 Valgus of hips

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 Progressive widening of standing base

 In Women,knees develop varus deformity

 Shifts COG anterior to sacral vertebrae

 Increased postural sway

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 Ability to balance on one leg either with eyes
closed or open decreases

 Righting reflexes & Reaction time increases

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GASTRO-INTESTINAL SYSTEM

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 A reduction in stomach hydrochloric acid,
digestive enzymes, saliva causes:

 Bloating and flatulence

 Impaired swallowing

 Reduced breakdown and absorption of foods

 Deficiencies in vitamin B, C, and K ; malnutrition

is a real possibility
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 LIVER
 Reduced blood flow

 Diminished capacity to regenerate damaged

liver cells.

 Altered clearance & half-life of drugs

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RENAL SYSTEM

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 Blood flow decreases(10% per decade)

 Number & size of nephrons decrease

 By 80 years,glomeruli fall by 30-40%

 Other 30% become sclerotic & nonfunctional

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 First 50 years of life,kidneys grow from 50-
250 gms.

 From the age of 50 years decreases to 180gms

 Mainly due to cortical loss,medulla maintains

volume

 Glomerulosclerosis
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 GFR decreases 1 ml/min per year.

 Normal serum creatinine

 Capacity to reabsorb Na+ ,secretion of potassium

& hydrogen ions

 Decreased anti-diuretic hormone

 Decreased response to aldosterone & vasopressin

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 ENDOCRINE SYSTEM
❑ Sex Hormones
 Men-slightly ed testosterone

 Women-ed levels of estrogens, progesterone and

prolactin after menopause

❑ Insulin
 The normal fasting glucose level rises 6-14 mg/dl
every 10 years after age 50
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 Probably due to loss in number of insulin
receptor sites in cells

 Progressive impairment of glucose tolerance

❑Thyroid Gland
❑Pituitary gland

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SLEEP PATERNS

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 Begin in 4th decade

 Increse in the amount of time spent sleeping

 Change in the stages of sleep

 Increase in the nighttime awakenings

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 By the sixth decade,stage 4 is almost gone.

 After the age of 85 years, going to sleep often

takes longer.

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 THANK
YOU

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