Metabolic Equivalents of Task (MET) - The ratio of the working metabolic rate to the resting metabolic rate. It is typically associated with injury to the extrapyramidal pathways of the central nervous system as seen in Parkinson's disease.
Introduction
Society needs alternative strategies to productively engage seniors to maintain the standard of living our society currently enjoys (in line with ongoing efforts in Japan, home to perhaps the world's oldest population). An additional benefit of such engaged seniors is to maintain social and intellectual engagement for sanity and brain aging, preventing an older and ever-growing group of the impoverished, isolated, sick, bored and desperate.
Goals of this Handbook
Even with dramatic improvements in the health of the elderly, the increasing burden of increased care for the elderly will be a defining issue for all industrialized countries over the next 50–100 years.2 In the United States, the centenarian population will grow to more than 1 million (2050) and even higher numbers by 2100.
Overview of Contents
The third part of the chapter reviews contemporary theories and models of aging and emotions. Continued scientific progress in the neuroscience of aging must be accompanied by ongoing consideration of the difficult ethical issues.
Audiences
Key Points
Healthy Aging” as Physical, Mental, and Social Well-Being
Nevertheless, age-related physical and functional decline may limit individuals' ability to maintain social relationships. As the number of older adults with moderate to severe disabilities continues to increase16, consideration of social support networks and relationships becomes critical to facilitating healthy aging.
Toward Defining Key Terms and Concepts: Social Networks and Social Relationships
Therefore, it is important to understand the social network and relational factors that influence and influence the well-being of older adults. The way social networks affect individuals may be determined in part by community resources and the network's ability to access those resources and contacts.23 Evidence suggests that strong personal social networks consisting of family and neighbors can help reduce negative impacts. urban segregation among individuals living in poverty.24 Cohen and Wills25 reviewed two ways in which social relationships influence health: “stress buffering,” where social networks are thought to provide interpersonal coping resources when individuals face stressful events, and “main effects,” where social networks provide the context in which individuals can be socially engaged or the degree to which an individual is integrated into a large social network.25 Evidence suggests that these two pathways likely coexist.26 In the context of mind and brain aging, it is useful to consider these different types of network characteristics when exploring their association with health to inform future research and practice.
Relationships between Social Networks and Health
Both compositional (e.g., group membership, frequency of contact between network members, social isolation, (dis)connectedness) and functional characteristics of social networks, including social (dis)engagement, social support, and social conflict, have been examined. identified as risk and/or protective factors for cognitive functioning, ability and decline.56-59More frequent participation in social activities and higher levels of perceived social support60 as well as having close social ties61 were associated with better cognitive functioning in older adults without clinical symptoms of dementia. A longitudinal study spanning 7.5 years found that social support, especially emotional support, is a significant predictor of better cognitive functioning.59 In terms of social engagement, higher levels of participation in social activities, maintenance of social connections and frequency of visual contacts with family members appear to act as protective factors for cognitive decline among the elderly.57,58,62 Moreover, a longitudinal study of Japanese-American men found that those who were socially involved at low levels in middle and later life were at a low level. had an increased risk of dementia than those who were involved at a high level, and those who declined from a high to a low level of involvement over time had the highest incidence of dementia.63 Although it is difficult to determine the To disentangle the cyclical nature of the relationships between health status and social engagement (e.g., the level of engagement affected by the development of dementia), some of these findings suggest the influence of social engagement on cognitive decline.
Relationships Between Social Networks and the Aging Mind and Brain
Some evidence also sheds light on the biological pathways through which social networks influence health. There is suggestive evidence of a link between social relationships and human immune function.7–9 In animal studies, social isolation has been associated with delayed immune response75 and the development of type 2 diabetes.76 In terms of brain health, social engagement can improve synaptic activity and an efficient brain. recovery and repair, thereby reducing individuals' risk of dementia.63 One study documented improvements in executive functioning through social engagement accompanied by positive changes in brain activity among seniors who volunteered in public schools.10 Another recent study showed that living alone and having less social support was associated with reduced processing speed.55 It has also been shown that stress responses (e.g. hypothalamic-pituitary-adrenal function) are altered by the presence of social support among women before cancer surgery11 and increases in cortisol production over time lead to a decrease in memory performance; whereas reductions in cortisol production led to improved memory in community-dwelling older women.77 The studies reviewed here suggest the existence of multiple pathways through which social networks and relationships can influence health, which in part explains why social relationships influence general health but not specific disease processes such as physical and cognitive decline. 14.
Characteristics of Social Networks and Social Relationships among Older Adults
However, other studies have shown that social network size does not change over the life course,85 because older adults replace lost ties with new ones.86 Together, these studies suggest that individual variations defy simple general trends. As previously mentioned, older adults may be at greater risk of losing a source of social support or becoming socially disengaged due to potential changes in the composition of their social network.
Addressing the Links Between Social Relationships and Cognitive Aging
Social Networks of Families Caring for the Aging Mind and Brain
Compositional characteristics of family networks (ie, size, demographic composition) have implications for how families provide care and adapt to the changing needs of family members. Similarly, networks with more biological family members may have more caregiving resources because of a sense of filial obligation among them.151 One study showed that the proportion of relatives and network size were negatively related to distress. related to the family of caregivers and supporting availability weakly mediated these associations. 152 Characteristics of network functions such as the exchange of support and resources among members have also been extensively examined and shown to be important in caregiver well-being. 20 Network-level interventions such as identifying and activating potential supportive resources that are pending153 or restructuring interaction patterns to facilitate negotiations and optimize care processes can greatly improve the well-being of all family systems, including affected relatives and primary caregivers.
Concluding Thoughts: Healthy Aging of our Mind and Brain – Where are we Headed?
More research is needed to increase our understanding of how technology affects social relationships and how it may be useful in facilitating perceived social engagement among older adults. Once such an understanding is gained, social network assessment tools can be developed to help identify the strategies to facilitate optimal aging of the mind and brain through the enhancement of social networks and relationships among older adults.
Acknowledgments
As reviewed here, participation in social interactions among older adults is likely influenced by the complex interaction of many elements, including physiological, psychological, and social factors. Examining the mediating mechanisms through which social participation may influence cognitive aging will help health professionals develop social programs that can effectively and appropriately improve or maintain cognitive functioning in older adults.
Key Readings
Baltimore Longitudinal Study of Aging. The Journals of Gerontology–Series B, Psychological Sciences and Social Sciences,51, S30 (1996). Social networks among Blacks and Whites: The interaction between race and age. Journal of Gerontology Series B Psychological and Social Sciences, 56, S112 (2001).
Why do we Age: Evolutionary Theories of Aging
To do this, we will consider some of the reasons for the deterioration of the organism with age, beyond simple entropy. An example of this was the relatively high prevalence of the dominant allele that causes Huntington's disease.
Cellular Mechanisms that Drive Aging
The dependence of sirtuins on cellular NAD links their enzymatic activity directly to the energy status of the cell. One of the main players in the inflammatory response that has been well studied is the multi-subunit regulator of the innate immune response NF-κB.
Brain Aging: Is Brain Aging Special and How does it Affect Organismal Aging?
Caloric restriction increases neurotrophic factor levels and attenuates neurochemical and behavioral deficits in a primate model of Parkinson's disease.Proc. Animals can model specific aspects of diseases that increase with aging, such as Parkinson's disease and Alzheimer's disease.
Model Organisms
This has been shown to cause selective degeneration of dopaminergic neurons, suggesting that this could be an important part of the puzzle.62 However, there are some caveats to the Parkinson's research in C. Early electrophysiological studies in this model revealed hyperactivity of the subthalamic nucleus in relation to motor symptoms of the disease.
Summary
Dissecting the pathological effects of human Abeta40 and Abeta42 in Drosophila: A potential model for Alzheimer's disease. Proc. Oxidative post-translational modifications of α-synuclein in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) mouse model of Parkinson's disease.J.
What Is the Humanistic Perspective?
The humanistic perspective states that activities and interventions that increase an individual's sense of purpose and involvement are an important aspect of healthy aging. Furthermore, arts interventions are less likely to be adopted in the wider community unless they can demonstrate effectiveness and cost benefit.”9.
Literature and Writing
For example, physician and poet Rafael Campo's "The Mental Status Room" (2005) reveals the hidden poetics of the Folstein test, turning the standard questions used to screen for neurogenerative changes back to the poem's speaker—and its reader (Box 5.3). Neuropsychologist Steven Sabat's The Experience of Alzheimer's Disease: Life Through A Tangled Veil (2001) is notable for its deeply sensitive and insightful analyzes of transcribed clinical dialogues with his severely cognitively impaired elderly patients.
Visual Art
Studies have examined the effects of reminiscence therapy on older adults, including those with depression, dementia (Alzheimer's and vascular types), and problematic behavior. Although outcome measures are difficult to standardize, improvements in general cognition and behavior, as well as their therapeutic applications, suggest the value of visual arts for older adults regardless of neurological status.
Film
In addition to portraying multiple older actors and the effects of alcoholism in later life, Nebraska illustrates the principles of validation therapy (i.e., the caregiver's acceptance of the truth experienced by an older person with cognitive disabilities).45 On television Derek is a fictional actor. Documentary-style comedy-drama set in a British nursing home. While mainstream films have helped improve the visibility of Alzheimer's disease and other forms of dementia, critics have criticized their tendency to focus on "the selfhood of the figures surrounding the character with dementia, rather than on those who suffer from it”.46
![Figure 5.12 Still from Hayley Morris ’ s Undone [short film] (2012). (Reprinted with permission of the artist).](https://thumb-ap.123doks.com/thumbv2/123dok/11714831.0/126.722.72.647.94.412/figure-hayley-morris-undone-short-reprinted-permission-artist.webp)
Critical Approaches: The “Neuro” Paradigm
However, both scientific and humanistic researchers have begun to question the claims of objectivity on the basis of the neuroscientific turn and in the neurological sciences more generally (a critical position known as neuroskepticism). Just as critics have noted the Alzheimerization of biomedical aging research, so too can we speak of the Alzheimerization of aging and older age in various art forms.
Conclusion
As Williams, Higgs, and Katz argue,61 neuroculture is not simply a question of the power or persuasive appeal of the neurosciences in the laboratory or clinic, but of their broader social, cultural, political, and economic significance and importance for humanity's future and potential for its optimization." As the "neuro" paradigm continues to powerfully shape how old age is understood to affect the brain and representations of the aging mind, researchers in the sciences and humanities are charged with an important ethical responsibility, as new collaborations between artists, neuroscientists, social scientists, and art therapists suggest , neither the scientific nor the humanistic approach can fully realize its potential without the insight of the other.
Note
Scott Diesing and Matthew Rizzo
Corroborative or additional history from the patient's family or loved ones is important in evaluating altered mind and memory. Encephalopathy (Greek for "affliction of the brain") is an umbrella term1 that includes many neurological disorders and abnormal brain states of aging.
History
The patient may show poor hygiene, wear the same unwashed clothes, leave clothes out, or dress inappropriately for a situation. The family may notice that the patient's weight has dropped without easy explanation.
The Examination
VI (Abducens nerve) Outward deviation of the eye VII (Facial nerve) Motor control of the face. XI (Accessory nerve) Shrugging and turning of the neck XII (Hypoglossal nerve) Motor control of the tongue.
Making the Diagnosis
Electroencephalography (EEG), event-related potentials (ERP), and magnetoencephalography (MEG) noninvasively assess the brain's electromagnetic activity. EEG can be useful in assessing cognitive impairment because of its ability to identify focal or asymmetric cortical dysfunction.
Discussion of the Diagnosis with the Patient
D. Jones
A neuropsychological assessment is used to guide key aspects of the care of older patients, such as determining whether a patient is able to make informed decisions, is able to manage their medical needs, is safe to drive, or needs supervised care. Domains commonly measured in neuropsychological assessment include intellectual functions, verbal and visual memory, language, visual perception, executive functions, mood, and personality.
Background
Furthermore, many of the neurological conditions in which assessment may be most beneficial are disproportionately represented in older populations. Practical implications of the results of neuropsychological assessment are often used to guide patient care, for example to determine whether a patient is capable of making informed decisions, able to manage complex medical/medication demands, or supervised care need after an illness.
Models of Assessment
Nevertheless, the Boston process approach permeates many interpretations of clinical findings, which is a testament to the popularity and strengths of the method. The current core tests used in the Iowa-Benton approach are presented in Table 7.1, with a sampling of the armamentarium of tests available and used for extended assessment in Table 7.2.
Domains of Assessment
This is a test of naming common items and the patient is asked to name the items themselves and some parts of the item. It is the patient's job to determine which characteristic is correct, based on subsequent feedback each time he or she sorts a card.
Training and Credentialing in Neuropsychological Assessment
Although there are several measures that can be seen, some of the most common include the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the Beck Depression Inventory, and the Geriatric Depression Scale. This training model was established at the Houston Conference on Specialty Training and Education in Clinical Neuropsychology.
Neuropsychological Syndromes and the Elderly
Finally, in the recent past a large number of clinical neuropsychologists are seeking board certification. In our interview with the patient in 2014, he denied any cognitive decline in the past two years, although he noted a mild memory deficit.
Structural MRI
Cross-sectional studies Cross-sectional MRI studies have shown consistent age effects6-13, particularly with regard to volume loss in the prefrontal cortex. It has been proposed that the accumulation of non-heme iron in the brain is a biomarker for the progressive neuroanatomical and cognitive decline in healthy aging.
Diffusion-Weighted MRI
Dementia with Lewy bodies is characterized by increased ADC in the precuneus.88Elevated ADC is identified with different distribution patterns between different variants of frontotemporal dementia89. Nonlinear relationships have been found between white matter volume and age in the left superior longitudinal fascicle and bilateral superior corona radiation103.
Magnetic Resonance Spectroscopy (MRS)
Hippocampal ADC is higher in MCI and AD patients. 75,77 ADC values in the hippocampal formation are elevated before conventional MRI reflects early ultrastructural changes in AD progression. Increased RD is associated with increased MD and decreased FA with age. 102 It is commonly assumed that RD is modulated by extracellular distance between membranes, axon diameter, and degree of myelination. 91 During adulthood, white matter volumes and microstructural changes as assessed with DTI show a negative linear relationship in the anterior thalamic radiation, internal capsule, cerebral peduncle, cerebellum, and external capsule,103 and some reports suggest that white matter DTI changes precede volume changes.
Functional MRI
In contrast to task-related functional studies, resting-state functional connectivity (RSFC) targets the coordinated nature of brain activity between brain regions and is often measured by estimates of the temporal correlation in the BOLD signal between different brain regions while participants rest passively in the scanner MRI.135 In support of the idea of age-related changes in network organization, changes in temporal coherence patterns of spontaneous activity in the resting brain were observed in older compared to younger adults. Age-related decreases in RSFC have been reported in the DMN as well as in the dorsal attention and frontoparietal control network.139 Compared to young individuals, older adults show an interesting dissociation: a weaker RSFC is observed within brain networks involved in high-level cognitive abilities. functions; however, stronger connections are observed between networks.140 In addition, network boundaries are less distinct (ie, reduced “systemic modularity”) in older compared to young adults.140.
Perfusion-Weighted MRI
Outlook and Future
Longitudinal measures of forebrain cholinergic atrophy in the transition from healthy aging to Alzheimer's disease. Visualization and characterization of structure and architecture of white matter fibers in the human pyramidal tract using diffusion tensor MRI.Magn.
Principles of Positron Emission Tomography (PET) Imaging
Although the images were acquired over a period of time, they are corrected by decaying to the beginning of the first acquisition in the sequence. Synthesis and quality assurance testing of radiopharmaceuticals should be done in approximately 2-3 half-lives.
Clinical/Research Uses of PET
All PET radiopharmaceuticals must be an FDA-approved agent (NDA [new drug application]) or an investigational agent used under an investigational new drug (IND) protocol or under local RDRC (research drug review committee) approval. Although numerous agents have been investigated, only a handful of PET radiopharmaceuticals have demonstrated utility and now FDA approval.
![Figure 5.10 Jean Raichle, Falling [Watercolour] (c. 2012). (Reprinted with permission of Marilyn Raichle).](https://thumb-ap.123doks.com/thumbv2/123dok/11714831.0/123.722.185.541.92.363/figure-raichle-falling-watercolour-reprinted-permission-marilyn-raichle.webp)