Page 25 - Petelin, Ana, ur. 2021. Zdravje starostnikov / Health of the Elderly. Zbornik povzetkov z recenzijo / Book of Abstracts. Koper: Založba Univerze na Primorskem/University of Primorska Press
P. 25
ited lecture plenarna predavanja | plenary lectures
Between ageing and dementia
Zvezdan Pirtošek
University of Ljubljana, Medical faculty, Department of Neurology,
Ljubljana, Slovenia
Neurology Clinic, University Medical Center, Ljubljana, Slovenia
Historically, the boundary between physiological ageing and dementia has re-
mained blurred and undefined, and in most societies and periods, dementia has
been understood as an integral part of ageing. Only neuropathological studies
by Alois Alzheimer’s clearly defined dementia as a disease state with charac-
teristic clinical (pronounced impairment of higher mental functions that large-
ly precludes meaningful daily activities) and histological (amyloid plaques and
neurofibrillary tangles) signs. Nevertheless, in the initial or preclinical stages of
Alzheimer’s disease it is often difficult - even for an experienced clinician - to
determine on the basis of a clinical examination whether the person has an in-
itial (most often memory) impairment associated with physiological ageing or
whether his problems already indicative of the neurodegenerative disease pro-
cess.
With age, the speed of information processing slows down, so among the first
signs is a decline in divided attention, slight difficulties in recall and slower learn-
ing of new information, slowed psychomotor responses, thought process and
speech; but these changes are very individual, and some studies find that at
the age of 70, 25% of the elderly still function cognitively as well as the average
20-year-old. We talk about a mild cognitive impairment (MCI) when the first
cognitive changes (especially forgetfulness) are reported by an individual or his
relatives, while he is still independent, without any problems in performing dai-
ly activities. Detailed testing confirms the problems.
MCI can be caused by stress, overload, depression, but it also poses an in-
creased risk of underlying dementia; in this case, repeated, serial testing will
give a worsening result, and the transition to neurodegenerative dementia
could then be able to be confirmed by imaging methods and cerebrospinal fluid
examination. If the memory disorder (i.e. MCI of amnestic type) is in the fore-
ground, the transition to Alzheimer’s disease is more probable, but if a decline
of some other cognitive function (attention, speech, arithmetic, abstract think-
ing – i.e. MCI of non-amnestic type), the development of another type of de-
mentia is more likely.
A special challenge for medicine is the so-called ‘super agers’, seniors, who re-
main cognitively extremely well preserved deep into old age that typically ex-
ceeds a century. Interestingly, some have the typical histological changes de-
scribed by Alois Alzheimer.
Keywords: ageing, mild cognitive impairment, dementia
23
Between ageing and dementia
Zvezdan Pirtošek
University of Ljubljana, Medical faculty, Department of Neurology,
Ljubljana, Slovenia
Neurology Clinic, University Medical Center, Ljubljana, Slovenia
Historically, the boundary between physiological ageing and dementia has re-
mained blurred and undefined, and in most societies and periods, dementia has
been understood as an integral part of ageing. Only neuropathological studies
by Alois Alzheimer’s clearly defined dementia as a disease state with charac-
teristic clinical (pronounced impairment of higher mental functions that large-
ly precludes meaningful daily activities) and histological (amyloid plaques and
neurofibrillary tangles) signs. Nevertheless, in the initial or preclinical stages of
Alzheimer’s disease it is often difficult - even for an experienced clinician - to
determine on the basis of a clinical examination whether the person has an in-
itial (most often memory) impairment associated with physiological ageing or
whether his problems already indicative of the neurodegenerative disease pro-
cess.
With age, the speed of information processing slows down, so among the first
signs is a decline in divided attention, slight difficulties in recall and slower learn-
ing of new information, slowed psychomotor responses, thought process and
speech; but these changes are very individual, and some studies find that at
the age of 70, 25% of the elderly still function cognitively as well as the average
20-year-old. We talk about a mild cognitive impairment (MCI) when the first
cognitive changes (especially forgetfulness) are reported by an individual or his
relatives, while he is still independent, without any problems in performing dai-
ly activities. Detailed testing confirms the problems.
MCI can be caused by stress, overload, depression, but it also poses an in-
creased risk of underlying dementia; in this case, repeated, serial testing will
give a worsening result, and the transition to neurodegenerative dementia
could then be able to be confirmed by imaging methods and cerebrospinal fluid
examination. If the memory disorder (i.e. MCI of amnestic type) is in the fore-
ground, the transition to Alzheimer’s disease is more probable, but if a decline
of some other cognitive function (attention, speech, arithmetic, abstract think-
ing – i.e. MCI of non-amnestic type), the development of another type of de-
mentia is more likely.
A special challenge for medicine is the so-called ‘super agers’, seniors, who re-
main cognitively extremely well preserved deep into old age that typically ex-
ceeds a century. Interestingly, some have the typical histological changes de-
scribed by Alois Alzheimer.
Keywords: ageing, mild cognitive impairment, dementia
23
