Geriatrics 1

Cardiology and Vascular System.- Epidemiology of Heart Disease, High Blood Pressure and Cardiovascular Disease.- A. Mortality and Morbidity of Heart Disease in Old Age.- I. Mortality.- II. Morbidity and Prevalence.- B. Prevalence of Heart Disease in Old Age.- I. Ischaemic Heart Disease.- 1. Incidence.- 2. Complications.- 3. Risk Factors.- II. Hypertension.- III. Hypotension.- IV. Valvular Heart Disease.- 1. Rheumatic Heart Disease.- 2. Aortic Valve Disease.- V. Pulmonary Heart Disease.- VI. Miscellaneous Forms of Heart Disease.- 1. Subacute Bacterial Endocarditis.- 2. Cardiac Amyloidosis.- VII. Congestive Heart Failure.- VIII. Electrocardiographic Abnormalities.- References.- Conduction System.- A. Introduction.- B. Age-Related Anatomical Changes.- I. Sinus Node.- II. Internodal Myocardium.- III. Atrioventricular Node.- IV. His’s Bundle and Branches.- C. Age-Related Functional Changes.- D. Age-Related Changes in the Blood Supply.- References.- Cardiac Output.- A. Resting Conditions.- B. Physical Exercise.- C. Causes of Reduced Cardiac Output in Old Age.- I. Heart Rate.- II. Stroke Volume.- D. Digitalization.- E. Effect of Physical Training.- F. Distribution of Cardiac Output.- G. Limiting Factors for Physical Work Capacity in Old Age.- References.- Myocardium and Valves.- A. Introduction.- B. Normal Ageing Changes.- C. Myocardial Pathology.- I. Ischaemic Heart Disease.- II. Senile Cardiac Amyloidosis.- 1. Age and Sex.- 2. Clinical Features.- 3. Pathogenesis.- 4. Isolated Valvular Amyloid.- III. Cardiomyopathies.- 1. Hypertrophic Cardiomyopathy.- 2. Congestive Cardiomyopathy.- IV. Myocarditis.- V. Metabolic Diseases.- VI. Non-specific Myocardial Changes.- VII. Tumours.- D. Valve Pathology.- I. Aortic Sclerosis and Stenosis.- II. Mitral Ring Calcification.- III. Mucoid Degeneration — The Floppy Mitral Valve.- IV. Chronic Inflammatory Valve Disease.- 1. Rheumatic Valve Disease.- 2. Rheumatoid and Other Inflammatory Diseases.- V. Infective Endocarditis.- VI. Non-Bacterial Thrombotic Endocarditis.- VII. Uncommon Valve Abnormalities.- VIII. Prosthetic Valve Pathology.- IX. Cardiac Pathology and Congestive Cardiac Failure.- References.- Valvular Disease of the Heart.- A. Epidemiology of Valvular Disease.- I. Rheumatic Heart Disease.- II. Non-rheumatic Mitral Disease.- III. Aortic Valve Disease.- B. Mitral Valve Disease.- I. Age Changes in the Mitral Valve.- II. Rheumatic Mitral Disease.- 1. Pathology.- 2. Clinical Features.- 3. Haemodynamics.- 4. Complications.- 5. Prognosis.- 6. Treatment.- III. Calcification of the Mitral Ring.- 1. Pathology.- 2. Clinical Features.- IV. Mucoid Deformity of the Mitral Valve.- 1. Pathology.- 2. Clinical Features.- V. Papillary Muscle Dysfunction.- VI. Left Atrial Myxoma.- C. Aortic Valve Disease.- I. Age Changes in the Aortic Valve.- II. Aortic Stenosis.- 1. Pathology.- 2. Clinical Features and Diagnosis.- 3. Haemodynamics.- 4. Prognosis.- 5. Treatment.- III. Aortic Incompetence.- 1. Pathology.- 2. Clinical Features and Diagnosis.- 3. Treatment.- D. Other Valve Disease.- I. Tricuspid Valve Disease.- 1. Pathology.- 2. Tricuspid Stenosis.- 3. Tricuspid Incompetence.- II. Pulmonary Valve Disease.- III. Multiple Valve Disease.- E. Endocarditis.- I. Infective Endocarditis.- 1. Pathology.- 2. Clinical Features.- 3. Treatment.- II. Non-bacterial Thrombotic Endocarditis.- References.- Cardiac Arrhythmias.- A. Introduction.- B. Diagnostic Considerations.- I. Etiology.- 1. Physiologic Causes.- 2. Aging Changes.- 3. Disease.- 4. Iatrogenic (Drug-Induced) Factors.- II. Types of Common Arrhythmias and Management.- 1. World Health Organization Classification.- 2. Normal Supraventricular Rhythms.- 3. Abnormal Supraventricular Arrhythmias.- 4. Ventricular Arrhythmias.- 5. Special Arrhythmia Syndromes.- III. Special Diagnostic Procedures.- 1. Carotid Sinus Massage.- 2. Continuous Ambulatory Electrocardiographic Monitoring.- 3. Other Specialized Diagnostic Recordings.- 4. Treadmill Exercise Stress Testing.- C. Therapeutic Considerations.- I. Drug Therapy.- 1. Clinical Pharmacokinetics.- 2. Age-Related Considerations.- 3. Clinical Pharmacology of Antiarrhythmic Agents.- II. Electric Methods.- 1. Direct Current Cardioversion.- 2. Pacing.- References.- Heart Block.- A. Introduction.- B. Prevalence.- C. Pathology and Common Causes.- I. Sinoatrial Block.- II. Atrioventricular Block.- III. Intraventricular Block.- D. General Clinical Aspects.- I. Sinoatrial Block.- II. Atrioventricular Block.- III. Intraventricular Block.- E. Symptomatology.- F. Diagnosis.- I. General Diagnostic Aspects.- II. Differential Diagnosis of Syncope.- G. Prognosis.- H. Treatment.- I. Drug Treatment.- II. Heart Pacing.- References.- The Arterial and Venous System.- A. Introduction.- I. Epidemiology.- II. Current Clinical Concepts.- B. Occlusive Arterial Diseases.- I. Acute Arterial Disorders.- 1. Arterial Embolism.- 2. Acute Arterial Thrombosis.- II. Chronic Arterial Conditions.- 1. Arteriosclerosis Obliterans.- 2. Aortoiliac Occlusion.- 3. Femoropopliteal Arterial Occlusive Disease.- 4. Peripheral Arterial Disease in Diabetes Mellitus.- 5. Evaluation of the Vascular Condition.- 6. Instrumental Vascular Examination.- 7. Noninvasive Methods.- 8. Arteriography.- 9. Treatment.- C. Aneurysms.- I. Abdominal Aortic Aneurysm.- 1. Etiology.- 2. Natural Course of an Abdominal Aneurysm.- 3. Diagnostic Tests.- 4. Treatment.- 5. Ruptured Aneurysm.- 6. Other Complications.- II. Aneurysms of Visceral Branches of the Abdominal Aorta.- III. Peripheral Aneurysms.- 1. Femoral Aneurysms.- 2. Popliteal Aneurysms.- IV. Anastomonic Aneurysms.- D. Acute Venous Thrombosis.- I. Clinical Manifestations.- II. Upper Extremity Thrombophlebitis.- III. Precipitating Factors.- IV. Ischemic Venous Thrombosis.- 1. Phlegmasia Cerulea Dolens.- 2. Venous Gangrene.- 3. Management.- V. Diagnosis.- VI. Pulmonary Embolism.- VII. Treatment of Thromboembolism.- 1. Medical Treatment.- 2. Anticoagulant Therapy.- 3. Surgical Management.- VIII. Postphlebitic Syndrome.- 1. Venous Hemodynamics.- 2. Treatment.- References.- Central Nervous System.- Cerebral Blood Flow, Electroencephalography and Behavior.- A. Introduction.- B. Normal Cerebral Aging.- I. Behavior.- II. Cerebral Blood Flow.- III. Electroencephalography.- C. Abnormal Cerebral Aging.- I. Clinical Symptoms.- II. Cerebral Blood Flow and Metabolism.- III. Electroencephalography.- D. Concluding Remarks.- References.- Functional Consequences of Neurofibrillary Degeneration of the Alzheimer Type.- A. Introduction.- B. Classification of Neurofibrillary Degeneration.- I. Neurofibrillary Degeneration of the Alzheimer Type.- II. Neurofibrillary Degeneration of Supranuclear Palsy.- III. Experimentally Induced Neurofibrillary Degeneration.- IV. Occurrence of Neurofibrillary Degeneration Other than in Alzheimer’s Disease.- C. Distribution of Neurofibrillary Degeneration in Alzheimer’s Disease.- D. Survival Time of Neurons with Neurofibrillary Degeneration..- E. Molecular Origin of Neurofibrillary Degeneration.- F. Neurofibrillary Degeneration and Altered Function.- I. Human Brain.- II. Experimental Animal Models of Neurofibrillary Degeneration.- G. Summary.- References.- Neurochemistry of the Aging Brain.- A. Introduction.- B. Nucleic Acids and Protein Biosynthesis.- I. Deoxyribonucleic Acid.- II. Chromatin and Histone.- III. Ribonucleic Acid.- IV. Protein Biosynthesis in the Brain: The Investigation of Free Amino Acid Levels.- V. Proteins of the White Matter and Extracellular Space.- C. Lipids of the Central Nervous System.- I. Fatty Acid Metabolism.- II. Gangliosides of the Aging Brain.- III. Lipids of the Myelin Sheath.- D. Carbohydrate Metabolism of the Aging Brain.- I. Glucose Uptake and Utilisation.- II. Glycolysis and the Metabolic Activity of the Citric Acid Cycle.- III. Oxidative Phosphorylation and Oxygen Consumption in the Aging Brain.- E. Age-Related Changes in Various Enzymes Unrelated to Transmitter Production.- I. Oxidoreductases.- II. Age-Related Changes in the Hydrolases.- III. Lyases.- References.- Neuronal Lipofuscin and Its Significance.- A. Introduction.- B. Distribution and Properties.- C. Isolation and Quantitation.- D. Origin of Lipofuscin.- E. In Pathological States.- F. Significance of Lipofuscin.- G. Summary.- References.- Neurotransmitters in Normal Aging.- A. Introduction.- B. Specific Neuronal Systems.- I. Catecholamine Systems and Aging.- 1. Catecholamine Levels and Aging.- 2. Catecholamine Enzymes and Aging.- 3. Catecholamine Receptors and Aging.- 4. Catecholamine Cell Counts and Aging.- II. Serotonin Systems and Aging.- III. Acetylcholine Systems and Aging.- IV. GABA Systems and Aging.- V. Other Neurotransmitter Systems and Aging.- C. Conclusions.- References.- Neuroimmunology of the Aging Brain.- A. Introduction.- B. Diseases of the Nervous System with Immune Components.- C. Neuron-Binding Antibody and Aging.- D. Effects and Potential Targets of Neuron-Binding Antibodies.- E. A Consideration of Immune Privilege.- F. Conclusion.- References.- Senile Dementia.- A. Etymology, Historical, and Contemporary Use of the Term “Senile Dementia”.- I. Historical Understanding.- II. Contemporary Understanding.- III. Own Definition.- B. Clinical Semeiology.- I. Psychopathology and Course of Senile Dementia.- II. Neuropsychology.- 1. Aphasia, Agraphia, and Alexia.- 2. Apraxia.- 3. Agnosia and Acalculia.- 4. Neurological Aspects.- C. Additional Diagnostic Findings.- I. Psychometry and Psychopathometry.- 1. Psychophysiological Tests.- 2. Memory Tests.- 3. Intelligence Tests.- 4. Neuropsychological Tests.- 5. Questionnaires, Rating Scales, and Inventories.- 6. Recent Developments for Senile and Demented People.- II. Instrumental Findings.- D. Epidemiology.- 1. Prevalence.- 2. Incidence.- 3. Mortality.- 4. Course.- 5. Sociological Factors.- 6. Genetics.- E. Differential Diagnosis.- 1. Introduction.- 2. The Diseases.- F. Pathology and Future Developments.- G. Treatment.- References.- Alzheimer’s Disease and its Clinical Implications.- A. Definition of Alzheimer’s Disease and Scope of Chapter.- B. Frequency and Sociomedical Importance.- C. The Clinical Picture of Alzheimer’s Disease.- I. Clinical Characteristics and Course of the Disease.- II. Psychometric Assessment.- III. EEG Findings.- IV. Regional Cerebral Blood Flow.- D. The Neuropathological Picture of Alzheimer’s Disease.- I. Gross Findings.- II. Microscopical Findings.- 1. Senile (Neuritic) Plaques.- 2. Neurofibrillary Degeneration.- 3. Dendritic Changes.- 4. Granulovacuolar Degeneration and Hirano Bodies.- 5. Lipofuscin, Chronic Neuronal Shrinkage, and Inflated Cells.- 6. Glial Alterations.- 7. Spongiosis.- 8. Neuronal Loss.- 9. Regional Variations.- 10. Changes in Non-cortical Including Limbic Areas.- 11. Vascular Changes.- E. Atypical Alzheimer’s Disease.- F. Correlation Between Clinical and Pathological Features.- G. Differential Diagnosis of Alzheimer’s Disease.- H. Aetiology and Pathogenesis.- I. Immunological, Toxic, Viral and Hereditary Factors.- II. Transmitters.- I. Treatment with Transmitter Substances.- J. Early Diagnosis of Alzheimer’s Disease.- K. Concluding Remarks.- List of Abbreviations.- References.- Stroke.- A. Introductory Remarks on Physiology and Pathophysiology.- I. Cerebral Blood Flow and Disorders.- 1. Cerebral Blood Flow and Blood Pressure.- 2. Cerebral Blood Flow and the Influence of Carbon Dioxide Tension and Blood pH.- 3. Cerebral Blood Flow and the Influence of Oxygen and Glucose.- 4. Cerebral Blood Flow and Nervous Influences.- II. Energetic Brain Metabolism and Its Disorders.- III. Special Features in Old Age.- B. Morphologic Findings in Stroke and Underlying Disorders.- I. Cerebral Infarction.- II. Diffuse Ischemic Lesions.- III. Intracerebral Hypertensive Hemorrhage.- IV. Diseases of Cerebral Blood Vessels Leading to Stroke.- 1. Arteriosclerosis.- 2. Hypertensive Cerebrovascular Disease.- 3. Congophilic Angiopathy (Cerebrovascular Amyloidosis).- 4. Inflammatory Diseases of Brain Vessels.- 5. Other Vascular Diseases.- 6. Anomalies and Dysplasias of Cerebral Blood Vessels..- C. Clinical Manifestations of Stroke.- I. Symptoms of Stroke Affecting the Carotid System.- 1. General Remarks.- 2. Internal Carotid Artery.- 3. Common Carotid Artery.- 4. Aortic Arch.- 5. Anterior Cerebral Artery.- 6. Middle Cerebral Artery.- 7. Anterior Choroid Artery.- 8. Posterior Communicating Artery and Posterior Cerebral Artery.- II. Symptoms of Strokes Affecting the Vertebrobasilar System.- III. Symptoms in Diffuse Cerebrovascular Disorders.- D. Clinical Stages of Stroke.- I. Asymptomatic Stenosis or Occlusion (Stage I, “Asymptomatic Bruit”).- II. Transient Ischemic Attacks (Stage II).- III. Stroke in Evolution (Stage III).- IV. Completed Stroke (Stage IV).- E. Pathogenetic Mechanisms of Stroke.- I. Vascular Stenosis and Thrombotic Occlusions.- 1. Basic Diseases.- 2. Additional Factors.- II. Embolism.- III. Hemorrhages.- IV. Rheologic Causes.- F. Diagnostic Technical Procedures.- I. Cerebral Angiography.- II. Measurements of Cerebral Blood Flow.- III. Computerized Tomography.- IV. Electroencephalography.- V. Doppler Sonography.- VI. Brain Scanning.- VII. Other Noninvasive Methods.- G. Prevention, Treatment, and Prognosis.- I. Prevention.- 1. Treatment and Prevention of Risk Factors.- 2. Medical Prevention.- 3. Surgical Prevention.- II. Treatment.- 1. Management of Stroke in the Initial Stage.- 2. Rehabilitation.- III. Prognosis.- References.- Vertebrobasilar Syndrome.- A. Introduction.- B. Determinants of the Vertebrobasilar Syndrome.- I. Cervical Spondylosis.- II. The Subclavian Steal Syndrome.- III. Other Causes of the Vertebrobasilar Syndrome.- IV. Giant-Cell Arteritis.- V. Transient Vertebrobasiliar Ischaemic Attacks: Aetiology.- 1. Haemodynamic Crises.- 2. Embolic Mechanisms.- VI. Clinical Features of the Vertebrobasilar Syndrome.- VII. Transient Ischaemic Attacks.- VIII. Subclavian Steal Syndrome.- IX. Arterial Occlusion in the Vertebrobasilar Territory.- X. Basilar Artery Thrombosis.- C. Investigations.- I. Laboratory.- II. Radiology.- III. Angiography.- IV. Percutaneous Ultrasonic Doppler Technique.- V. Computerised Tomography.- D. Management of the Vertebrobasilar Syndrome.- I. Cervical Spondylosis.- II. Surgery.- III. Subclavian Steal Syndrome.- IV. Vertebral Artery Stenosis.- V. Transient Ischemic Attacks Involving the Vertebrobasilar System.- VI. Drugs Affecting Platelet Aggregation.- References.