Geriatrics 1, Softcover reprint of the original 1st ed. 1982
Cardiology and Vascular System Central Nervous System

In 1909 a short contribution entitled "Geriatrics" was published in the New York Medical Journal. According to this article, old age represents a distinct period oflife in which the physiologic changes caused by aging are accompanied by an increasing number of pathologic changes. We now know that the organs of the body age neither at the same rate nor to the same extent and that physiologic alterations are indeed superimposed by pathologic changes; as a result of the latter phenomenon the origins and course of illnesses in the elderly can present unusual characteristics. The frequency of concurrent disorders in the elderly entails the danger of polypragmatic pharmacotherapy, i. e. , the use of various drugs to combat various disorders while neglecting the possibly adverse combined effects of these drugs. To obviate this danger, special knowledge in the field of geriatrics, the medical branch of gerontology, is necessary. Geriatrics is constantly increasing in importance owing to the near doubling of life expectancy over the past 130 years and to the improved diagnostic and therapeutic techniques made available by medical pro­ gress. The rapid recent development of experimental gerontology has played an essential role in enabling us to understand the special features of geriatrics. This progress has, however, been accompanied by such a vast increase in the volume of literature on the subject that specialists in the field can scarcely maintain an overall perspective of new publications.

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.