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Neuropsychiatric Aspects of Aging

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  1. Overview
  2. Mental status examination
  3. Functional assessment
  4. Adverse drug events in the elderly
  5. Drugs with psychoactive effects
  6. Principles of drug therapy in the elderly
  7. Recommendations
  8. Bibliography

The process of aging produces important physiologic changes in the central nervous system, including neuroanatomic, neurotransmitter, and neurophysiologic changes. These processes result in age-related symptoms and manifestations for many older persons. These physiologic changes develop at dramatically variable rates in different older persons, however, the decline being modified by factors such as diet, environment, lifestyle, genetic predisposition, disability, disease, and side effects of drugs. These changes can result in the common age-related symptoms of benign senescence, slowed reaction time, postural hypotension, vertigo or giddiness, presbyopia, presbycusis, stiffened gait, and sleep difficulties.

[...] Neuropsychiatric disorders, the leading cause of disability in older persons, account for nearly 50% of functional incapacity. Severe neuropsychiatric conditions have been estimated to occur in 15 to 25% of older adults worldwide. These conditions are due to diseases that increase with age but are not part of the normal aging process. Alzheimer's disease and related dementias occur in approximately 10% of adults age 65 and older and 40% of adults older than 85. Delirium occurs in 5 to 10% of all persons age 65 and older, usually in the setting of acute illness and hospitalization. [...]

[...] The important relationship of functional status with health in older persons is reflected in the finding that functional measures are stronger predictors of mortality after hospitalization than are admitting diagnoses. Functional measures strongly predict other important hospital outcomes in the elderly, such as length of stay, functional status at discharge, future care needs, caregiver burden, risk for institutionalization, and long-term prognosis. The functional assessment should include an assessment of the patient's ability to perform basic self-care activities of daily living and instrumental activities of daily living, the higher level activities needed for independent living. [...]

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