Chapter 22

• Effects of Aging on the Nervous System

  • Loss of nerve cell mass
  • Atrophy of the brain and spinal cord
  • Brain weight decreases
  • Number of dendrites declines
  • Demyelination
  • Slower nerve conduction
  • Response and reaction times are slower
  • Reflexes become weaker
  • Plaques, tangles, atrophy of the brain
  • Free radicals accumulate
  • Decrease in cerebral blood flow
  • Fatty deposits accumulate in blood vessels
  • Ability to compensate declines with age
• Intellectual performance maintained until at least 80 years of age
• Effects of Aging on the Nervous System

  • Slowing in central processing
  • Delay in time required to perform tasks
  • Verbal skills maintained until age 70
  • Number and sensitivity of sensory receptors, dermatomes, and neurons decrease
  • Dulling of tactile sensation
  • Decline in the function of cranial nerves affecting taste and smell
• Subtle Indications of Neurologic Problems

  • New headaches that occur in the early morning or interrupt sleep
  • Change in vision (e.g., sudden decreased acuity, double vision, and blindness in portion of visual field)
  • Sudden deafness, ringing in ears
  • Mood, personality changes
  • Altered cognition or LOC
  • Clumsiness, unsteady gait
  • Numbness, tingling of extremity
  • Unusual sensation or pain over nerve
• Parkinsonism Stages


  • Early: Mild symptoms on one side only, Mask symptoms
  • Middle: Difficulty rising from chair, Flexed position when standing, Lean forward to initiate walking, Shuffling step with no arm swing, Unsteady gait, especially when turning
  • Very late: Unable to stand or walk, Cachectic
• Levodopa


  Dopamine precursor that is combined with dopa-carboxylase inhibitor
• Treatment of Parkinson's Disease

  1. Medication has to cross blood brain barrier

  2. Teach: when you get ready to move pickup your foot like you are marching

  3. Enzyme in intestinal mucosa, dopa decarboxylase, converts to dopamine lost before reaches general circulation

  4. Starting dose 25/100 mg tid

  5. Gradually increase to 25/250 qid

  6. GIVE Meds on time in the morning

  7. Take on an empty stomach

  8. Can cause orthostatic hypotension
• Dopamine agonists

  Directly stimulate dopamine receptors
• Transient Ischemic Attacks (TIA)

  Temporary or intermittent decrease in cerebral perfusion
• Signs and symptoms of TIA

  • Temporary vision loss in one eye
  • Tinnitus
  • Vertigo
  • Confusion
  • H/A
  • Transient Hemiparesis
• Recovery from TIA is usually within 1 day
• Increased risk for CVA after TIA
• Causes of CVA


  • Cerebral Hemorrhage
  • Embolus or thrombus that occludes an artery
  • Rupture of an extra cerebral artery subarachnoid hemorrhage
  • Atherosclerosis
• Risk Factors for CVA


  • Hypertension
  • DM
  • Smoking
  • Sedentary lifestyle
  • Obesity
  • Stress
• NIH Stroke Scale

  Assessment tool for patients with CVA
• Deficits assessed by NIH Stroke Scale

  • Gaze
  • Visual fields
  • Facial palsy
  • Motor strength
  • Ataxia
  • Sensation
  • Language
  • Dysarthria
  • Extension or inattention
• LEFT CVA results in right weakness and APHASIA
• RIGHT CVA is harder to rehab as everything in perception is off, resulting in left weakness and perceptual deficits
• Rehabilitation for Patient with CVA


  • To improve activity limitations
  • To alleviate psychological distress
  • To assist with receptive and expressive communication difficulties
• Conditions usually improve in stroke patients with small vessel disease
• Risks of stroke include motor and cognitive impairment problems
• Nursing Considerations for Neurologic Conditions

  • Promoting independence
  • Assistive devices
  • Periodic home visits
  • Regular contact with family and friends
  • Promoting self-care
  • Patience, reassurance, and encouragement
  • Personality problems may occur
  • Depression related to dependence
  • Loss of former roles and identities
  • Displaced reactions
  • Need to educate family members and friends
  • Preventing injury
  • High risk of accidents
  • Avoiding hazards
  • Safety considerations
  • Evaluate the environment for danger
  • Prevention of complications
• Seizure Disorders increase with age
• People over 75 yrs are twice as likely to develop new onset of SEIZURES