Skip to main content Accessibility help
×
Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-26T02:55:31.692Z Has data issue: false hasContentIssue false

Chapter 16 - Neurologic Problems

from Section III - Care of the Elderly by Organ System

Published online by Cambridge University Press:  30 June 2022

Jan Busby-Whitehead
Affiliation:
University of North Carolina, Chapel Hill
Samuel C. Durso
Affiliation:
The Johns Hopkins University, Maryland
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Rebecca Elon
Affiliation:
The Johns Hopkins University School of Medicine
Mary H. Palmer
Affiliation:
University of North Carolina, Chapel Hill
William Reichel
Affiliation:
Georgetown University Medical Center
Get access

Summary

As the population continues to age, clinicians will increasingly encounter neurological conditions in routine clinical practice. Neurological problems in the elderly have a profound impact on quality of life and can at times be life-threatening. Diagnosis and management of geriatric neurological problems is complicated by often vague presentations and the presence of comorbid conditions, as well as complex physiology and pharmacology in this age group. Moreover, when caring for these patients it is of utmost importance to have a holistic approach and include family and caregivers when developing care plans. In this chapter we review muscle weakness, sensory loss, seizure disorders, and headaches in the elderly patient. Causes, impact on quality of life, and available treatment options are discussed. Other topics including delirium, dementia, cerebrovascular disease, and gait disorders will be covered elsewhere.

Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
, pp. 189 - 207
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Drachman, DA, Swearer, JM. Neurological evaluation of the elderly patient. In: Albert, ML, Knoefel, JE, eds. Clinical Neurology of Aging, 3rd edition. New York: Oxford University Press, 2011, pp. 4153.Google Scholar
Manini, TM, Hong, SL, Clark, BC. Aging and muscle: A neuron’s perspective. Curr Opin Clini Nutr Metab Care. 2013; 16(1):110.Google Scholar
Sirven, JI, Mancall, EL. Neurological examination of the older adult. In: Sirven, JI, Malamut, BL, eds. Clinical Neurology of the Older Adult, 2nd edition. Philadelphia, PA: Lippincott Williams and Wilkins, 2008, pp. 57.Google Scholar
Chitnus, T, Weiner, HL. Multiple sclerosis in the elderly. In: Albert, ML, Knoefel, JE, eds. Clinical Neurology of Aging, 3rd edition. New York: Oxford University Press, 2011, pp. 536543.Google Scholar
Scalfari, A, Knappertz, V, Cutter, G, et al. Mortality in patients with multiple sclerosis. Neurology. 2013; 81:184192.Google Scholar
Ciotti, JR, Cross, AH. Disease modifying treatment in progressive multiple sclerosis. Curr Treat Options Neurol. 2018; 20:12.Google Scholar
Hughes, RA, Rees, JH. Clinical and epidemiologic features of Guillain-Barré syndrome. The Journal of Infectious Diseases. 1997; 176:S9298.Google Scholar
Yuki, N, Hartung, HP. Guillain-Barré syndrome. N Engl J Med. 2012; 366:22942304.Google Scholar
William, HJ, Jacobs, BC, Van Doorn, PA. Guillain-Barre syndrome. Lancet. 2016; 388:717727.Google Scholar
Cao-Lormeau, VM, et al. Guillain-Barre syndrome outbreak caused by Zika virus infection in French Polynesia. Lancet. 2016; 387(100027):15311539.Google Scholar
Vellozzi, C, et al. Guillain-Barre syndrome, influenza and influenza vaccination: The epidemiologic evidence. Clinical Infectious Disease. 2014; 58(8):11491155.Google Scholar
Worms, PM. The epidemiology of motor neuron disease: A review of recent studies. Journal of the Neurological Sciences. 2001; 191:39.Google Scholar
Rowland, LP, Shneider, NA. Amyotrophic lateral sclerosis. N Engl J Med. 2001; 344:16881700.Google Scholar
Voelker, R. Antioxidant drug approved for ALS. JAMA. 2017; 317(23):23472460.Google Scholar
Donaghy, M. Classification and clinical features of motor neuron diseases and motor neuropathies in adults. J. Neurol. 1999; 246:331333.CrossRefGoogle ScholarPubMed
Sieb, JP. Myasthenia gravis: An update for the clinician. Clinical and Experimental Immunology. 2013; 175:408418.Google Scholar
Drachman, DB. Myasthenia gravis. N Engl J Med. 1994; 330:17971810.Google Scholar
Mold, JW, Vesely, SK, Keyl, BA. The prevalence, predictors, and consequences of peripheral sensory neuropathy in older patients. J Am Board Fam Pract. 2004; 17:309318.Google Scholar
Hoffman Snyder, CR, Smith, BE. Common peripheral neuropathies in the older adult. In: Sirven, JI, Malamut, BL, eds. Clinical Neurology of the Older Adult, 2nd edition. Philadelphia, PA: Lippincott Williams and Wilkins, 2008, pp. 402419.Google Scholar
Zawora, M, Liang, TW, Jarra, H. Neurological problems in the elderly. In: Arenson, C, Busby-Whitehead, J, Brummel-Smith, K, et al., eds. Reichel’s Care of the Elderly: Clinical Aspects of Aging, 6th edition. New York: Cambridge University Press, 2009, pp. 140170.Google Scholar
Centers for Disease Control and Prevention. National diabetes statistics report: Estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services, 2014. www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf. Accessed on 08/03/2014.Google Scholar
Charnogursky, G, Lee, H, Lopez, N. Diabetic neuropathy. Handbook of Clinical Neurology. 2014; 120:773785.CrossRefGoogle ScholarPubMed
Schmader, KE. Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy. The Clinical Journal of Pain. 2002; 18:350354.CrossRefGoogle ScholarPubMed
Lacomis, D. Small-fiber neuropathy. Muscle and Nerve. 2002; 26:173188.Google Scholar
Brannagan, TH, Weimer, LH, Latov, N. Acquired neuropathies. In: Rowland, LP, ed. Merritt’s Neurology, 11th edition. Philadelphia, PA: Lippincott Williams and Wilkins, 2005, pp. 748767.Google Scholar
Ghaznawi, N, Virdi, A, Dayan, A, et al. Herpes zoster ophthalmicus: Comparison of disease in patients 60 years and older versus younger than 60 years. Ophthalmology. 2011; 118:22422250.CrossRefGoogle ScholarPubMed
Gnann, JW, Whitley, RJ. Herpes zoster. N Engl J Med. 2002; 347:340346.Google Scholar
Dooling, KL, et al. Recommendations of the advisory committee on immunization practices for use of herpes zoster vaccines. Center for Disease Control and Prevention, Morbidity and Mortality Weekly Report. 2018; 67(3):103108. www.cdc.gov/mmwr/volumes/67/wr/mm6703a5.htm.Google Scholar
Eldar, AH, Chapman, J. Guillain-Barré syndrome and other immune mediated neuropathies: Diagnosis and classification. Autoimmunity Reviews. 2014; 13:525530.CrossRefGoogle ScholarPubMed
Mahdi-Rogers, M, Hughes, RA. Epidemiology of chronic inflammatory neuropathies in southeast England. European Journal of Neurology. 2014; 21:2833.Google Scholar
Lijima, M, Koike, H, Nattori, N, et al. Prevalence and incidence rates of chronic inflammatory demyelinating polyneuropathy in the Japanese population. J Neurol Neurosurgery Psychiatry. 2008; 79(9):10401043.Google Scholar
Mellion, M, Gilchrist, JM, De La Monte, S. Alcohol-related peripheral neuropathy: nutritional, toxic, or both? Muscle and Nerve. 2011; 43:309316.Google Scholar
Kumar, N. Neurologic aspects of cobalamin (B12) deficiency. Handbook of Clinical Neurology. 2014; 120:915926.Google Scholar
Nemni, R, Gerosa, E, Piccolo, G, Merlinii, G. Neuropathies associated with monoclonal gammopathies. Haematologica. 1994; 79:557566.Google Scholar
Pop-Busui, R, Roberts, L, Pennathur, S, et al. The management of diabetic neuropathy in CKD. Am J Kidney Dis. 2010; 55:365385.Google Scholar
Dworkin, RH, O’Connor, AB, Backonja, M, et al. Pharmacologic management of neuropathic pain: Evidence-based recommendations. Pain. 2007; 132:237251.Google Scholar
Laccheo, I, Ablah, E, Heinrichs, R, et al. Assessment of quality of life among the elderly with epilepsy. Epilepsy Behav. 2008; 12:257261.Google Scholar
Stephen, LJ, Brodie, MJ. Epilepsy in elderly people. Lancet. 2000; 355:14411446.CrossRefGoogle ScholarPubMed
Leppik, IE, Birnbaum, AK. Epilepsy in the elderly. Annals of the New York Academy of Sciences. 2010; 1184:208224.Google Scholar
Ramsay, RE, Rowan, AJ, Pryor, FM. Special considerations in treating the elderly patient with epilepsy. Neurology. 2004; 62:S2429.Google Scholar
Huying, F, Limpe, S, Werhahn, KJ. Antiepileptic drug use in nursing home residents: A cross-sectional, regional study. Seizure. 2006; 15:194197.CrossRefGoogle ScholarPubMed
Hardie, NA, Garrard, J, Gross, CR, et al. The validity of epilepsy or seizure documentation in nursing homes. Epilepsy Research. 2007; 74:171175.Google Scholar
Brodie, MJ, Kelly, K, Stephen, LJ. Prospective audits with new antiepileptic drugs in focal epilepsy: Insights into population responses? Epilepsy and Behavior. 2014; 31:7376.Google Scholar
Wallace, H, Shorwon, S, Tallis, R. Age-specific incidence and prevalence rates of treated epilepsy in an unselected population of 2,052,922 and age-specific fertility rates of women with epilepsy. Lancet. 1998; 352:19701073.Google Scholar
Bladin, CF, Alexandrov, AV, Bellavance, A, et al. Seizures after stroke: A prospective multicenter study. Arch Neurol. 2000; 57:16171622.Google Scholar
Brodie, MJ, Elder, AT, Kwan, P. Epilepsy in later life. Lancet Neurol. 2009; 8:10191030.Google Scholar
Imfeld, P, Bodmer, M, Schuerch, M, et al. Seizures in patients with Alzheimer’s disease or vascular dementia: A population-based nested case control analysis. Epilepsia. 2013; 54:700707.Google Scholar
Irizarry, MC, Jin, S, He, F, et al. Incidence of new-onset seizures in mild to moderate Alzheimer disease. Arch Neurol. 2012; 69:368372.CrossRefGoogle ScholarPubMed
Sherzai, D, Losey, T, Vega, S, Sherzai, A. Seizures and dementia in the elderly: Nationwide inpatient sample 1999–2008. Epilepsy and Behavior. 2014; 36:5356.Google Scholar
Vossel, KA, Beagle, AJ, Rabinovici, GD, et al. Seizures and epileptiform activity in the early stages of Alzheimer disease. JAMA Neurol. 2013; 70:11581166.Google Scholar
Meierkord, H, Holtkamp, M. Non-convulsive status epilepticus in adults: Clinical forms and treatment. Lancet Neurol. 2007; 6:329339.Google Scholar
Jirsch, J, Hirsch, LJ. Nonconvulsive seizures: Developing a rational approach to the diagnosis and management in the critically ill population. Clinical Neurophysiology. 2007; 118:16601670.Google Scholar
McBride, AE, Shih, TT, Hirsch, LJ. Video-EEG monitoring in the elderly: A review of 94 patients. Epilepsia. 2002; 43:165.CrossRefGoogle ScholarPubMed
Kapoor, J, et al. Randomized trial of three anticonvulsants for Status Epilepticus. New England Journal of Medicine. 2019; 381;22.Google Scholar
Rowan, AJ, Ramsay, RE, Collins, JF, et al. New onset geriatric epilepsy: A randomized study of gabapentin, lamotrigine, and carbamazepine. Neurology. 2005; 64:18681873.Google Scholar
Cumbo, E, Ligori, LD. Levitiracetam, lamotrigine, and phenobarbital in patients with epileptic seizures and Alzheimer’s disease. Epilepsy Behavior. 2010; 17:461.Google Scholar
Lezaic, N, et al. The medical treatment of epilepsy in the elderly: A systematic review and meta-analysis. Epilepsia. 2019; 60(7):1325.Google Scholar
Speechio, LM, Tramacere, L, La Neve, A, Beghi, E. Discontinuing antiepileptic drugs in patients who are seizure free on monotherapy. J Neurol, Neurosurg Psychiatry. 2002; 72:2225.Google Scholar
Robbins, MS, Lipton, RB. Management of headache in the elderly. Drugs Aging. 2010; 27:377398.Google Scholar
Walker, RA, Wadman, MC. Headache in the elderly. Clin Geriatr Med. 2007; 23:291305.Google Scholar
Prencipe, M, Casini, A, Ferretti, C, et al. Prevalence of headache in an elderly population: Attack frequency, disability and use of medication. J Neurol Neurosurg Psychiatry. 2001; 70:377381.Google Scholar
Bamford, CC, Mays, M, Tepper, SJ. Unusual headaches in the elderly. Curr Pain Headache Rep. 2011; 15:295301.Google Scholar
Özge, A. Chronic daily headache in the elderly. Curr Pain Headache Rep. 2013; 17:382389.Google Scholar
Pringsheim, T, Davenport, J, Becker, W. Prophylaxis of migraine headache. CMAJ. 2010; 182:E269276.CrossRefGoogle ScholarPubMed
Charles, A. The evolution of a migraine attack: A review of recent evidence. Headache. 2013; 53:413419.CrossRefGoogle ScholarPubMed
Kristoffersen, ES, Lundqvist, C. Medication-overuse headache: Epidemiology, diagnosis and treatment. Ther Adv Drug Saf. 2014; 5:8799.CrossRefGoogle ScholarPubMed
Dodick, DW, Capobianco, DJ. Headaches. In: Sirven, JI, Malamut, BL, eds. Clinical Neurology of the Older Adult, 2nd edition. Philadelphia, PA: Lippincott Williams and Wilkins, 2008, pp. 197212.Google Scholar
Do, TP, et al. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology. 2019; 92(3):134144. PMID 30587518.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×