LInvecchiamento cognitivo tra Normalità e Patologia Lugano, 30 maggio 2012 Giorgio Annoni Cattedra e Scuola di Specializzazione in Geriatria Università degli Studi di Milano-Bicocca S.C.C. di Geriatria – Azienda Ospedaliera San Gerardo, Monza

CARATTERISTICHE NEUROPSICOLOGICHE DELLANZIANO Difficoltà a distribuire le risorse attentive Rallentamento della velocità di attenzione e della elaborazione dellinformazione Difficoltà percettive Difficoltà nellelaborazione delle strategie di apprendimento Riduzione delle capacità del magazzino mnesico a breve termine

AGING OF THE NERVOUS SYSTEM THE THREE MAJOR FUNCIONAL AREAS MOTOR FUNCTION: GATE AND BALANCE COGNITIVE FUNCTUION: MEMORY ELECTRICAL ACTIVITY: SLEEP

COGNITIVE FUNCTION Multi-faceted: - Memory - Language - Visuospatial - Mathematical - Executive (judgment, reasoning, planning)

MEMORY Multiple sub-systems: - Episodic (personally relevant events/episodes) - Working (manipulate learned info) - Semantic (knowledge of facts, meaning of words) - Procedural (performance of skills) Can run independently

MEMORY PROCESS Sensations Sensations Sensations Sensations Immediate Memory Short Term Memory Long Term Memory 1. Encoding 2. Storage 3. Retrieval

INVECCHIAMENTO CEREBRALE INVECCHIAMENTO CEREBRALE ANATOMIA PERDITA NEURONALE RIDUZIONE PESO A 70 ANNICIRCA 5% DEL PESO A 30 ANNI A 90 ANNICIRCA 20% DEL PESO A 30 ANNI SEDI INTERESSATE CORTECCIA – CELLULE PIRAMIDALI TERZO STRATO – SUBSTANZIA NIGRA – CORPO STRIATO MACROSOPICAMENTE APPIATTIMENTO CIRCONVOLUZIONI ALLARGAMENTO SOLCHI RIDUZIONE SOSTANZA GRIGIA ALLARGAMENTO VENTRICOLI LATERALI

MAP OF GLOBAL CHANGES OCCURRING IN THE GM VOLUME WITH AGE Black–blue scale: negative correlation (decreases); 2.4 cm 3 /year (-0.18% per year) Black–red scale: positive correlation (increases) Neurobiology of Aging 2007; 28: 1075–1087

EXPANSION (0.20% year) OF VENTRICULAR AND SULCAL SPACES WITH AGE Neurobiology of Aging 2007; 28: 1075–1087

NPCs and their progeny (blue) in mice et al. J. Neurosci. 2012;32:i-i ©2012 by Society for Neuroscience

INFLUENCES ON STEM-CELL FUNCTIONALITY

SPINE DENSITIES ON NEOCORTICAL PYRAMIDAL NEURONS FROM YOUNG (a-c) AND AGED (b-d) SUBJECT

SPINES IN YOUNG (e-f) AND AGED (g-h) RUNNING MICE

MEMORY WORSENING Stress/anxiety/depression/ sleep deprivation Medications (hypnotics, narcotics, anti-cholinergics, anti-histamines) Medical conditions (hypertension, diabetes, thyroid disfunction, sleep apnea, etc.) Alcohol, drugs

EFFECT OF BLOOD PRESSURE ON COGNITIVE FUNCTIONS (FRONTAL EXECUTIVE)

FACTORS MOST PREDICTIVE OF MAINTAINING OPTIMAL COGNITIVE FUNCTION VS MINOR COGNITIVE DECLINE J Am Geriatr Soc 2010; 55:259–264

Normalità Demenza SPETTRO CLINICO DELLINVECCHIAMENTO CEREBRALE

Normalità Demenza SPETTRO CLINICO DELLINVECCHIAMENTO CEREBRALE E i centenari?

COMMUNITY-BASED STUDIES OF CENTENARIANS AND DEMENTIA Int J Geriatr Psychiatry 2001; 16:537-42

VALUTAZIONE COGNITIVA DEI CENTENARI RESIDENTI NELLASL DI MONZA-BRIANZA Cognitivamente integri Det. cognitivo lieve Det. cognitivo moderato Det. cognitivo severo Marzo 2011

Episodic Memory: spaghetti plot for the sum of free recall as a function of time before AD diagnosis Journal of the International Neuropsychological Society (2008), 14, 266–278

Executive Function: spaghetti plot for category fluency (sum of the number of fruits, animals, and vegetables named in 60 s for each of the three categories) as a function of time before diagnosis Journal of the International Neuropsychological Society (2008), 14, 266–278

Verbal Intelligence: spaghetti plot of estimated verbal IQ as a function of time before diagnosis.