L’Invecchiamento cognitivo tra Normalità

e Patologia

Lugano, 30 maggio 2012

Giorgio AnnoniCattedra e Scuola di Specializzazione in Geriatria

Università degli Studi di Milano-BicoccaS.C.C. di Geriatria – Azienda Ospedaliera San Gerardo, Monza

CARATTERISTICHE CARATTERISTICHE NEUROPSICOLOGICHE NEUROPSICOLOGICHE

DELL’ANZIANODELL’ANZIANO

• Difficoltà a distribuire le risorse attentive

• Rallentamento della velocità di attenzione e della elaborazione dell’informazione

• Difficoltà percettive

• Difficoltà nell’elaborazione delle strategie di apprendimento

• Riduzione delle capacità del magazzino mnesico a breve termine

AGING OF THE NERVOUS SYSTEMAGING OF THE NERVOUS SYSTEM THE THREE MAJOR FUNCIONAL AREAS 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. Storage3. Retrieval

INVECCHIAMENTO CEREBRALEINVECCHIAMENTO CEREBRALE ANATOMIA

• PERDITA NEURONALE

• RIDUZIONE PESOA 70 ANNI CIRCA 5% DEL PESO A 30 ANNI

A 90 ANNI CIRCA 20% DEL PESO A 30 ANNI

• SEDI INTERESSATE

CORTECCIA – CELLULE PIRAMIDALI TERZO STRATO – SUBSTANZIA NIGRA – CORPO STRIATO

• MACROSOPICAMENTEAPPIATTIMENTO CIRCONVOLUZIONI

ALLARGAMENTO SOLCHI

RIDUZIONE SOSTANZA GRIGIA

ALLARGAMENTO VENTRICOLI LATERALI

MAP OF GLOBAL CHANGES OCCURRING IN THE MAP OF GLOBAL CHANGES OCCURRING IN THE GM VOLUME WITH AGEGM VOLUME WITH AGE

Black–blue scale: negative correlation (decreases); 2.4 cm3/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 EXPANSION (0.20% year) OF VENTRICULAR AND SULCAL SPACES WITH AGE 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 SPINE DENSITIES ON NEOCORTICAL PYRAMIDAL NEURONS FROM YOUNG (a-c) AND PYRAMIDAL NEURONS FROM YOUNG (a-c) AND

AGED (b-d) SUBJECTAGED (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 EFFECT OF BLOOD PRESSURE ON COGNITIVE FUNCTIONS (FRONTAL EXECUTIVE)FUNCTIONS (FRONTAL EXECUTIVE)

FACTORS MOST PREDICTIVE OF MAINTAINING OPTIMAL FACTORS MOST PREDICTIVE OF MAINTAINING OPTIMAL COGNITIVE FUNCTION COGNITIVE FUNCTION VSVS MINOR COGNITIVE DECLINE MINOR COGNITIVE DECLINE

J Am Geriatr Soc 2010; 55:259–264

Normalità Demenza

SPETTRO CLINICO DELL’INVECCHIAMENTO CEREBRALE

Normalità Demenza

SPETTRO CLINICO DELL’INVECCHIAMENTO CEREBRALE

E i centenari?

COMMUNITY-BASED STUDIES OF CENTENARIANS AND DEMENTIA

Int J Geriatr Psychiatry 2001; 16:537-42

VALUTAZIONE COGNITIVA DEI CENTENARI RESIDENTI NELL’ASL DI MONZA-BRIANZA

Cognitivamente integri(MMSE>24/30) 13%

Deterioramento cognitivolieve (MMSE 18-24/30) 31%

Det. cognitivo moderato(MMSE 12-18/30) 27%

Det. cognitivo severo(MMSE<12/30) 29%

Cognitivamente integri

Det. cognitivolieve

Det. cognitivomoderato

Det. cognitivosevero

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

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.