Friday, February 15, 2013

Geriatric Syndromes: The Role of Vascular Disorders

A geriatric syndrome is a general term used to refer to clinical conditions with multiple possible factors that are common among the elderly and associated with increased disability, nursing home placement, and death. Examples include impaired thinking, heart disease, dizziness, and impaired hearing and vision, among many others.

In an upcoming article in the Annals of Medicine, researchers from Finland argue based on a synthesis of prior research that vascular factors are an important cause of geriatric syndromes. Such vascular factors include aging and dysfunction of large and small blood vessels, cardiovascular diseases, and hardening of the arteries. An artery is a blood vessel that carries blood away from the heart. As the researchers note, small vessel disease can lead to blockages, which decreases blood supply to organs such as the brain, heart, kidney, retina, muscles, and bone. In fact, they argue that small vessel disease can affect any cell in the body because all cells are ultimately dependent on a proper blood supply to deliver oxygen.

In the article, the researchers provide evidence that even vascular disease that does not cause signs or symptoms is associated with frailty. They note that muscle loss can be caused by decreased blood supply of oxygen. They note that dementia is known to be caused by cerebrovascular disease but that other forms of dementia such as Alzheimer’s disease (considered to be separate) often co-occurs with cerebrovascular disease and that vascular pathology (e.g., hardening of the arteries) may contribute to its development. Dementia is a progressive loss of cognitive and intellectual functioning without loss of consciousness.

The researchers discussed some evidence that vascular factors increased the risk of delirium. Delirium is a state of fluctuating mental confusion that develops over a few hours or days. The authors are careful to note that while vascular factors can contribute to depression, neglect, and apathy (lack of interest) that these three problems can worsen vascular disorders. Thus, the relationship runs in both directions.

The researchers noted that subtle connections were emerging on the role of vascular disorders and urinary incontinence (loss of urinary control). An example is decreased oxygen to the frontal lobes, which works as the brain’s executive control center. If something goes significantly wrong it that part of the brain, the person will likely have difficulty with impulse regulation. The article discusses how disturbances of gait (walking) can by caused by vascular damage to the white matter of the brain, which can cause falls and bone breaks.

White matter is a group of white nerve fibers that conduct nerve impulses quickly. Vascular links to dizziness, hearing impairments, visual impairments, and osteoporosis is also presented. Osteoporosis is an abnormal loss of bone thickness and a wearing away of bone tissue. Earlier detection and treatment of vascular disease can hopefully lead to a decrease in geriatric syndromes over time.

Suggested reading: TOP 10 Geriatric Syndromes Clinical Management Strategies

Reference: Strandberg TE, Pitkälä KH, Tilvis RS, O'Neill D, Erkinjuntti TJ. (2013, in press). Geriatric syndromes-vascular disorders? Ann Med.

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