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THEORIES OF NEUROLOGICAL AGING AND DEMENTIA

THEORIES OF NEUROLOGICAL AGING AND DEMENTIA

THEORIES OF NEUROLOGICAL AGING AND DEMENTIA  
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The primary care physician must advise middle-age and older patients about ways to age successfully. Dementia is a common disabling illness that afflicts 10% of people over age 65 and 47% of people over age 85. Most older people perceive their health as "good" and 2/3 of people over the age of 65 describe themselves as healthy. Over ½ of persons over the age of 85 can remain independent. The primary care physician can enhance this sense of health and self-determination by providing specific recommendations to the older patient (1). No specific wellness program has been studied over a 20-30 year period to determine the effectiveness of a successful aging intervention. These studies will almost certainly never be funded or completed. The practicing clinician must assemble specific recommendations based on available scientific observations and advice to older individuals on the best ways to prevent cognitive decline. This handout includes a series of safe interventions that probably slow the onset of dementia based on the best available science. All recommendations are based on peer reviewed literature. Theories on the Cause of Aging Many different mechanisms are hypothesized for age-related brain changes including apoptosis, telomere loss, neuroendocrine alterations, autoimmune changes, oxidative stress and others. Age-related brain damage may be produced by dysfunction of neuronal cytoskeleton or damage to mitochondria that diminish neuronal energy. The human genome does not undergo apoptosis, i.e., programmed self-destruction, until age 120 or 130 and approximately 2/3 of human aging may be determined by life choices and environment rather than genetics. With the present human life expectancy at 79 and future life expectancies exceeding 100, our best prescription for aging is a wellness program (2,3,4,5). Brain aging occurs in aged monkey, bears, and dogs that resemble human brain pathology.
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