Cerebral Physiology of the Aged: Influence of Circulatory Disorders

  • Walter D. Obrist
Part of the Advances in Behavioral Biology book series (ABBI, volume 3)


The purpose of this paper is to examine the concept of vascular insufficiency as it relates to cerebral physiologic alterations in old age and to associated states of intellectual deterioration. Vascular insufficiency has been defined as an inadequate blood supply relative to the metabolic needs of the tissue (Sokoloff 1961). It may be present continuously or occur intermittently whenever blood flow falls below normal levels, or it may become manifest only under conditions of increased metabolic demand.


Cerebral Blood Flow Blood Pressure Level Regional Cerebral Blood Flow Cerebral Circulation Ischemic Hypoxia 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Adams, J.E.; Smith, M.C.; and Wylie, E.J. 1963. Cerebral blood flow and hemodynamics in extracranial vascular disease: Effect of endarterectomy. Surgery 53:449.PubMedGoogle Scholar
  2. Agnoli, A.; Fieschi, C; Bozzao, L.; Battistini, N.; and Prencipe, M. 1968. Autoregulation of cerebral blood flow: Studies during drug-induced hypertension in normal subjects and in patients with cerebral vascular diseases. Circulation 38: 800.PubMedGoogle Scholar
  3. Bailey, O.T. 1963. Influence of hypoxia in various diseases. In Selective Vulnerability of the Brain in Hypoxaemia. J.P. Schade and W.H. McMenemey (eds.). Philadelphia: F.A. Davis, p. 227.Google Scholar
  4. Baker, A.B.; Resch, J.A.; and Loewenson, R.B. 1969. Hypertension and cerebral atherosclerosis. Circulation 39:701.PubMedGoogle Scholar
  5. Birren, J.E.; Botwinick, J.; Weiss, A.D.; and Morrison, D.F. 1963. Interrelations of mental and perceptual tests given to healthy elderly men. In Human Aging: A Biological and Behavioral Study. PHS Publication No. 986. Washington, D.C.: U.S. Govt. Printing Office, p. 143.CrossRefGoogle Scholar
  6. Brody, H. 1955. Organization of the cerebral cortex. III. A study of aging in the human cerebral cortex. J. Comp. Neurol. 102: 511.PubMedCrossRefGoogle Scholar
  7. Brody, H. 1970. Structural changes in the aging nervous system. Interdiscipl. Topics Geront. 7: 9.Google Scholar
  8. Bryant, L.R.; Eiseman, B.; Spencer, F.C.; and Lieber, A. 1965. Frequency of extracranial cerebrovascular disease in patients with chronic psychosis. New Eng. J. Med. 272: 12.PubMedCrossRefGoogle Scholar
  9. Busse, E.W., and Wang, H.S. 1972. The multiple factors contributing to dementia in old age. In Proceedings of the Fifth World Congress on Psychiatry. Princeton, N.J.: Excerpta Medica (in press).Google Scholar
  10. Cohen, P.J.; Alexander, S.C.; Smith, T.C.; Reivich, M.; and Wollman, H. 1967. Effects of hypoxia and normocarbia on cerebral blood flow and metabolism in conscious man. J. Appl. Physiol. 23: 183.PubMedGoogle Scholar
  11. Corday, E.; Rothenberg, S.F.; and Putnam, T.J. 1953. Cerebral vascular insufficiency. Arch. Neurol. Psychiat. 69: 551.Google Scholar
  12. Corsellis, J.A.N. 1962. Mental Illness and the Ageing Brain. London: Oxford University Press.Google Scholar
  13. Crawford, E.S.; DeBakey, M.E.; Blaisdell, F.W.; Morris, G.C., Jr.; and Fields, W.S. 1960. Hemodynamic alterations in patients with cerebral arterial insufficiency before and after operation. Surgery 48: 76.PubMedGoogle Scholar
  14. Dastur, D.K.; Lane, M.H.; Hansen, D.B.; Kety, S.S.; Butler, R.N.; Perlin, S.; and Sokoloff, L. 1963. Effects of aging on cerebral circulation and metabolism in man. In Human Aging: A Biological and Behavioral Study. PHS Publication No. 986. Washington, D.C.: U.S. Govt. Printing Office, p. 57.Google Scholar
  15. Denny-Brown, D. 1960. Recurrent cerebrovascular episodes. Arch. Neurol. 2: 194.PubMedCrossRefGoogle Scholar
  16. Denny-Brown, D., and Meyer, J.S. 1957. The cerebral collateral circulation. 2. Production of cerebral infarction by ischemic anoxia and its reversibility in early stages. Neurology 7: 567.PubMedGoogle Scholar
  17. Drake, W.E., Jr., and Drake, M.A.L. 1968. Clinical and angiographic correlates of cerebrovascular insufficiency. Amer. J. Med. 45: 253.PubMedCrossRefGoogle Scholar
  18. Eisdorfer, C. 1967. Psychologic reaction to cardiovascular change in the aged. Mayo Clin. Proc. 42: 620.PubMedGoogle Scholar
  19. Eisenberg, S.; Madison, L.; and Sensenbach, W. 1960. Cerebral hemodynamic and metabolic studies in patients with congestive heart failure. Circulation 21: 704.PubMedGoogle Scholar
  20. Ewalt, J.R., and Ruskin, A. 1944. The electroencephalogram in patients with heart disease. Texas Rep. Biol. Med. 2: 161.Google Scholar
  21. Fazekas, J.F., and Alman, R.W. 1964. The role of hypotension in transitory focal cerebral ischemia. Amer. J. Med. Sci. 248: 567.PubMedCrossRefGoogle Scholar
  22. Fieschi, C.; Agnoli, A.; Prencipe, M.; Battistini, N.; Bozzao, L.; and Nardini, M. 1969. Impairment of the regional vasomotor response of cerebral vessels to hypercarbia in vascular diseases. Europ. Neurol. 2: 13.PubMedCrossRefGoogle Scholar
  23. Finnerty, F.A., Jr.; Witkin, L.; and Fazekas, J.F. 1954. Cerebral hemodynamics during cerebral ischemia induced by acute hypotension. J. Clin. Invest. 33: 1227.PubMedCrossRefGoogle Scholar
  24. Fisher, C.M. 1954. Occlusion of the carotid arteries. Arch. Neurol. Psychiat. 72: 187.Google Scholar
  25. Fisher, C.M. 1968. Dementia in cerebral vascular disease. In Cerebral Vascular Diseases. J.F. Toole, R.G. Siekert, and J.P. Whisnant (eds.). New York: Grune & Stratton, p. 232.Google Scholar
  26. Gastaut, H., and Meyer, J.S. (eds.) 1961. Cerebral Anoxia and the Electroencephalogram. Springfield, Ill.: Charles C Thomas.Google Scholar
  27. Geraud, J.; Bes, A.; Delpla, ML; and Marc-Vergnes, J.P. 1969. Cerebral arteriovenous oxygen differences. Reappraisal of their significance for evaluation of brain function. In Research on the Cerebral Circulation. J.S. Meyer, H. Lechner, and O. Eichhorn (eds.). Springfield, Ill.: Charles C Thomas, p. 209.Google Scholar
  28. Harper, A.M. 1966. Autoregulation of cerebral blood flow: Influence of the arterial blood pressure on the blood flow through the cerebral cortex. J. Neurol. Neurosurg. Psychiat. 29: 398.PubMedCrossRefGoogle Scholar
  29. Harvald, B. 1958. EEG in old age. Acta Psychiat. Scand. 33: 193.CrossRefGoogle Scholar
  30. Hedlund, S.; Köhler, V.; Nylin, G.; Olsson, R.; Regnström, O.; Rothström, E.; and Aström, K.E. 1964. Cerebral blood circulation in dementia. Acta Psychiat. Scand. 40: 77.PubMedCrossRefGoogle Scholar
  31. Heyman, A.; Patterson, J.L., Jr.; Duke, T.W.; and Battey, L.L. 1953. The cerebral circulation and metabolism in arteriosclerotic and hypertensive cerebrovascular disease. New Eng. J. Med. 249: 223.PubMedCrossRefGoogle Scholar
  32. Høedt-Rasmussen, K., and Skinhøj, E. 1966. In vivo measurements of the relative weights of gray and white matter in the human brain. Neurology 16: 515.PubMedGoogle Scholar
  33. Ingvar, D.H., and Gustafson, L. 1970. Regional cerebral blood flow in organic dementia with early onset. Acta Neurol. Scand. 46 (suppl. 43): 42.PubMedCrossRefGoogle Scholar
  34. Jalavisto, E. 1964/65.. On the interdependence of circulatory-respiratory and neural-mental variables. Gerontologia 10: 31.PubMedCrossRefGoogle Scholar
  35. Kannel, W.B. 1971. Current status of the epidemiology of brain infarction associated with occlusive arterial disease. Stroke 2: 295.PubMedCrossRefGoogle Scholar
  36. Kapp, J.; Cook, W.; and Paulson, G. 1966. Chronic brain syndrome: Arteriographic study in elderly patients. Geriatrics 21: 174.PubMedGoogle Scholar
  37. Kendell, R.E., and Marshall, J. 1963. Role of hypotension in the genesis of transient focal cerebral ischaemic attacks. Brit. Med. J. 2: 344.PubMedCrossRefGoogle Scholar
  38. Kety, S.S. 1956. Human cerebral blood flow and oxygen consumption as related to aging. Res. Publ. Ass. Nerv. Ment. Dis. 35: 31.Google Scholar
  39. Kety, S.S.; King, B.D.; Horvath, S.M.; Jeffers, W.A.; and Hafkenschiel, J.H. 1950. The effects of an acute reduction in blood pressure by means of differential spinal sympathetic block on the cerebral circulation of hypertensive patients. J. Clin. Invest. 29: 402.PubMedCrossRefGoogle Scholar
  40. Kezdi, P.; Zaks, M.S.; Costello, H.J.; and Boshes, B. 1965. The impact of chronic circulatory impairment on functioning of central nervous system. Ann. Intern. Med. 62:67.PubMedGoogle Scholar
  41. Lassen, N.A.; Munck, O.; and Tottey, E.R. 1957. Mental function and cerebral oxygen consumption in organic dementia. Arch. Neurol. Psychiat. 77: 126.Google Scholar
  42. Malamud, N. 1965. A comparative study of the neuropathologic findings in senile psychoses and in “normal” senility. J. Amer. Geriat. Soc. 13: 113.PubMedGoogle Scholar
  43. May, A.G.; De Weese, J.A.; and Rob, C.G. 1963. Hemodynamic effects of arterial stenosis. Surgery 53: 513.PubMedGoogle Scholar
  44. May, A.G.; Van de Berg, L.; De Weese, J.A.; and Rob, C.G. 1963. Critical arterial stenosis. Surgery 54: 250.PubMedGoogle Scholar
  45. Meier, M.J. 1970. Objective behavioral assessment in diagnosis and prediction: Presentation 14. In Behavioral Change in Cerebrovascular Disease. A.L. Benton (ed.). New York: Harper & Row, p. 119.Google Scholar
  46. Meyer, J.S.; Leiderman, H.; and Denny-Brown, D. 1956. Eiectroencephalographic study of insufficiency of the basilar and carotid arteries in man. Neurology 6: 455.PubMedGoogle Scholar
  47. Meyer, J.S.; Ryu, T.; Toyoda, M.; Shinohara, Y.; Wiederhold, I.; and Guiraud, B. 1969. Evidence for a Pasteur effect regulating cerebral oxygen and carbohydrate metabolism in man. Neurology 19: 954.PubMedGoogle Scholar
  48. Millikan, C.H. 1965. The pathogenesis of transient focal cerebral ischemia. Circulation 32: 438.PubMedGoogle Scholar
  49. Novack, P.; Shenkin, H.A.; Bortin, L.; Goluboff, B.; and Soffe, A.M. 1953. The effects of carbon dioxide inhalation upon the cerebral blood flow and cerebral oxygen consumption in vascular disease. J. Clin. Invest. 32: 696.PubMedCrossRefGoogle Scholar
  50. O’Brien, M.D., and Mallett, B.L. 1970. Cerebral cortex perfusion rates in dementia. J. Neurol. Neurosurg. Psychiat. 33: 497.PubMedCrossRefGoogle Scholar
  51. Obrist, W.D. 1972. Problems of aging. In Handbook of Electroencephalography and Clinical Neurophysiology, vol. 6. A. Remond (ed.). Amsterdam: Elsevier Publ. Co. (in press).Google Scholar
  52. Obrist, W.D., and Bisseil, L.F. 1955. The electroencephalogram of aged patients with cardiac and cerebral vascular disease. J. Geront. 10: 315.PubMedGoogle Scholar
  53. Obrist, W.D.; Busse, E.W.; Eisdorfer, C; and Kleemeier, R.W. 1962. Relation of the electroencephalogram to intellectual function in senescence. J. Geront. 17: 197.PubMedGoogle Scholar
  54. Obrist, W.D.; Busse, E.W.; and Henry, C.E. 1961. Relation of electroencephalogram to blood pressure in elderly persons. Neurology 11: 151.PubMedGoogle Scholar
  55. Obrist, W.D.; Chivian, E.; Cronqvist, S.; and Ingvar, D.H. 1970. Regional cerebral blood flow in senile and presenile dementia. Neurology 20: 315.PubMedGoogle Scholar
  56. Obrist, W.D.; Sokoloff, L.; Lassen, N.A.; Lane, M.H., Butler, R.N.; and Feinberg, I. 1963. Relation of EEG to cerebral blood flow and metabolism in old age. Electroenceph. Clin. Neurophysiol. 15: 610.PubMedCrossRefGoogle Scholar
  57. Obrist, W.D.; Thompson, H.K.; King, C.H.; and Wang, H.S. 1967. Determination of regional cerebral blood flow by inhalation of 133-xenon. Circ. Res. 20: 124.PubMedGoogle Scholar
  58. Obrist, W.D.; Thompson, H.K.; Wang, H.S.; and Cronqvist, S.A. 1971. A simplified procedure for determining fast compartment rCBFs by 133xenon inhalation. In Brain and Blood Flow. R.W.R. Russell (ed.). London: Pitman Publ. Co., p. 11.Google Scholar
  59. Paulson, O.B. 1971. Cerebral apoplexy (stroke): Pathogenesis, pathophysiology and therapy as illustrated by regional blood flow measurements in the brain. Stroke 2: 327.PubMedCrossRefGoogle Scholar
  60. Paulson, O.B.; Lassen, N.A.; and Skinhøj, E. 1970. Regional cerebral blood flow in apoplexy without arterial occlusion. Neurology 20: 125.PubMedGoogle Scholar
  61. Reitan, R.M. 1970. Objective behavioral assessment in diagnosis and prediction: Presentation 15. In Behavioral Change in Cerebrovascular Disease. A.L. Benton (ed.). New York: Harper & Row, p. 155.Google Scholar
  62. Riggs, H.E., and Wahal, K.M. 1962. Role of cardiovascular insufficiency in intellectual deterioration in senium. Geriatrics 17: 26.PubMedGoogle Scholar
  63. Roth, M. 1971. Classification and aetiology in mental disorders of old age: Some recent developments. In Recent Developments in Psychogeriatrics. D.W.K. Kay and A. Walk (eds.). Ashford, U.K.: Headley Bros., p. 1.Google Scholar
  64. Rothschild, D. 1942. Neuropathology changes in arteriosclerotic psychoses and their psychiatric significance. Arch. Neurol. Psychiat. 48: 417.Google Scholar
  65. Schade’, J.P., and McMenemey, W.H. (eds.) 1963. Selective Vulnerability of the Brain in Hypoxaemia. Philadelphia: F.A. Davis.Google Scholar
  66. Scheinberg, P. 1950a. Cerebral blood flow in vascular disease of the brain. Amer. J. Med. 8: 139.PubMedCrossRefGoogle Scholar
  67. Scheinberg, P. 1950b. Cerebral circulation in heart failure. Amer. J. Med. 8: 148.PubMedCrossRefGoogle Scholar
  68. Schieve, J.F., and Wilson, W.P. 1953. The influence of age, anesthesia and cerebral arteriosclerosis on cerebral vascular activity to CO2. Amer. J. Med. 15: 171.PubMedCrossRefGoogle Scholar
  69. Shanbrom, E., and Levy, L. 1957. The role of systemic blood pressure in cerebral circulation in carotid and basilar artery thromboses. Amer. J. Med. 23: 197.PubMedCrossRefGoogle Scholar
  70. Shapiro, W., and Chawla, N.P.S. 1969. Observations on the regulation of cerebral blood flow in complete heart block. Circulation 40: 863.Google Scholar
  71. Shimojyo, S.; Scheinberg, P.; and Reinmuth, O. 1967. Cerebral blood flow and metabolism in the Wernicke-Korsakoff syndrome. J. Clin. Invest. 46: 849.PubMedCrossRefGoogle Scholar
  72. Simard, D.; Olesen, J.; Paulson, O.B.; Lassen, N.A.; and Skinhøj, E. 1971. Regional cerebral blood flow and its regulation in dementia. Brain 94: 273.PubMedCrossRefGoogle Scholar
  73. Simon, A., and Malamud, N. 1965. Comparison of clinical and neuropathological findings in geriatric mental illness. In Psychiatric Disorders in the Aged. Manchester, U.K.: Geigy Ltd., p. 322.Google Scholar
  74. Sokoloff, L. 1961. Aspects of cerebral circulatory physiology of relevance to cerebrovascular disease. Neurology 11: 34.Google Scholar
  75. Sokoloff, L. 1966. Cerebral circulatory and metabolic changes associated with aging. Res. Publ. Ass. Nerv. Ment. Dis. 41: 237.Google Scholar
  76. Spieth, W. 1964. Cardiovascular health status, age, and psychological performance. J. Geront. 19: 277.PubMedGoogle Scholar
  77. Sulg, I.A.; Cronqvist, S.; Schüller, H.; and Ingvar, D.H. 1969. The effect of intracardial pacemaker therapy on cerebral blood flow and electroencephalogram in patients with complete atrioventricular block. Circulation 39: 487.Google Scholar
  78. Szafran, J. 1963. Age differences in choice reaction time and cardio-vascular status among pilots. Nature 200: 904.PubMedCrossRefGoogle Scholar
  79. Tomlinson, B.E.; Blessed, G.; and Roth, M. 1970. Observations on the brains of demented old people. J. Neurol. Sci. 11: 205.PubMedCrossRefGoogle Scholar
  80. Turton, E.C. 1958. The EEG as a diagnostic and prognostic aid in the differentiation of organic disorders in patients over 60. J. Ment. Sci. 104: 461.PubMedGoogle Scholar
  81. Wilkie, F., and Eisdorfer, C. 1971. Intelligence and blood pressure in the aged. Science 172: 959.PubMedCrossRefGoogle Scholar
  82. Young, W.; Gofman, J.W.; Malamud, N.; Simon, A.; and Waters, E.S.G. 1956. The interrelationship between cerebral and coronary atherosclerosis. Geriatrics 11: 413.PubMedGoogle Scholar
  83. Zülch, K.J. 1969. Reconsiderations of the clinical problem of cerebrovascular insufficiency. In Research on the Cerebral Circulation. J.S. Meyer, H. Lechner, and O. Eichhorn (eds.). Springfield, Ill.: Charles C Thomas, p. 1.Google Scholar

Copyright information

© Plenum Press, New York 1972

Authors and Affiliations

  • Walter D. Obrist
    • 1
  1. 1.Duke University Medical CenterDurhamUSA

Personalised recommendations