Zusammenfassung
Altern geht mit metabolischen, strukturellen und anatomischen Veränderungen auf Hirnebene einher. Sehr viele Hirnregionen sind in unterschiedlichem Ausmaß davon betroffen, insbesondere präfrontale und medio-temporale Regionen. Es besteht kein sicherer Nachweis für asymmetrische Neurodegeneration, aber für asymmetrische Netzwerktopologien. Systematische Studien zu Veränderungen der Netzwerkprozesse im Alter stehen noch aus. Änderungen des Hirnmetabolismus spezifisch für unterschiedliche Altersphasen sind evident. Der Bedeutung von Neuroinflammation bei Älteren wird ein großes Potenzial für die Beschreibung alterskorrelierter Veränderungen zugeschrieben. Die Bedeutung von Sexualhormonen für neuronale und kognitive Funktion im Alter ist für den Menschen noch nicht ausreichend aufgeklärt. Veränderungen von Neurotransmitterbalancen bei Älteren sind gezeigt worden. Es besteht konvergente Evidenz, dass die anatomischen und physiologischen Veränderungen im Alter mit Änderungen der kognitiven und emotionalen Verarbeitung einhergehen. Auf kognitiver Ebene ist eine deutliche Leistungsheterogenität sichtbar. Relative Leistungsstabilität ist insbesondere für Wortschatz, semantische und implizite Gedächtnisleistungen zu erwarten, relativer Leistungsabfall für episodische und Arbeitsgedächtnisleistung, selektive und geteilte Aufmerksamkeitsleistung sowie für Exekutivfunktionen. Ältere Personen haben ein erhöhtes Risiko postoperativ ein Delir und/oder eine kognitive Beeinträchtigung zu erleiden, was neben der Leistungsheterogenität bei der Organisation und Durchführung von neuropsychologischer Diagnostik spezifisch zu berücksichtigen ist. Trotz vieler Einzelbefunde bleibt das Gesamtbild noch lückenhaft. Kausale Erklärungen sind schwierig, da Ursachen für Veränderungen im Alter vielfältig sind und mit vielen biologischen und psychologischen Faktoren interagieren.
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Sammer, G., Bauer, E. (2021). Neuropsychologie altersassoziierter Veränderungen. In: Uhl, E., Schöller, K. (eds) Neurochirurgie bei älteren Patienten. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-60354-3_2
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