While aging is seen as progressive deteriorative changes, during the adult period of life, which underlie an increasing vulnerability to challenges and thereby decrease the ability of the organism to survive, successful aging refers to physical, mental, and social well-being in older age.
Normal aging is associated with a reduction in brain weight, signs of minimal to moderate atrophy of the cerebral cortex, reduction in the volume of telencephalic lobes and white matter, and a minimal to moderate enlargement of the ventricular system.
Incidental white matter changes are a common finding on magnetic resonance imaging (MRI) of the brain in elderly persons. They are described as periventricular, deep, and subcortical signal abnormalities. Caps/lining and punctate deep subcortical white matter lesions are by far the most common signal changes in elderly subjects and occur in more than half of asymptomatic persons even in age groups below 55 years. White matter lesions affect executive functions, abstract reasoning, and motor function.
Pathways active in normal brain aging include genes for successful aging, sirtuins, telomeres, oxidative stress, inadequate repair of damage, dysregulation of cell number, stress response, inflammation, signaling cascades, synaptic transmission, axon guidance, calcium signaling, protein synthesis, translocator protein (TSPO), cathepsins, ghrelin, klotho, iron, and insulin. Genes involved in aging processes are concerned with maintenance of cholesterol, lipid or lipoprotein levels, cytokines, drug metabolism, and insulin signaling.
Treatment includes the maintenance of a healthy life style and stabilization of atherosclerosis, diabetes mellitus, hypertonus, and hyperlipidemia. Successful aging tends to be more dependent on behavior, attitude, and environment.
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