The deep tendon reflexes are checked Deep tendon reflexes (See also Introduction to the Neurologic Examination) Deep tendon (muscle stretch) reflex testing evaluates afferent nerves, synaptic connections within the spinal cord, motor nerves, and descending. Increased muscle tone, measured by flexing and extending the elbow or knee, is a normal finding in older people however, jerky movements during examination and cogwheel rigidity are abnormal. Strengthening the upper extremities is also beneficial for overall function. Such weakness is treatable with resistance training for the legs especially, it can improve mobility and reduce fall risk. If weakness is symmetric, does not bother the patient, and has not changed the patient’s function or activity level, it is likely to be due to disuse rather than neurologic disease. For example, during the physical examination, the clinician may easily straighten a patient’s elbow despite the patient’s effort to sustain a contraction. ![]() Thus, the examiner must define the precise character of symptoms, including exact location, time of occurrence. Older people, particularly those who do not do resistance training regularly, may appear weak during routine muscle strength testing How to Assess Muscle Strength Patients who report weakness may mean fatigue, clumsiness, or true muscle weakness. Deficiency causes megaloblastic anemia, damage. A smooth, painful tongue may indicate vitamin B12 deficiency Vitamin B12 Deficiency Dietary vitamin B12 deficiency usually results from inadequate absorption, but deficiency can develop in vegans who do not take vitamin supplements. Signs may include a typical facial appearance, hoarse slow speech, and dry skin. Symptoms include cold intolerance, fatigue, and weight gain. read more or hypothyroidism Hypothyroidism Hypothyroidism is thyroid hormone deficiency. In edentulous patients, the tongue may enlarge to facilitate chewing however, enlargement may also indicate amyloidosis Amyloidosis Amyloidosis is any of a group of disparate conditions characterized by extracellular deposition of insoluble fibrils composed of misaggregated proteins. Common age-related changes include varicose veins on the ventral surface, benign migratory glossitis ( ), and atrophied papillae on the sides of the tongue. The dorsal and ventral surfaces of the tongue are examined. Areas of black pigment or hemorrhages in and around the macula indicate macular degeneration. In older patients, mild to moderate elevated intracranial pressure may not result in papilledema because cortical atrophy occurs with aging papilledema is more likely when pressure is markedly increased. Findings may be unremarkable unless a disorder is present because the retina’s appearance usually does not change much with aging. Early symptoms are related to hyperglycemia and include polydipsia. read more, or diabetes Diabetes Mellitus (DM) Diabetes mellitus is impaired insulin secretion and variable degrees of peripheral insulin resistance leading to hyperglycemia. ![]() Hypertension with no known cause (primary formerly, essential. read more, hypertension Hypertension Hypertension is sustained elevation of resting systolic blood pressure (≥ 130 mm Hg), diastolic blood pressure (≥ 80 mm Hg), or both. read more, and evidence of glaucoma Overview of Glaucoma Glaucomas are a group of eye disorders characterized by progressive optic nerve damage in which an important part is a relative increase in intraocular pressure (IOP) that can lead to irreversible. Dilated funduscopic findings are diagnostic color photographs, fluorescein. read more, optic nerve or macular degeneration Age-Related Macular Degeneration (AMD or ARMD) Age-related macular degeneration (AMD) is the most common cause of irreversible central vision loss in older patients. ![]() Diagnosis is by ophthalmoscopy and slit-lamp examination. The main symptom is gradual, painless vision blurring. Ophthalmoscopy is done to check for cataracts Cataract A cataract is a congenital or degenerative opacity of the lens.
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