By A. N. Exton-Smith MD, FRCP, P. W. Overstall MB, MRCP (auth.)

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Glucose tolerance, plasma insulin levels and insulin sensitivity in elderly patients. Age and Ageing, 8, 65 Strehler, B. L. and Mildvan, A. S. (1960). General theory of mortality and ageing. , Stokoe, I. , Mcghee, A. and Stephenson, E. (1964). Old people at home - their unreported needs. Lancet, i, 1117 34 3 Mental disorders THE AGEING BRAIN There is usually some atrophy of the brain, particularly the frontal lobes, with shrinkage of the gyri and widening of sulci. Microscopically there is an accumulation in neurones of lipofuscin, a yellowbrown pigment that although probably not harmful in itself, indicates a reduction in efficiency of the nerve cell's metabolism.

Granulovacuolar degeneration This is, as its name indicates, a small intracytoplasmic vacuole with a central dense granule. It is found only in neurones and most commonly affects pyramidal cells in the hippocampus. Senile plaques, neurofibrillary tangles and granulovacuolar degeneration are commonly found, in descending order of frequency, in the brains of normal people over the age of 65 years. They represent different degenerative changes and are not related to each other either in their frequency or in their distribution.

Hypochondriasis This is often a symptom of depression or anxiety, but sometimes represents a separate neurotic condition. Particularly in the elderly it may be an escape from personal failure. Obsessional and compulsive behaviour This rarely begins in old age but may persist from earlier life and worsen as the person becomes more inward-looking. Obsessional behaviour may be a feature of depression or dementia. Management of the neuroses The neurotic disorders do not respond readily 57 lO treatment.

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