Neuroanatomy: Age-related changes

The advancement of medical technology, combined with better access to treatment and focus on preventive strategies, has led to an extension of the human lifespan. An in-depth knowledge of the age-related changes in the brain and its function helps the neuroanesthesiologist to better comprehend the implications of anesthesia in elderly neurosurgical patients. Aging affects the brain at all levels, from molecules, vasculature, and morphology to cognition. Most brain structures decline in volume with age, but at highly different rates. The regional cortical volume decreases with age, with the greatest effects seen in the frontal cortex, followed by the temporal areas, posterior association areas, and occipital areas. The cerebrospinal fluid compartments, including the ventricular systems, increase in volume with age, partly due to atrophy in other brain areas like the deep white matter. The basal forebrain cholinergic complex, providing major cholinergic projections to the cerebral cortex and hippocampus, undergoes moderate degenerative changes during aging, leading to cholinergic hypofunction.