The numbers of limb motor neurons in the human lumbosacral cord throughout life

Motor unit firing rates and contractile properties in tibialis anterior of young and old men

The effects of aging on motoneuron firing rates and muscle contractile properties were studied in tibialis anterior muscle by comparing results from six young (20.8 +/- 0.8 yr) and six old men (82.0 +/- 1.7 yr). For each subject, data were collected from repeated tests over a 2-wk period. Contractile tests included maximal voluntary contraction (MVC) with twitch interpolation and stimulated twitch contractions. The old men had 26% lower MVC torque (P < 0.01) than did the young men, but percent activation was not different (99.1 and 99.3%, respectively). Twitch contraction durations were 23% longer (P < 0.01) in the old compared with the young men. During a series of repeated brief steady-state contractions at 10, 25, 50, 75, and 100% MVC, motor unit firing rates were recorded. Results from approximately 950 motor unit trains in each subject group indicated that at all relative torque levels mean firing rates were 30-35% lower (P < 0.01) in the old subjects. Comparisons between young and old subjects' mean firing rates at each of 10%, 50%, and MVC torques and their corresponding mean twitch contraction duration yielded a range of moderate-to-high correlations (r = -0.67 to -0.84). That lower firing rates were matched to longer twitch contraction durations in the muscle of old men, and relatively higher firing rates were matched with shorter contraction times from the young men, indirectly supports the neuromuscular age-related remodeling principle.

Age-related changes in fastest and slowest conducting axons of thenar motor units

Single thenar motor unit F waves (FMUPs) were collected from 23 healthy volunteers (age range 21-91 years, mean 46 +/- 20 SD). In each subject, 10 distinct FMUPs were recorded, using surface stimulating and recording electrodes, and the conduction velocity (CV) of each motor unit was calculated. The distribution of CVs (overall range 42-66 m/s; individual FMUP CV dispersion range 6-27% of the maximal FMUP CV) was close to those previously reported whatever the technique used. With age, a progressive CV reduction was observed, and maximal FMUP CV was significantly correlated with age (r = -0.58, P < 0.01), whereas no statistically significant correlation was found between minimal FMUP CV and age (r = -0.27, ns). Individual FMUP CV dispersion presented a statistically significant decrease with age (r = -0.46, P < 0.05). Furthermore, thenar motor unit number (MUNE), estimated by the adapted multiple point stimulation method, decreased progressively with age and was statistically correlated with maximal FMUP CV (r = 0.59, P < 0.01), whereas there was no correlation with minimal FMUP CV (r = 0.34, ns). Thus, we propose that motor unit loss is progressive with age throughout life, affecting particularly the largest and fastest conducting motor units. Preferential involvement of these fibers could be responsible for the age-related changes in motor nerve CV.

Upregulation of GFRalpha-1 and c-ret in primary sensory neurons and spinal motoneurons of aged rats

Aging is associated with a decline in neuromuscular and somatosensory functions. Senile muscle atrophy, considered to be of neurogenic origin, is prevalent, and sensory thresholds increase with age. However, the loss of motoneurons and primary sensory neurons is small, while sensory and motor innervation appears disturbed due to aging-related axon lesions. One mechanism which may play a role in this process is altered trophin signaling. We here report that the glial cell line-derived neurotrophic factor (GDNF) receptor GFRalpha-1 mRNA and GFRalpha-1 protein-like immunoreactivity are upregulated in spinal motoneurons, and in dorsal root ganglion neurons of 30-month-old rats. The established signaling mechanism for the GDNF/GFRalpha-1 complex is through binding to the tyrosine kinase receptor encoded by the c-ret proto-oncogene, and we also show here that c-ret mRNA is upregulated in both motoneurons and primary sensory neurons of aged rats. The findings reported here, combined with evidence presented in other studies of changes in p75(NTR) and trk receptor expressions in aging primary sensory neurons and motoneurons, point at marked alterations in trophin signaling in senescence.

Expression of p75(NTR), trkB and trkC in nonmanipulated and axotomized motoneurons of aged rats

Several lines of evidence indicate that adult neurons remain dependent on neurotrophins and that changes in tissue expression of neurotrophins and/or their receptors may play a role in senile neurodegeneration. We have studied the expression of p75NTR, trkB and trkC, respectively, in lumbar motoneurons of young adult (2-3 months) and aged (30 months) rats subjected to sciatic transection using in situ hybridization and immunohistochemistry. Nonmanipulated age-matched animals were processed in parallel. In nonmanipulated aged rats, high levels of p75NTR could be seen in a number of motoneurons (10-15%), while in young adult animals no p75NTR could be detected. Seven days following sciatic axotomy, a conspicuous ipsilateral upregulation p75NTR was observed in young adult rats. Also in aged rats there was a marked ipsilateral increase in number of p75NTR expressing neurons ( approximately 100%). In comparison to young adult rats, aged rats showed a decreased expression of both trkB (5/6 animals) and trkC (6/6 animals). Furthermore, in response to sciatic transection, 3 out of 5 aged rats did not show an increased expression of trkB. In aged rats, axotomy did not induce any significant change in trkC expression. In the young adult rats, we recorded a side-to-side effect with lower values ipsilaterally, however, it cannot be excluded that this difference was caused by an upregulation in the contralateral motoneurons. Oligonucleotide probes against BDNF and NT3 mRNA showed only very few faintly positive neurons in both age groups. Our results indicate that the pattern of regulatory changes of NT receptors in response to axotomy is different in aged and young adult rats. The lack of covariation between p75NTR and trkB and trkC regulation in aged rats indicates a changed role for p75NTR in senescent motoneurons.

The relationship of peripheral motor nerve conduction velocity to age-associated loss of grip strength

Age-associated loss of muscle strength is attributed to decreasing muscle mass. Both strength and mass are dependent on peripheral innervation. However, the association between nerve function and age-associated strength loss has not been studied directly. The median nerve contribution to grip strength was estimated using nerve conduction velocity (NCV). Grip strength and NCV were measured in 197 male participants of the Baltimore Longitudinal Study of Aging (age 59.0 +/- 13.9 years). Multiple regression and path analyses were used separately to examine the association between median NCV and grip strength. Grip strength showed a negative quadratic relationship with increasing age (r2 = 0.32, p < 0.001) with a major change in slope occurring after 64.7 years of age. Median NCV (r2 = 0.14, p < 0.001) declined linearly with age. Median NCV significantly contributed to grip strength (p < 0.001) while controlling for forearm muscle mass (forearm circumference), self-reported 24-hour caloric expenditures, and age. The median nerve has an independent contribution to age-associated levels of muscle strength. The level of the effect was smaller than what could be attributed to forearm muscle mass or age.

1998 ISEK Congress Keynote Lecture: Motor units: how many, how large, what kind? International Society of Electrophysiology and Kinesiology

There are now at least nine methods for motor unit number estimation (MUNE) in living human muscles. All methods are based on the comparison of an average single motor unit potential (or twitch) with the response of the whole muscle. Such estimations have been performed for proximal and distal muscles of the arm and leg in healthy subjects and in patients with various neuromuscular disorders. In healthy subjects there is a loss of motor units which is most evident in distal muscles and after the age of 60 years. Substantial losses of motor units have been measured in patients with ALS, post-polio symptoms, and diabetic peripheral neuropathies. In contrast, normal MUNEs have been found in approximately half of patients with persisting obstetric brachial palsies. The sizes of motor units show considerable variations within the same muscle and also between muscles; very large units are usually present in severe partial denervation. Although many motor unit properties are largely governed by motoneurons, some exhibit less plasticity in humans than in other mammals.

Age-associated changes in the innervation of muscle fibers and changes in the mechanical properties of motor units

In both humans and animals there is a progressive loss of muscle strength with age. Tests of handgrip and knee extension in men show that some decline in strength is evident by the age of 55 years and is pronounced by the age of 65, compared with the 25- to 35-year period when strength is at a maximum. A comparable age-related decline in peak force development has also been shown in hind-limb muscles of aged rats. Motoneurons and consequently motor units are lost with age, and this is apparent in man after the age of 60. Again, a comparable decline has been demonstrated in the motoneuron population of hindlimb muscles of rats aged 20-24 months. Loss of motoneurons in young adults (through either injury or disease) results in the remaining intact motoneurons sprouting to innervate the denervated fibers. This capacity for sprouting has been shown to be seriously impaired in the hindlimb muscles of aged rats. Furthermore, the well-established relationship between motor unit size and fatigability (smaller units tend to be more fatigue resistant) also tends to break down, with large units just as likely to be fatigable as fatigue resistant. The normally large, fatigable motor units also appear to be reduced in size in the aged muscles. The age-related loss of motoneurons and associated loss of muscle fibers accounts in part for the reduced functional capacity of muscle with age. The reason for the impairment of the aged motoneuron remains to be investigated, but it may relate to the integrity of the oxidative metabolic pathways within the cell, given that mitochondrial respiratory chain function is known to be reduced with age.

Expression of acetylcholine receptor mRNAs in atrophying and nonatrophying skeletal muscles of old rats

We examined the age-related association in skeletal muscle between atrophy and expression of mRNAs encoding both the gamma-subunit of the nicotinic acetylcholine receptor (AChR), and myogenin, a transcription factor that upregulates expression of the gamma-subunit promoter. Gastrocnemius and biceps brachii muscles were collected from young (2-mo-old), adult (18-mo-old), and old (31-mo-old) Fischer 344/Brown Norway F1 generation cross male rats. In the gastrocnemius muscles of old vs. young and adult rats, lower muscle mass was accompanied by significantly elevated AChR gamma-subunit and myogenin mRNA levels. In contrast, the biceps brachii muscle exhibited neither atrophy nor as drastic a change in AChR gamma-subunit and myogenin mRNA levels with age. Expression of the AChR epsilon-subunit mRNA did not change with age in either gastrocnemius or biceps brachii muscles. Thus changes in skeletal muscle AChR gamma-subunit and myogenin mRNA levels may be more related to atrophy than to chronological age in old rats.

Effects of creatine monohydrate ingestion in sedentary and weight-trained older adults

To investigate the effects of an oral creatine supplementation in older adults, 32 elderly subjects (67-80 years; 16 females, 16 males) were randomly assigned to four equivalent subgroups (control-creatine; control-placebo; trained-creatine; trained-placebo) based on whether or not they took part in an 8-week strength training programme and an 8-week oral creatine monohydrate creatine supplementation programme. The strength training programme consisted of three sets of eight repetitions at 80% of one-repetition maximum, for leg press, leg extension and chest press, 3 days a week. The 52-day supplementation programme consisted of 20 g of creatine monohydrate (or glucose) and 8 g of glucose per day for the initial 5 days followed by 3 g of creatine monohydrate (or glucose), and 2 g of glucose per day. Prior to and after the training and supplementation periods, body mass, body fat, lower limb muscular volume, 1-, 12-repetitions maxima and isometric intermittent endurance tests for leg press, leg extension and chest press were determined. In all groups, no significant changes in anthropometric parameters were observed. For all movements, the increases in 1- and 12-repetitions maxima were greater (P < 0.02) in trained than control subjects. No significant interactions (supplementation/training/time) were observed for the 1-, 12-repetitions maxima, and the isometric intermittent endurance, whatever the movement considered. We conclude that oral creatine supplementation does not provide additional benefits for body composition, maximal dynamical strength, and dynamical and isometric endurances of healthy elderly subjects, whether or not it is associated with an effective strength training.

Age-related biology and diseases of muscle and nerve

Age-related biological changes in neurons and skeletal muscle commonly affect neuromuscular function and strongly influence the expression of neuromuscular disease. Of primary importance is the attrition of entire motor units, with resultant neurogenic atrophy of skeletal muscle. Other age-related processes are sensory neuron loss, distal axonal degeneration, axonal atrophy, accumulation of multiple mitochondrial DNA mutations in muscle, and physical inactivity and deconditioning. The decline for most of these begins in early life and proceeds steadily; the curious lack of an abrupt falloff with age is not yet accounted for by any theory of pathogenesis.

Longitudinal study of the contractile and electrical properties of single human thenar motor units

Serial motor unit number estimates have shed important light on the extent and rates of motoneuron losses in aging and amyotrophic lateral sclerosis. However, the estimates alone provide few clues to the health and functional status of surviving motor units. A reliable means for assessing the functional status of the surviving motor units would therefore by a welcome addition to our present tools for studying motor units. Examining the physiological properties of samples of motor units drawn at intervals during the course of a motoneuronal disease suffers from the important limitation that the samples may not be representative of one another. The latter problem could be circumvented by serially studying the same motor units. This study describes a noninvasive technique capable of longitudinally tracking the contractile and electrical properties of specific single thenar motor units in healthy subjects, in some instances over several years. The technique proved to be reasonably reliable and provided information on a wide range of contractile and electrical properties of motor units. Such an approach could serve as a potentially powerful and sensitive means of studying the life histories of single motor units in aging, diseases of the motoneuron, and in the latter instances, the responses of the motoneurons to treatment.

Aging and the nigro-striatal pathway

Aging is associated with a progressive impairment in motor function. This feature, together with the decline in mental function, could be considered as an aging syndrome which may finally compromise the ability of the elderly to maintain an active, independent life-style. In the present paper a wide variety of morphological aspects, which have been classically related to brain aging and others such as cytoskeletal changes, the role of growth factors and molecular changes, will be reviewed focusing on aging of the nigrostriatal pathway. In addition to sharing features of aging common to other structures, it is likely that the nigrostriatal pathway has specific characteristics derived from its particular molecular characteristics and/or from a selective vulnerability to aging. To gain further insight into the aging syndrome, the acquisition of rigorous criteria for selecting control cases is paramount. The improvement of methods for the preservation of human tissue is also crucial.

Differences in the synaptic complement of thoracic motoneurons of adult and ageing cats after permanent or reversible axotomy

We have compared the effects of intercostal nerve crush (reversible axotomy) or nerve transection with proximal ligation (permanent axotomy) on the somatic synaptic terminals of thoracic motoneurons of adult (1-2 years) and ageing (10-15 years) cats. Retrograde axonal transport of horseradish peroxidase (HRP) was used to identify axotomised motoneurons; control motoneurons were labelled by the intramuscular injection of HRP. Synaptic frequency and cover of control motoneurons in adult and ageing cats was similar. In adults, 8-16 days following both types of axotomy, synaptic cover was halved without any significant change in synaptic frequency. By 32-64 days following reversible axotomy, synaptic frequency and cover were not significantly different from controls. By contrast, 32-64 days following permanent axotomy synaptic frequency and cover were reduced to 30-50% of adult control values. In ageing cats 2 months following reversible axotomy, synaptic frequency and cover were reduced to 40% and 33% of ageing control values, respectively, while no significant change from controls was found 2 months following permanent axotomy. The long-term synaptic response of axotomised motoneurons in ageing cats is therefore opposite to that of adults.

Ageing and physiological functions

In youth, most physiological functions have generous spare capacity. Even in health, however, increasing age is characterized by progressive erosion of these 'safety margins'. Examples include the decline of bone mass (towards a threshold for likelihood of fracture), of glomerular filtration rate (towards a threshold for susceptibility to clinical renal failure), of renal tubular function (towards a threshold for clinically important susceptibility to dehydration), of hepatic function (towards a threshold for accumulation following conventional 'young adult' doses of common medications), or of lower limb explosive power (towards thresholds for impaired functional mobility). Increasing age is also characterized by a rising prevalence of chronic pathologies, complicating attempts to determine the rate or the mechanism of the age-related decline in a physiological function. Nevertheless, it is clear that in many organs the loss of function is largely attributable to the loss of functioning cells, even in the absence of overt disease. This apparently fundamental aspect of ageing remains poorly understood.

The effect of age on retrieval of local anesthetic solution from the epidural space

We conducted this prospective study to determine whether advancing age is correlated with retrieval of local anesthetic solution from the epidural space. Three hundred forty-six patients (ASA physical status I or II, 20-93 yrs of age, 177 female and 169 male patients) undergoing epidural anesthesia were enrolled. The epidural space was identified by a loss of resistance technique using air, and a catheter was introduced 3 cm. Three milliliters of 2% lidocaine with epinephrine was injected as a study dose by hand at a rate of 1 mL/s with the patient in the supine position. The syringe was immediately aspirated to retrieve the local anesthetic solution. A retrieved volume of 0.5 mL or more with a glucose concentration less than 6 mg/dL was defined as retrieval positive, and a volume of less than 0.5 mL was defined as retrieval negative. There was a significant correlation between age and retrieval volume among all the patients (Y = 0.008X-0.222, P < 0.0001) with a significant increase in the positive retrieval incidence and volume from the patients in their 50s (11%, 0.6 +/- 0.3 mL) to the patients in their 60s (26%, 1.0 +/- 0.6 mL) (P < 0.05 for both). The incidence of positive retrieval and the retrieval volume were greater in the patients in their 60s and older (30%, 1.1 +/- 0.63 mL) than in the younger than 60 (10%, 0.6 +/- 0.3 mL) (P < 0.0001 and P < 0.001). The glucose concentration was 2.3 +/- 1.2 mg/dL in the positive cases. We conclude that there is a weak positive correlation between age and the local anesthetic solution retrieved from the epidural space.

IMPLICATIONS

We conducted a study in 346 patients to determine whether advancing age could be correlated with retrieval of local anesthetic solution from the epidural space. We found a weak positive correlation between advanced age and the amount of solution retrievable from the epidural space. Further studies are required to determine whether this phenomenon may call for dose adjustments in patients aged more than 60 yrs.

Simulation of motor unit recruitment and microvascular unit perfusion: spatial considerations

Muscle fiber activity is the principal stimulus for increasing capillary perfusion during exercise. The control elements of perfusion, i.e., microvascular units (MVUs), supply clusters of muscle fibers, whereas the control elements of contraction, i.e., motor units, are composed of fibers widely scattered throughout muscle. The purpose of this study was to examine how the discordant spatial domains of MVUs and motor units could influence the proportion of open capillaries (designated as perfusion) throughout a muscle cross section. A computer model simulated the locations of perfused MVUs in response to the activation of up to 100 motor units in a muscle with 40,000 fibers and a cross-sectional area of 100 mm2. The simulation increased contraction intensity by progressive recruitment of motor units. For each step of motor unit recruitment, the percentage of active fibers and the number of perfused MVUs were determined for several conditions: 1) motor unit fibers widely dispersed and motor unit territories randomly located (which approximates healthy human muscle), 2) regionalized motor unit territories, 3) reversed recruitment order of motor units, 4) densely clustered motor unit fibers, and 5) increased size but decreased number of motor units. The simulations indicated that the widespread dispersion of motor unit fibers facilitates complete capillary (MVU) perfusion of muscle at low levels of activity. The efficacy by which muscle fiber activity induced perfusion was reduced 7- to 14-fold under conditions that decreased the dispersion of active fibers, increased the size of motor units, or reversed the sequence of motor unit recruitment. Such conditions are similar to those that arise in neuromuscular disorders, with aging, or during electrical stimulation of muscle, respectively.

Cholinergic deficits in aged rat spinal cord: restoration by GM1 ganglioside

Cholinergic neurons of spinal cord are central for the processing of motor, autonomic, and sensory modalities. Aging is associated with a variety of motor and autonomic symptoms that might be attributed, in part, to impaired spinal cord function. We found that cholinergic neurochemistry is diminished in the spinal cord of 22-24-month-old rats compared with 3-month-old rats. Choline acetyltransferase, high-affinity choline transport and hemicholinium-3 binding to the choline carrier were reduced in the aged spinal cord. The activity of the choline transporter and the hemicholinium-3 binding were decreased in all spinal segments, cervical, thoracic, lumbar and sacral. Hemicholinium-3 binding was reduced in ventral and dorsal horns along all spinal segments. The activity of choline acetyltransferase was decreased only in cervical and lumbar cord. Treatment of aged animals with GM1 induced the recovery of the presynaptic cholinergic markers in the aged spinal cord.

Age-related changes in motor unit function

This review focuses on the functional relationship between age-related morphological and physiological changes at the level of the motor unit (MU). It is well established that older humans are weaker than younger people, exhibit reduced force control, and have slower neuromuscular contractile properties. Older people may also exhibit a decrease in MU discharge rate, and an increase in variability of MU discharge at high force levels. The matching of MU discharge and contractile properties may be an age-related neurophysiological strategy adopted to optimize motor control, similar to that observed in acute conditions such as fatigue. Because muscle force output is modulated partially by MU discharge behavior, the study of these properties may offer insights into the physiology of muscular weakness and motor function in older people. In turn, this will allow the implementation of optimal exercise and rehabilitation programs to reduce the degree of dependence associated with aging.

Evidence for nervous system degeneration with advancing age

Human skeletal muscle undergoes major structural and functional changes with advancing age. A progressive degeneration of the nervous system is now considered a major factor underlying these alterations. This review will briefly describe the changes that occur in the human motor unit with increasing age and focus specifically on the changes that relate to a degeneration of the nervous system.

Age-related changes in the twitch contractile properties of human thenar motor units

The purpose of this study was to examine the effects of aging on the contractile and electrophysiological properties of human thenar motor units (MUs). Percutaneous electrical stimulation of single motor axons within the median nerve was used to isolate and examine the twitch tensions, contractile speeds, and surface-detected MU action potential (S-MUAP) sizes of 48 thenar MUs in 17 younger subjects (25-53 yr) and 44 thenar MUs in 9 older subjects (64-77 yr). A wide range of twitch tensions, contractile speeds, and S-MUAP sizes was observed in both age groups. However, older subjects had significantly larger MU twitch tensions and slower MU twitch contraction and half-relaxation times. These changes were accompanied by increased S-MUAP sizes. These findings suggest that the human thenar MU pool undergoes significant age-related increase in MU size and slowing of contractile speed. Such adaptation may help to overcome previously reported age-related losses of thenar MUs.

Expression of neuronal nitric oxide synthase in spinal motoneurons in aged rats

We investigated the expression of nitric oxide synthase (NOS) in motoneurons of aged rats by the nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase (NADPH-d) reaction. The number of NADPH-d positive neurons (i.e. presumed motoneurons) in the motor nucleus at L4-L6 level of the spinal cord was 0.0 +/- 0.0 for 13- to 15-month-old rats, 2.2 +/- 0.8 for 24-month-old rats, and 7.9 +/- 5.4 for 29- to 32-month-old rats. These NADPH-d positive neurons were multipolar in shape and the soma cross-sectional area was 820 +/- 245 mu2 (n = 56; range, 359-1460 mu2) which was similar to the value for alpha-motoneurons. The results indicate that nitric oxide (NO) may be produced by a few motoneurons in the aged rat spinal cord and may lead these neurons to eventual death.

Poliomyelitis

1996 is polio awareness year. This paper reviews the clinical syndrome of acute paralytic poliomyelitis and its sequelae. We discuss epidemiological studies of the syndrome of late functional deterioration many years after the acute infection and the current hypotheses of the pathophysiology of such disorders. Recent evidence has suggested that potentially treatable factors may be implicated in the majority of such patients and it is therefore important to exclude such disorders before attributing late functional deterioration to progressive post-polio muscular atrophy.

Changes in motor unit estimates with aging

Elderly persons usually exhibit some degree of muscle atrophy, together with a reduction in voluntary strength, but there is still argument concerning the nature of the cellular events involved. This issue was reexamined by estimating the numbers and relative sizes of motor units in three limb muscles, using a fully automated system (Galea et al., 1993). In 79 healthy volunteers aged 20-98 years, estimations of motor unit numbers were performed on the thenar, biceps brachii, and extensor digitorum brevis muscles. Motor unit populations were noted to decrease significantly with age in the distal muscles but appeared to remain constant in the biceps. The excitable muscle fiber mass, as reflected in the peak-to-peak amplitude and area of the maximum M-wave, was diminished in all three muscles. Although the area of the average motor unit action potential was not significantly different between groups, the ratio of this potential to the M-wave area increased with increasing age. The results suggest that muscle deterioration in the elderly is due to a combination of changes in the muscle fibers and in their nerve supply and that the extent may differ between proximal and distal muscles.

Synaptophysin in spinal anterior horn in aging and ALS: an immunohistological study

Aged-related spinal cord changes such as neuronal loss have been related to the degree of clinical severity of amyotrophic lateral sclerosis (ALS); morphological data on synapses are, however, wanting. Variations in synaptophysin (Sph) expression in aging and ALS were thus studied at the level of lower motor neurons in 40 controls with non-neurological diseases and 11 cases of ALS. Control sections of formalin fixed paraffin embedded cervical (C7/8), thoracic (T10) and lumbar spinal cord (L5) and C6, C7, C8 and L5 of ALS cases were stained with haematoxylin and eosin, luxol fast blue (LFB), and immunostained with a mouse monoclonal antibody against Sph. The neuropil of the anterior horn (AH) in all control cases demonstrated Sph positivity. A dot-like pattern of positivity of presynaptic terminals on soma of motor neurons and fine immunoreactivity along neuronal processes were observed. A significant reduction of Sph immunostaining was observed in the neuropil with increasing age and 3 different somatic patterns were seen: a- well preserved Sph reactivity around the soma and the proximal dendrites of histologically normal neurons; b- few chromatolytic neurons showing large numbers of dot-like presynaptic terminals around the cell body and in a "fused" pattern; c- intense, diffuse, and homogeneous reactivity of some neurons. Attenuation of Sph reactivity in the AH neuropil, to its complete loss, was observed in all ALS cases. In addition to patterns a-c, two additional microscopic findings were noted in ALS: d- chromatolytic neurons showing complete absence of Sph reactivity; e- absence of Sph reactivity around the soma and the proximal dendrites of histologically normal surviving neurons. Our findings demonstrate that there is a decrease in Sph immunostaining with aging, thus suggesting an alteration in dendritic networks of the AH with aging. Changes in the pattern of Sph immunoreactivity in cell bodies may represent synaptic plasticity and/or degeneration. Reinnervation may also be a possible mechanism as a response to neuronal loss in oldest control cases. Sph reactivity results may thus lend support to the presence of superimposed aging components in ALS cases which may give an insight into explaining the increasing severity of the disease which is encountered with advancing age.

Number and relative size of thenar motor units estimated by an adapted multiple point stimulation method

An adapted multiple point stimulation (AMPS) method is described for estimating the number and relative size of thenar motor units. With this method, the median nerve was stimulated at various sites from the wrist to the elbow. To avoid alternation, only two or three clearly identifiable surface-recorded motor unit action potentials (S-MUAPs) were recruited at each point by incremental stimulation. A total of 10 S-MUAPs, elicited from four to five distinct stimulation points, was used to calculate the average S-MUAP size. By dividing the maximum M-potential size by that value, a motor unit number estimate (MUNE) was derived. In 59 healthy volunteers, from 19 to 87 years old, the mean average S-MUAP size was 87 +/- 27.6 microV.ms and the mean MUNE was 278 +/- 113 motor units. When performed repeatedly, the results were reproducible. The number of motor units declined exponentially with age while average S-MUAP sizes increased only moderately. To assess the validity of the AMPS method, its results were correlated with those obtained using the F-response technique. The correlation coefficient was 0.83 (P < 0.001).

Increase in alpha-CGRP and GAP-43 in aged motoneurons: a study of peptides, growth factors, and ChAT mRNA in the lumbar spinal cord of senescent rats with symptoms of hindlimb incapacities

Sprague-Dawley rats develop progressive motor dysfunctions during the third year of life. We use this as a model to examine possible neuronal mechanism(s) that may cause motor impairments occuring during aging. In this study we have used indirect immunofluorescence histochemistry (IF) and in situ hybridization histochemistry (ISH) to study quantitatively and qualitatively the staining pattern and mRNA expression of calcitonin gene-related peptide (alpha-CGRP), growth-associated protein 43 (GAP-43), and acidic fibroblast growth factor (aFGF) in spinal lumbar motoneurons of young adult (2-3 months) and aged (30 months) Sprague-Dawley rats. In addition, mRNAs encoding choline acetyltransferase (ChAT), beta-CGRP, and cholecystokinin (CCK) were analyzed. All aged rats used in this study disclosed symptoms of hindlimb incapacity, ranging from mild weight-bearing insufficiency to paralysis of the hind limbs. The symptoms were confined to the musculature of the hindlimb and hip regions. Only a small number (approximately 15%) of the large motoneurons that innervate the hindlimb muscles were lost in those aged rats that had clinical symptoms of hindlimb motor incapacities. The remaining motoneurons expressed ChAT mRNA at levels similar to those of young adult rats. The vast majority of these motoneurons showed increased mRNA levels for alpha-CGRP and GAP-43. Aged motoneurons contained more CGRP like immunoreactivity (LI), but the number of immunoreactive neurons was smaller than in adult rats. GAP-43-LI could be detected in motoneurons in aged, but not in adult, rats. GAP-43-LI was always colocalized with CGRP-LI in aged motoneurons. Studies of individual aged rats revealed that the increase of GAP-43 mRNA-positive cell bodies occurred in cases with the most severe clinical symptoms, whereas the increase in alpha-CGRP was even evident in rats with mild symptoms. No alterations in content of aFGF-LI or aFGF mRNA could be detected in the aged rat, and the content of CCK and beta-CGRP mRNAs was also normal. The usefulness of this rat model for studies of neuromuscular aging and possible functional roles for GAP-43 and CGRP in plastic and regenerative processes during aging are discussed.

Aging of human muscle: structure, function and adaptability

With increasing age, human skeletal muscles gradually decrease in volume, mainly due to a reduced number of motor units and muscle fibers, and a reduced size of type 2 fibers. As a result, progressive weakening and impaired mobility occur. High-resistance strength training is beneficial, even in the very old, and could possibly reverse some of the detrimental effects of age-related weakness. The importance of exercise for older people affords an excellent opportunity for the medicine community as a major source of information and promotion of physical activity for this rapidly growing segment of the population. In this review, we summarize the current knowledge of the effects of aging on the human neuromuscular system, describe some of the major underlying mechanisms of the aging atrophy and focus on the importance of strength training to improve muscle function in older people.

Pathogenetic mechanisms of post-polio syndrome: morphological, electrophysiological, virological, and immunological correlations

To understand the mechanism of post-poliomyelitis muscular atrophy (PPMA) and the post-polio syndrome (PPS) in general, we performed the following studies: (1) histopathology in spinal cord sections from patients who died 9 days to 44 years after acute paralytic poliomyelitis; (2) enzyme histochemistry, immunocytochemistry (for lymphocyte subsets, MHC antigens and N-CAM) and polymerase chain reaction (PCR) for poliovirus RNA in the muscle biopsies from symptomatic or asymptomatic muscles of post-polio patients; (3) determination of lymphocyte subsets and circulating IgG or IgM antibodies against GM1 and poliovirus; (4) virological studies in the spinal fluid for oligoclonal bands and search for poliovirus genome with PCR; (5) electrophysiological studies including single fiber EMG, fiber density and macro-EMG; and (6) [31P] exercise MRS spectroscopy on previously affected muscles to search for a metabolic correlate of fatigue. These studies concluded that in PPS a continuing dysfunction is present in the spinal cord motor neurons, resulting in ongoing muscle denervation and reinnervation first evident at the axonal branch points. Symptoms are related to attrition of the oversprouting motor neurons which after a period of time cannot support all their axonal sprouts, resulting in failure of re-reinnervation. In some patients with PPS there is also an ongoing immune activation and presence of defective viral particles in the spinal fluid. However, their role in the pathogenesis of PPS is presently unknown.

The role of exercise in the patient with post-polio syndrome

Recent studies have shown that judicious exercise can improve muscle strength, cardiorespiratory fitness, and the efficiency of ambulation in post-polio patients. It may also add to the patient's sense of well-being. These benefits appear to occur when the patients stay within reasonable bounds while exercising in order to avoid overuse problems. In particular, the patients should be instructed to avoid activities that cause increasing muscle or joint pain or excessive fatigue, either during or after their exercise program. The literature indicates that exercise within these constraints leads to a number of beneficial physiologic and psychologic adaptations in patients with post-polio syndrome. Judicious exercise should be viewed as important adjuvant in the overall therapeutic program of the patient. Patients seen in post-polio clinics frequently complain of new fatigue, weakness, muscle pain, and/or joint pain. The most frequent complaints involving activities of daily living include new difficulties with walking and stair climbing. The therapeutic benefit of exercise in these patients to minimize or reverse decline in function is an important question frequently asked by patients with post-polio syndrome. In the general population, physical activity is known to be an important adjunct to good health, bestowing both physiologic and psychologic benefits leading to a reduction in the risk to develop a number of serious ailments as well as leading to better psychological adjustment. On the other hand, limitation in physical activity results in a number of deleterious effects. Patients with post-polio syndrome have unique problems, however, which need to be considered when prescribing an exercise program for an individual patient. A number of functional etiologies for declining function have been hypothesized including disuse weakness, overuse weakness, weight gain, and chronic weakness. Because of the variability in which the motor neurons to different muscle groups may have been affected in a particular patient, both asymmetric and scattered weakness may be present. The challenge in prescribing exercise for the patient with post-polio syndrome comes in recognizing these unique factors in each patient and modifying the prescription accordingly. One must protect muscles and joints experiencing the adverse effects of overuse or body areas with very significant chronic weakness (in general, in areas where the muscles have less than antigravity strength on manual muscle testing) while exercising those body areas experiencing the deleterious effects of disuse. Weight gain is to be avoided if at all possible in this population, because increased weight only leads to further difficulty in the performance of daily activities.(ABSTRACT TRUNCATED AT 400 WORDS)

Differential effects of aging on motoneurons and peripheral nerves innervating the hindlimb and forelimb muscles of rats

We examined the number and size of ulnar (forelimb) and medial gastrocnemius (MG, hindlimb) motoneurons in middle-aged (9 months of age) and aged (27 months of age) male Fischer 344 rats. Morphological properties of the ulnar and the MG nerves were also studied. No significant difference was found in the mean number of the ulnar motoneurons between the two age groups, while that of MG motoneurons was significantly less in aged animals. A decrease in the number of myelinated fibers (including both afferent and efferent fibers) in the ulnar nerves was less than that in the MG nerves, although the age difference was not significant in either of the nerves. Soma atrophy of aged motoneurons was found in both MG and ulnar motor nuclei. The mean fascicular areas and myelinated fiber diameters were significantly increased in both the MG and the ulnar nerves in aged rats, but these were less pronounced for the ulnar nerve. The results indicate that most ulnar motoneurons, unlike MG motoneurons, survive at least to the age of 27 months. Morphological changes in the peripheral nerves were also less for the ulnar nerve than for the MG nerve. Thus, we conclude that the effects of aging on motoneurons and peripheral nerves innervating MG muscle of the hindlimb are greater than those innervating forelimb muscles.

Impairments of the response preparation process in the elderly

In 20 young adults (23.1 +/- 1.64 yrs) and 20 old adults (68.5 +/- 5.53 yrs), H-reflexes were evoked simultaneously in the right soleus muscle that was preparing to respond to a reaction time stimulus and in the left soleus muscle that was uninvolved in the impending reaction time response. In the one-second period preceding the presentation of the response stimulus, the right H-reflex was inhibited as compared to the left H-reflex in the young adults; whereas, in the old adults, the response preparation profiles for the left and right H-reflexes were similar. Following the presentation of the response stimulus, H-reflex facilitation in the young adults reflected a non-specific tuning response and a specific, movement-related response. The nonspecific H-reflex enhancement was not observed in our older adults. These results indicate that the generalized tuning sequence necessary for movement planning is impaired in the elderly.

What do we mean by a statistical model?

Statisticians are too often satisfied by fitting data rather than investigating the process out of which the data arose. The assumptions on which they base their models may be quite unrealistic, and while it is true that a model should not be more complicated than necessary, neither should it be too simple. Ways of approaching several sets of data from different areas of clinical medicine are considered, and different attitudes to the purpose of modelling highlighted. The transition from smoothing data, through fitting curves, to modelling underlying processes is discussed.

Age-related changes in androgen receptor levels in cranial nerve nuclei of male rats

Sensory and motor events are important for mating, and several cranial nerve nuclei mediating these events contain androgen receptors (AR). Since mating behavior declines with age, we tested whether AR binding is decreased in cranial nerve nuclei of old male rats. Cytosol and cell nuclear androgen receptor (AR) binding was assessed in the cochlear, hypoglossal and facial nuclei in young (4 months) and old (20 months) male Fischer 344 rats. For comparison with other neural and non-neural tissue, AR binding in combined hypothalamus, preoptic area and amygdala (HPA), and muscle tissue from tongue and masseter were examined. Cytosol AR binding was significantly decreased in all three cranial nerve nuclei of old males. No age-related changes were observed in HPA or muscle. Cell nuclear AR binding was unaffected by age in all of the tissues analyzed. Neuron numbers in motor nuclei of the hypoglossal, facial and trigeminal nerves were compared between young and old rats. A significant decrease in neuron number was found only in the hypoglossal nucleus of old rats, indicating that neuronal loss is not a factor in the reduction of AR's in cranial nerve nuclei. It is suggested that the loss of AR's in cranial nerve nuclei of old rats contributes to the decline in male copulatory behavior by reducing responsiveness to sensory and motor cues.

Reference values of motor unit action potentials obtained with multi-MUAP analysis

We collected reference values of motor unit action potentials (MUAPs) from healthy deltoid, brachial biceps, first dorsal interosseous, lateral vastus, and anterior tibial muscles in 105 subjects between 15 and 86 years. The MUAPs were recorded with a concentric needle electrode and extracted with a decomposition method we call multi-MUAP analysis. The main goal is to identify and extract MUAPs. Also, the firing pattern of the motor units can be followed. No significant changes with age were found for duration, spike duration, thickness, amplitude, area, size index, or number of phases in all muscles studied. We did not find any influence of gender or height. We found higher amplitudes and shorter durations compared with previous studies. This may be due to a higher contraction level that can be used with a decomposition technique. No right-left side differences were found. The coefficient of variation of the parameters in repeated examinations was small, which implies a good reliability of the measurements. Interexaminer variability of four investigators was not greater than in repeated studies.

Physiological properties of single thenar motor units in the F-response of younger and older adults

The purpose of this study was to characterize the properties of single thenar motor units in the F-response of healthy younger (n = 15; age 33 +/- 11 years) and older subjects (n = 15; age 68 +/- 3 years). Trains of 300 stimuli at intensities evoking M-potentials 10%, 20%, and 30% of the peak-to-peak amplitude of the maximum M-potential, were delivered to the median nerve. In the young, observed firing probabilities of surface-detected motor unit action potentials (S-MUAPs) extracted from the F-response ranged from less than 1-10%, the S-MUAPs varied in size from 0.015% to 5.3% of the maximum M-potential negative peak area, and they were similar in size to the population of S-MUAPs collected by multiple point stimulation of the median nerve. The percentage difference between the slowest and fastest conducting fibers for individual subjects ranged from 8% to 20%, which translated to conduction velocities (CVs) of 48-68 m.s-1 (mean 59 +/- 4). The preceding were all independent of stimulus intensity. The S-MUAP sizes were significantly larger in older subjects (39%), and the range and distribution of motor unit CVs (38-61 m.s-1; mean 52 +/- 3) were markedly shifted to reflect a slower population of motor fibers. These findings suggest that age-related axonal slowing may uniformly affect all median motor fibers.

Segmental fasciculations as a late sequel of spinal cord injury

In two patients with a history of spinal cord injury many years ago fasciculations developed in muscles belonging to previously damaged segments. In both patients MRI of the cervical spine showed an area of abnormal signal intensity representing a cavity, near the level of the neurological abnormalities and the cord injury. During a 4-year follow-up period no new neurological or MRI abnormalities were detected. A hypothesis for the genesis of fasciculations following spinal cord injury is presented.

Disease-specific patterns of neuronal loss in the spinal ventral horn in amyotrophic lateral sclerosis, multiple system atrophy and X-linked recessive bulbospinal neuronopathy, with special reference to the loss of small neurons in the intermediate zone

The ventral horn cells of the fourth lumbar segment were morphometrically analysed in six cases of amyotrophic lateral sclerosis (ALS; there common forms and three pseudopolyneuritic forms), six of multiple system atrophy (MSA) with autonomic failure, four of X-linked recessive bulbospinal neuronopathy (X-BSNP), and seven age-matched autopsy cases of non-neurological disorders. In the common form of ALS, large and medium-sized neurons of the medial and lateral nuclei were markedly lost; small neurons in the intermediate zone were slightly diminished but fairly well preserved. In the pseudopolyneuritic form of ALS, marked loss was present in the large and medium-sized neurons, and in the small neurons located in the intermediate zone as well. In the MSA, in contrast to ALS, there was a marked reduction in small neurons in the intermediate zone, and large and medium-sized neurons of the medial and lateral nuclei tended to be preserved. In X-BSNP, large and medium-sized neurons were almost completely lost and small neurons were also markedly depopulated. These findings indicated that the pattern of neuron loss in the ventral horn is distinct among these diseases depending on size, location and function of the ventral horn cell population. These disease-specific patterns of neuron loss suggest a difference in the process of neuronal degeneration of ventral horn cells among the disease examined.

Effects of ageing on the motor unit: a brief review

This review briefly summarizes the current state of knowledge regarding age related changes in skeletal muscle, followed by a more in-depth review of ageing effects on animal and human motor units (MUs). Ageing in humans is generally associated with reductions in muscle mass (atrophy), leading to reduced voluntary and electrically evoked contractile strength by the 7th decade for most muscle groups studied. As well, contraction and one-half relaxation times are typically prolonged in muscles of the elderly. Evidence from animal and human studies points toward age associated MU loss as the primary mechanism for muscle atrophy, and such losses may be greatest among the largest and fastest MUs. However, based on studies in animals and humans, it appears that at least some of the surviving MUs are able to partially compensate for MU losses, as indicated by an increase in the average MU size with age. The fact that muscles in the elderly have fewer, but on average larger and slower, MUs has important implications for motor control and function in this population.

[Neuromuscular abnormalities in disuse, ageing and cachexia]

Cachexia, ageing and disuse and their effects on the human and animals neuromuscular system are reviewed. Disuse induces reduction of muscle fibers (mainly II) diameter with peripheral myofibrils lost; there is no core-targetoid or even reduction on myophosphorilase activity, both typical of denervation; the acetylcholine spontaneous release and trophic factors on myoneural junction are maintained; muscle fibers could change to angular shape. Ageing affects nerve and muscle by a continuous and progressive process of denervation and reinnervation; the number of motor units diminishes in sixties without any denervation electric activity; there is also reduction on the amount of ACh release on terminal neurons and mitochondrial oxidative capacity leading to compensatory type I muscle fiber number increase. Cachexia also induces reduction on muscle fibers diameter first on legs and then on arms and trunk; there is type II atrophy with occasional angular fibers, RNA/proteic synthesis reduction and normal DNA.

Age-related loss of knee joint afferents in mice

Previous work in our laboratory revealed markedly different rates of age-related death of four monoaminergic neuronal populations in the C57BL/6 mouse. Although dorsal root ganglion neurons (DRGns) have been reported not to suffer similar age-related death in rodents, we determined if there is age-related death of the subpopulation of DRGns innervating the knee joints of C57BL/6 mice, which are known to develop degenerative arthritis with aging. The somata of dorsal root ganglion neurons innervating the mouse knee joint (KJ-DRGns) were identified by retrograde tracing with Fluoro-Gold (FG). Lumbar ganglia were serially sectioned and the numbers of FG-labelled KJ-DRGns counted at five ages encompassing the animal's life span. Changes in size of the total population of lumbar DRGns (L-DRGns) were estimated by counting nucleated somata from every fifth toluidine blue-stained serial section from the L3 and L4 lumbar ganglia at three different ages. Using a computer-assisted video morphometric technique somal areas were measured from random sections to determine the distribution of sizes of neurons in the KJ-DRGn and general lumbar DRGn populations at different ages. Counts of FG-labelled joint afferents were 238.5 +/- 80.3 (mean +/- SD) KJ-DRGns per knee at 2 months of age, declining to 103.2 +/- 20.1 by 24 months, representing a 57% loss over the average life span of the C57 mice. The loss occurred in two phases, with a rapid rate over the first 8 months of life and a more moderate rate of loss over the remaining months. L-DRGn numbers revealed a slower overall rate of loss in comparison to the KJ-DRGn population with an average 33.7% loss over the life span of this mouse. Somal size measurements revealed that the larger sizes of KJ-DRGns were lost over the first 8 months of life, with little change in the distribution of somal sizes thereafter. The distributions of sizes of the L-DRGn population did not change significantly over the life spans of the mice. The data provides evidence that the age-related loss of KJ-DRGns is significantly greater than DRGns in general, and may be particularly apparent in the population of larger sized presumed mechanoreceptor neurons. The loss of the KJ-DRGns is approximately reciprocal to the incidence rate of knee joint osteoarthritis reported for the C57BL/6 mice.

Reliability of Cybex II isokinetic evaluations of torque in post-poliomyelitis syndrome

The aim of this study was to ascertain the reliability of isokinetic strength measurements in a population of post-poliomyelitis subjects (PPS). Eight subjects (four males and females, mean age of 47.5 +/- 10 and 56.8 +/- 16 years, respectively) were evaluated, on a weekly basis for three weeks at approximately the same time of day. During each test session the knee flexors and extensors (bilaterally, where possible) were evaluated. Subjects became familiar with the equipment prior to recording three maximal contractions at the four test velocities (1.05, 2.09, 3.14, 4.18rads.s-1). A two-minute rest period was allowed between sets of contractions. The variables of peak torque, angle of peak torque, torque at specific joint angles (0.79 and 1.05rads), total contractile work, maximum power, and average power were measured on-line with the Cybex II a system using a commercially available software package. In both muscle groups, all the variables were significantly weaker on the most affected, but testable limb (p < 0.01) in subjects where both limbs could be tested (n = 5). Peak torque and total work of the quadriceps were observed to decrease with increasing velocity of movement. The effects of velocity were less apparent in the hamstrings. Average and maximum power developed by the knee extensors and flexors increased with increasing velocity of movement. Reliability of performance over three test sessions was confirmed by the intraclass correlation coefficient (ICC) values derived from the univariate ANOVAs calculated for each of the above variables (> 0.80).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical and electrophysiological study of the peripheral nervous system in the elderly

The effect of age on the peripheral nervous system was investigated by clinical examination and neurophysiological studies in 59 subjects aged 60-103 years and 23 young subjects. A full laboratory screen for factors which, though clinically silent, may constitute risk factors (RFs) for peripheral neuropathy was also performed in the elderly subjects. Our findings show that the presence of RFs affects exceptionally the electrophysiological parameters in a statistically significant way. The age-dependent changes in nerve conduction parameters were well predicted by non-linear models. The simultaneous electromyographical study demonstrates the re-innervation capacity of the motor system.