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Autonomic dysfunction in older people

  • J Richard G Marigold (a1), Monica Arias (a2), Michael Vassallo (a1) (a2), Stephen C. Allen (a1) (a2) and Joseph SK Kwan (a1)...

Summary

The autonomic nervous system comprises the sympathetic, parasympathetic and enteric nervous systems and plays an integral role in homeostasis. This includes cardiovascular and temperature control, glucose metabolism, gastrointestinal and reproductive function and increasing evidence to support its involvement in the inflammatory response to infection and cancer. Ageing is associated with autonomic dysfunction, and many clinical syndromes associated with older adults are due to inadequate autonomic responses to physiological stressors. The aim of this review is to explore the relationship between autonomic dysfunction and ageing illustrated with examples of maladaptive autonomic responses in a variety of different clinical syndromes including an exploration of autonomic cellular changes. Appropriate investigation and management strategies are outlined, recognizing the fine balance needed to improve symptoms without creating further medical complications.

Copyright

Corresponding author

Address for correspondence: Dr J Richard G Marigold, Department of Medicine for Older People, Royal Bournemouth Hospital, Castle Lane East, Bournemouth BH7 7DW, UK. Email: rmarigold@hotmail.com

References

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1Langley, JN. The autonomic nervous system. Brain 1903; 26: 126.
2Myllyla, V, Tulppo, M. Cardiovascular Autonomic Dysfunction. In Bolis, CL, Licinio, J, Govoni, S (eds). Handbook of Autonomic Nervous System in Health and Disease. Marcel Dekker Inc, New York, 2003.
3Saenz de Tejada, I, Kim, N, Lagan, I, Krane, RJ, Goldstein, I. Regulation of adrenergic activity in penile corpus cavernosum. J Urol 1989; 142: 1117–21.
4Collins, KJ. Low indoor temperatures and morbidity in the elderly. Age Ageing 1986; 15: 212–20
5Widicombe, JG, Sterling, GM. Autonomic nervous system and breathing. Arch Intern Med 1970; 126: 311–29.
6Fagius, J. Sympathetic nerve activity in metabolic control – some basic concepts Acta Physiol Scand 2003; 177: 337–43.
7Kopp, UC, DiBona, GF. Neural regulation of renin secretion. Semin Nephrol 1993; 13: 543–51.
8Bulygin, IA. A consideration of the general principles of organization of sympathetic ganglia. J Auton Nerv Syst 1983; 8: 303–30.
9Woodcock, EA, Du, XJ, Reichelt, ME, Graham, RM. Cardiac a1-adrenergic drive in pathological remodelling. Cardiovasc Res 2008; 77: 452–62.
10Kvietys, PR, Granger, DN. Physiology and pathophysiology of the colonic circulation. Clin Gastroenterol 1986; 15: 967–83.
11Lewis, MJ, Short, AL, Lewis, KE. Autonomic nervous system control of the cardiovascular and respiratory systems in asthma. Respir Med 2006; 100: 1688–705.
12Johnson, RH, Spaulding, JM. Disorders of the Autonomic Nervous System, chapter 11, The Eyes. Contemp Neurol Ser 1974; 11: 199219.
13Rampin, O. Neural control of erection. J Soc Biol 2004; 198: 217–30.
14Collins, KJ, Exton-Smith, AN, James, MH, Oliver, DJ. Functional changes in autonomic nervous responses with ageing. Age Ageing 1980; 9: 1724.
15Oliver, DJ. Heart rate response to standing as a test for autonomic neuropathy BMJ 1978; 1: 1349–50.
16National Diabetes Data Group. Diabetes in America, 2nd edition. Bethesda, MD, National Institutes of Health, 1995.
17Abrass, IB, Schwartz, RS. Special presentation of endocrine disease in the elderly. In Fitzgerald, FT (ed), Current Practice of Medicine, vol 1, no 2. Philadelphia, PA, Current Medicine Inc, 1998, pp. 415–18.
18Ewing, DJ, Campbell, IW, Clarke, BF. Heart rate changes in diabetes mellitus. Lancet 1981; 1: 183–86.
19Low, PA, Walsh, JC, Huang, CY, McLeod, JG. The sympathetic nervous system in diabetic neuropathy: a clinical and pathological study. Brain 1975; 98: 341–56.
20Langer, A, Freeman, MR, Josse, RG, Steiner, G, Armstrong, PW. Detection of silent myocardial ischaemia in diabetes mellitus. Am J Cardiol 1991; 67: 1073–78.
21Burgos, LG, Ebert, TJ, Asiddao, C, Turner, LA, Pattison, CZ, Wang-Cheng, R, Kampine, JP. Increased intraperative cardiovascular morbidity in diabetics with autonomic neuropathy. Anaesthesiology 1989; 70: 591–97.
22Veglio, M, Sivieri, R, Chinaglia, A, Scaglione, L, Cavallo-Perin, P. QT interval prolongation and mortality in type 1 diabetic patients: a 5 year cohort prospective study. Diabetes Care 2000; 23: 1381–83.
23Stevens, MJ, Raffel, DM, Allman, KC, Dayanikli, F, Ficaro, E, Sandford, T, Wieland, DM, Pfeifer, MA, Schwaiger, M. Cardiac sympathetic dysinnervation in diabetes: implications for enhanced cardiovascular risk. Circulation 1998; 98: 961–68.
24Gavazzi, I. Collateral sprouting and responsiveness to nerve growth factor of ageing neurones. Neurosci Lett 1995; 189: 4750.
25Cotman, CW, Gomez-Pinilla, F. Basic fibroblast growth factor in the mature brain and its possible role in Alzheimer's disease. Ann NY Acad Sci 1991; 638: 221–31.
26Vlassara, H, Bucula, R, Striker, L. Pathological effects of advanced glycosylation: Biochemical, biological and clinical implications for diabetes and ageing. Lab Invest 1994; 70: 138–51.
27Arima, K, Uéda, K, Sunohara, N, Hirai, S, Izumiyama, Y, Tonozuka-Uehara, H, Kawai, M. Immunoelectron-microscopic demonstration of NACP/alpha-synuclein-epitopes on the filamentous component of Lewy bodies in Parkinson's disease and in dementia with Lewy bodies. Brain Res 1998; 808: 93100.
28Trojanowski, JQ. Tauists, Baptists, Syners, Apostates and new data. Ann Neurol 2002; 52: 263–65
29Rüb, U, Del Tredici, K, Schultz, C, Ghebremedhin, E, de Vos, RA, Jansen Steur, E, Braak, H. Parkinson's disease: the thalamic components of the limbic system are severly impaired by alpha synuclein staining immunopositive inclusion body pathology. Neurobiol Aging 2002; 23: 245–54.
30Yoshida, M. Multiple system atrophy: alpha synuclein and neuronal degeneration. Neuropathology 2007; 27: 484–93.
31Daniel, S. The neuropathology and neurochemistry of multiple system atrophy. In Matthias, C, Bannister, R (eds). Autonomic Failure: a textbook of clinical disorders of the autonomic nervous system. Oxford, Oxford University Press. 1999; pp. 321328.
32Minguez-Castellanos, A, Chamorro, CE, Escamilla-Sevilla, F, Ortega-Moreno, A, Rebollo, AC, Gomez-Rio, M, Concha, A, Munoz, DG. Do alpha synuclein aggregates in autonomic plexuses predate Lewy body disorders? A cohort study. Neurology 2007; 68: 2012–18.
33Rittirsch, D, Flierl, MA, Ward, PA. Harmful molecular mechanisms in sepsis. Nat Rev Immunol 2008; 8: 776–87.
34Medzhitov, R, Janeway, C Jr. Innate immunity. N Engl J Med 2000; 343: 338–44.
35Hawlisch, H, Belkaid, Y, Baelder, R, Hildeman, D, Gerard, C, Köhl, J. C5a negatively regulates Toll-like receptor-4-induced immune responses. Immunity 2005; 22: 415–26.
36Munford, RS, Tracey, KJ. Is severe sepsis a neuroendocrine disease? Mol Med 2002; 8: 437–42.
37Barajon, I, Serrao, G, Arnaboldi, F, Opizzi, E, Ripamonti, G, Balsari, A, Rumio, C. Toll-like receptors 3, 4, and 7 are expressed in the enteric nervous system and dorsal root ganglia. J Histochem Cytochem 2009; 57: 1013–23.
38Schmidt, H, Hoyer, D, Hennen, R, Heinroth, K, Rauchhaus, M, Prondzinsky, R, Hottenrott, K, Buerke, M, Müller-Werdan, U, Werdan, K. Autonomic dysfunction predicts both 1- and 2-month mortality in middle-aged patients with multiple organ dysfunction syndrome Crit Care Med 2008; 36: 967–70.
39Sayk, F, Vietheer, A, Schaaf, B, Wellhoener, P, Weitz, G, Lehnert, H, Dodt, C. Endotoxemia causes central downregulation of sympathetic vasomotor tone in healthy humans. Am J Physiol Regul Integr Comp Physiol 2008; 295: R89198.
40Zhao, A, Bossone, C, Piñeiro-Carrero, V, Shea-Donohue, T. Colitis-induced alterations in adrenergic control of circular smooth muscle in vitro in rats. J Pharmacol Exp Ther 2001; 299: 768–74.
41Guichard, A, Vignon, G. La Polyradiculoneurite cancereuse metastatique. Le J Médecine de Lyon 1949; 30: 197207.
42Anderson, NE, Rosenblum, MK, Graus, F. Autoantibodies in paraneoplastic syndromes associated with small-cell lung cancer. Neurology 1988; 38: 1391–98.
43Ficker, DM, Hammack, JE. Primary central nervous system lymphoma presenting as autonomic dysfunction. J Neurooncol 1995; 23: 245–48.
44Oskarsson, BE, Quan, D, Wiley, RG. Paraneoplastic autonomic neuropathy. E-medicine – last updated 3 January 2009. Available at: http://emedicine.medscape.com/article/1156808-overview (accessed 10 June 2010).
45Lorusso, L, Hart, IK, Ferrari, D, Ngonga, GK, Gasparetto, C, Ricevuti, G. Autonomic paraneoplastic neurological syndromes. Autoimmun Rev 2007; 6: 162–68.
46Oh, SJ, Dropcho, EJ, Claussen, GC. Anti-Hu-associated paraneoplastic sensory neuropathy responding to early aggressive immunotherapy: report of two cases and review of literature. Muscle Nerve 1997; 20: 1576–82.
47Ewing, DJ, Clarke, BF. Diagnosis and management of diabetic autonomic neuropathy BMJ 1982; 285: 916–18.
48Eckberg, DL. Physiological basis for human autonomic rhythms. Ann Med 2000; 32: 341–49.
49Ewing, DJ, Campbell, IW, Murray, A, Neilson, JM, Clarke, BF. Immediate heart rate response to standing: simple test for autonomic neuropathy in diabetes. BMJ 1978; 1: 145–47.
50Ewing, DJ. Cardiovascular reflexes and autonomic neuropathy. Clin Sci Mol Med 1978; 55: 321–27.
51Risk, M, Bril, V, Broadbridge, C, Cohen, A. Heart rate variability measurement in diabetic neuropathy: review of methods. Diabetes Technol Ther 2001; 3: 6376.
52Ewing, DJ, Irving, JB, Kerr, F, Wildsmith, JA, Clarke, BF. Cardiovascular responses to sustained handgrip in normal subjects and in patients with diabetes mellitus: a test of autonomic function. Clin Sci Mol Med 1974; 46: 295306.
53Ebert, TJ, Stowe, DF, Barney, JA, Kalbfleisch, JH, Smith, JJ. Summated circulatory responses of thermal and baroreflexes in humans. J Appl Physiol 1982; 52: 184–89.
54Callister, R, Suwarno, NO, Seals, DR. Sympathetic activity is influenced by task difficulty and stress perception during mental challenge in humans. J Physiol 1992; 454: 373–87.
55Birklein, F, Spitzer, A, Riedl, B. The assessment of sudomotor function for diagnosis of autonomic diseases. Principles and methods. Fortschr Neurol Psychiatr 1999; 67: 287–95.
56Low, PA, Caskey, PE, Tuck, RR, Fealey, RD, Dyck, PF. Quantitative sudomotor axon reflex test in normal and neuropathic subjects. Ann Neurol 1983; 14: 573–80.
57Schatz, IJ, Bannister, R, Freeman, RL et al. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology 1996; 46: 1470.
58Harris, T, Lipsitz, LA, Kleinman, JC, Cornoni-Huntley, J. Postural change in blood pressure associated with age and systolic blood pressure: The National Health and Nutrition Examination Survey II. J Gerontol 1991; 46: M15963.
59Lipsitz, LA. Orthostatic hypotension in the elderly. N Engl J Med 1989; 321: 952–57.
60James, MA, Potter, JF. Orthostatic blood pressure changes and arterial baroreflex sensitivity in elderly subjects. Age Ageing 1999; 28: 522–30.
61Low, PA, Opfer-Gehhrking, TL, McPhee, BR et al. Prospective evaluation of clinical characteristics of orthostatic hypotension. Mayo Clin Proc 1995; 70: 617–22.
62Ooi, W. The association between orthostatic hypotension and recurrent falls in nursing home residents. Am J Med 2000; 108: 106–11.
63Bulpitt, CJ, Peters, R, Staessen, JA, Thijs, L, De Vernejoul, MC, Fletcher, AE, Beckett, NS. Fracture risk and the use of a diuretic (indapamide SR) +/– perindopril: a substudy of the Hypertension in the Very Elderly Trial (HYVET). Trials 2006; 19: 733.
64Landi, G, Perrone, P, Guidotti, M. Bilateral TIAs and unilateral seizures due to orthostatic hypotension. A case report. Ital J Neurol Sci 1983; 2: 239–41.
65Luukinen, H, Koski, K, Laippala, P, Airaksinen, KE. Orthostatic hypotension and the risk of myocardial infarction in the home-dwelling elderly. J Intern Med 2004; 255: 486–93.
66Román, GC. Brain hypoperfusion: a critical factor in vascular dementia. Neurol Res 2004; 26: 454–58.
67van Lieshout, JJ, ten Harkel, AD, Wieling, W. Fludrocortisone and sleeping in the head-up position limit the postural decrease in cardiac output in autonomic failure. Clin Auton Res 2000; 10: 3542.
68Petrella, RJ, Cunningham, DA, Smith, JJ. Influence of age and physical training on postural adaptation. Can J Sport Sci 1989; 14: 49.
69Freeman, R. Current pharmacologic treatment for orthostatic hypotension. Clin Auton Res 2008; 18: 1418.
70Decaux, G. Fludrocortisone in orthostatic hypotension. N Engl J Med 1979; 301: 1121–22.
71Wittbrodt, ET, Kovalick, LJ. The use of oral vasopressors in the management of autonomic dysfunction and orthostatic hypotension. Ann Pharmacother 1999; 33: 565–71.
72McClellan, KJ, Wiseman, LR, Wilde, MI. Midodrine. A review of its therapeutic use in the management of orthostatic hypotension. Drugs Aging 1998; 12: 7686.
73Masuo, K, Mikami, H, Ogihara, T, Tuck, ML. Changes in frequency of orthostatic hypotension in elderly hypertensive patients under medications. Am J Hypertens 1996; 9: 263–68.
74Hoeldtke, RD, Streeten, DH. Treatment of orthostatic hypotension with erythropoietin. N Engl J Med 1993; 329: 611–15.
75Dewey, RB Jr, Rao, SD, Holmburg, SL, Victor, RG. Ergotamine/caffeine treatment of orthostatic hypotension in parkinsonism with autonomic failure. Eur J Neurol 1998; 5: 593–99.
76Woo, J, Or, KH, Teoh, R, Nicholls, MG. Treatment of severe orthostatic hypotension with the somatostatin analogue octreotide. Aust NZ J Med 1990; 20: 822–23.
77Shannon, J, Jordan, J, Costa, F, Robertson, RM, Biaggioni, I. The hypertension of autonomic failure and its treatment. Hypertension 1997; 30: 1062–67.
78Robertson, D, Wade, D, Robertson, RM. Postprandial alterations in cardiovascular hemodynamics in autonomic dysfunctional states. Am J Cardiol 1981; 48: 1048–52.
79Jordan, J, Shannon, JR, Black, BK, Ali, Y, Farley, M, Costa, F, Diedrich, A, Robertson, RM, Biaggioni, I, Robertson, D. The pressor response to water drinking in humans: a sympathetic reflex? Circulation 2000; 101: 504–9.
80Biaggioni, I, Robertson, RM. Hypertension in orthostatic hypotension and autonomic dysfunction. Cardiol Clin 2002; 20: 291301.
81Wilcox, CS, Puritz, R, Lightman, SL, Bannister, R, Aminoff, MJ. Plasma volume regulation in patients with progressive autonomic failure during changes in salt intake and posture. J Lab Clin Med 1984; 104: 331–39.
82Naschitz, JE, Slobodin, G, Elias, N, Rosner, I. The patient with supine hypertension and orthostatic hypotension: a clinical dilemma. Postgrad Med J 2006; 82: 246–53.
83Singer, W, Sandroni, P, Opfer-Gehrking, TL, Suarez, GA, Klein, CM, Hines, S, O'Brien, PC, Slezak, J, Low, PA. Pyridostigmine treatment trial in neurogenic orthostatic hypotension. Arch Neurol 2006; 63: 513–18.
84Paulson, OB, Strandgaard, S, Edvinsson, L. Cerebral autoregulation. Cerebrovasc Brain Metab Rev 1990; 2: 161–92.
85Yam, AT, Lang, EW, Lagopoulos, J, Yip, K, Griffith, J, Mudaliar, Y, Dorsch, NW. Cerebral autoregulation and ageing. J Clin Neurosci 2005; 12: 643–46.
86Brooks, DJ, Redmond, S, Matthias, CJ, Bannister, R, Symon, L. The effect of orthostatic hypotension on cerebral blood flow and middle cerebral artery velocity in autonomic failure, with observations on the action of adrenaline. J Neurol Neurosurg Psychiatry 1989; 52: 962–66.
87Novak, V, Novak, P, Spies, JM, Low, PA. Autoregulation of cerebral blood flow in orthostatic hypotension. Stroke 1998; 29: 104–11.
88Sutton, R, Petersen, M, Brignole, M et al. Proposed classification for tilt induced vasovagal syncope. Europace 1992; 2: 180–83.
89Wayne, HH. Syncope: physiologic considerations and an analysis of the clinical characteristics in 510 patients. Am J Med 1961; 30: 418–38.
90Zaqqa, M, Massumi, A. Neurally mediated syncope. Tex Heart Inst J 2000; 27: 268–72.
91Wieling, W, van Lieshout, J. Maintenance of postural normotension in humans. In Low, PA (ed), Clinical Autonomic Disorders: evaluation and management, 2nd edn.Philadelphia: Lippincott-Raven, 1997; 7382.
92Samoil, D, Grubb, BP. Vasovagal (neurally mediated) syncope: pathophysiology, diagnosis and therapeutic approach. Europace 1992; 2: 234–41.
93The Task Force on Syncope, European Society of Cardiology. Guidelines on Management (Diagnosis and Treatment) of Syncope – Update 2004. Eur Heart J 2004; 25: 2054–72.
94Benditt, DG, Ferguson, DW, Grubb, BP, Kapoor, WN, Kugler, J, Lerman, BB, Maloney, JD, Raviele, A, Ross, B, Sutton, R, Wolk, MJ, Wood, DL. ACC expert consensus document: tilt table testing for assessing syncope. J Am Coll Cardiol 1996; 28: 263–75.
95Bloomfield, D, Maurer, M, Bigger, JT Jr. Effects of age on outcome of tilt-table testing. Am J Cardiol 1999; 83: 1055–58.
96Krediet, CT, van Dijk, N, Linzer, M, van Lieshout, JJ, Wieling, W. Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation 2002; 106: 1684–89.
97Brignole, M, Croci, F, Menozzi, C, Solano, A, Donateo, P, Oddone, D, Puggioni, E, Lolli, G. Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope. J Am Coll Cardiol 2002; 40: 2053–59.
98El-Sayed, H, Hainsworth, R. Salt supplement increases plasma volume and orthostatic tolerance in patients with unexplained syncope. Heart 1996; 75: 134–40.
99Younoszai, AK, Franklin, WH, Chan, DP, Cassidy, SC, Allen, HD. Oral fluid therapy: a promising treatment for vasodepressor syncope. Arch Pediatr Adolesc Med 1998; 152: 165–68.
100Ventura, R, Maas, R, Zeidler, D, Schoder, V, Nienaber, CA, Schuchert, A, Meinertz, T. A randomized and controlled pilot trial of beta-blockers for the treatment of recurrent syncope in patients with a positive or negative response to head-up tilt test. Pacing Clin Electrophysiol 2002; 25: 816–21.
101Da Costa, D, McIntosh, S, Kenny, RA. Benefits of fludrocortisone in the treatment of symptomatic vasodepressor carotid sinus syndrome. Br Heart J 1993; 69: 308–10.
102Ward, CR, Gray, JC, Gilroy, JJ, Kenny, RA. Midodrine: a role in the management of neurocardiogenic syncope. Heart 1998; 79: 4549.
103Di Girolamo, E, Di Iorio, C, Sabatini, P, Leonzio, L, Barbone, C, Barsotti, A. Effects of paroxetine hydrochloride, a selective serotonin reuptake inhibitor, on refractory vasovagal syncope: a randomized, double-blind, placebo-controlled study. J Am Coll Cardiol 1999; 33: 1227–30.
104Connolly, SJ, Sheldon, R, Roberts, RS, Gent, M. The North American Vasovagal Pacemaker Study: a randomised controlled trial of permanent cardiac pacing for the prevention of vasovagal syncope. J Am Coll Cardiol 1999; 33: 1620.
105McIntosh, SJ, Lawson, J, Kenny, RA. Clinical characteristics of vasodepressor, cardioinhibitory, and mixed carotid sinus syndrome in the elderly. Am J Med 1993; 95: 203–8.
106Kerr, SR, Pearce, MS, Brayne, C, Davis, RJ, Kenny, RA. Carotid sinus hypersensitivity in asymptomatic older persons: implications for diagnosis of syncope and falls. Arch Intern Med 2006; 166: 515–20.
107Brignole, M, Menozzi, C. Carotid sinus syndrome: diagnosis natural history and treatment. Europace 1992; 4: 247–54.
108Davies, AJ, Kenny, RA. Frequency of neurologic complications following carotid sinus massage. Am J Cardiol 1998; 81: 1256–57.
109European Society of Cardiology. Guidelines for cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2007; 28: 2256–95.
110Hussain, RM, McIntosh, SJ, Lawson, J, Kenny, RA. Fludrocortisone in the treatment of hypotensive disorders in the elderly. Heart 1996; 76: 507–9.
111NIH Consensus Development Panel on Impotence. NIH Consensus Conference: Impotence. JAMA 1993; 270: 8390.
112Johannes, CB, Araujo, AB, Feldman, HA, Derby, CA, Kleinman, KP, McKinlay, JB. Incidence of erectile dysfunction in men 40–69 years old. Longitudinal results from the Massachusetts male aging study. J Urol 2000; 163: 460–63.
113Morley, JE, Korenman, SG, Kaiser, FE et al. Relationship of brachial penile pressure index to myocardial infarction and cerebrovascular events. Am J Med 1998; 84: 445–48.
114Wespes, E, Amar, E, Hatzichristou, D, Hatzimouratidis, K, Montorsi, F, Pryor, J, Vardi, Y; EAU. EAU Guidelines on Male Sexual Dysfunction: an update. Eur Urol 2006; 49: 806–15.
115Goldstein, I, Lue, TF, Padma-Nathan, H, Rosen, RC, Steers, WD, Wicker, PA. Oral sildenafil in the treatment of erectile dysfunction. N Engl J Med 1998; 338: 1397–404.
116Singaram, C, Ashraf, W, Gaumnitz, E et al. Dopaminergic defect of enteric nervous system in Parkinson's disease patients with chronic constipation. Lancet 2005; 346: 861–64.
117Belmin, J, Auffray, JC, Berbezier, C, Boirin, P, Mercier, S, de Reviers, B, Golmard, JL. Level of dependency: a simple marker associated with mortality during the 2003 heatwave among French dependent elderly people living in the community or in institutions. Age Ageing 2007; 36: 298303.
118Cheshire, WP, Freeman, R. Disorders of sweating. Semin Neurol 2003; 23: 399406.
119Simon, HB. Hyperthermia. New Engl J Med 1993; 329: 483–87.
120Wilson, TE, Sauder, CL, Kearney, ML, Kuipers, NT, Leuenberger, UA, Monahan, KD, Ray, CA. Skin-surface cooling elicits peripheral and visceral vasoconstriction in humans. J Appl Physiol 2007; 103: 1257–62.
121Kenney, WL. Thermoregulation at rest and during exercise in healthy older adults. Exerc Sport Sci Rev 1997; 25: 4176.
122Kenney, WL, Morgan, AL, Farquar, WB et al. Decreased active vasodilator sensitivity in aged skin. Am J Physiol 1991; 260: H85561.
123Danzl, DF, Pozos, RF. Accidental hypothermia. New Eng J Med 1994; 331: 1756–60.
124National Center for Health Statistics. Compressed mortality file. Hyattsville, Maryland: US Department of Health and Human Services, CDC, National Center for Health Statistics, 2003.
125Chantler, C, Kelly, S. Deaths from hypothermia in England and Wales. Health Statistics Quart 1999; 02: 5052.
126Collins, KJ, Exton-Smith, AN, Dore, C. Urban hypothermia: Preferred temperature and thermal perception in old age. Br Med J 1981; 282: 175–77.
127Kenney, WL, Buskirk, ER. Functional consequences of sarcopenia: Effect on thermoregulation. J Gerontol A Biol Sci Med Sci 1995; 50: 7885.
128Collins, KJ, Dore, C, Exton-Smith, AN, Fox, RH, MacDonald, IC, Woodward, PM. Accidental hypothermia and impaired temperature homeostasis in the elderly. Br Med J 1977; 1: 353–56.
129Richardson, D, Tyra, J, McCray, A. Attenuation of the cutaneous vasoconstrictor response to cold in elderly men. J Gerontol 1992; 47: M21114.

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