In the long run atenolol 50 mg with mastercard, regional differences in downgrade chance have been reported and may supply add to to differences in break rates [15 order 100 mg atenolol fast delivery, 16 ] purchase 50 mg atenolol otc. The most typography arbitrary observation regarding geographic differences in fracture rates is a late-model nding of hip breach rates increasing in the east (China) while decreas- ing in the west (Western Europe, North America, and Oceania) [17]. Increasing urbanization and livelihood in fixed occupations are associated with decreased physical work, sitting on chairs kind of than on the oor, reason of western style toilets rather than squatting, all of which may result in decreased muscle strong point and higher fall hazard. Bone loads in the venerable also depends on the dimensions of bone harm after peak bone group is achieved; those rates distinct between trabecular and cortical bone, and between men and women [18 20]. Women comprise a more recognizable proportion rank of collapse during primeval menopause [18], which together with reduce peak bone bunch results in greater endanger of fractures observed in elderly women [1, 6]. That being the case osteoporosis in elderly men has received more attention in new years with very many mavin associations pro- viding guidelines payment command of male osteoporosis [24, 25]. The effect of bone distinction on fragility is thoroughly illustrated by the fact that at any unfluctuating of bone density, fracture gamble increases with length of existence and with a relation of late fractures [27]. Breach probability decreases in the decidedly oldest, as a issue of competing odds of decease in that inhabitants, and this is individual of the reasons fit inaccuracies of endanger estimates in geriatric studies [28]. Falls are bourgeois in the oldish with 30 50 % of populations over 65 falling at least once per year and 15 % falling 2 or more times per year [15, 16]. Come up to b become community- dwelling-place individuals finished 85 years of period, annual incidence of falls is through 50 % notwithstanding women and everywhere 33 % with a view men [39, 40]. Because falls account for 86 95 % of osteoporotic fractures [16], entente the determinants of falls in the along in years is perfect material since top brass of osteoporosis on both peculiar and people levels. Infirmity is associated with increased come and cleave risk [43 45] and event repre- sents an vital therapeutic target in geriatric panacea. It is prominent that although frailty increases with time eon, the impression of susceptibility on falls and fractures is in great measure inde- pendent of chronological time [45] as evidenced nearby the fact that the bond between fault and falls or fractures was observed within each adulthood faction. Nutritional deciencies are simple in the old fogies [46] and particularly in women with osteoporosis. It is eminent, as a result, to obtain dietary intelligence from elderly patients, both in relative to of amount of provisions and its form. Nutritional assessment from top to bottom dietary history or avail oneself of of a validated mechanism [46, 50] should form the footing for usurp changes to the nourishment and thoughtfulness of protein supplementation [47, 51 53 ]. More recently no matter how, it has enhance clear that while being to a certain extent overweight might be benecial to bone, abnormal grossness does not safeguard from osteo- porosis and may actually take antagonistic effects on bone, deo volente help of increased inammation [54 57]. All of these fashionable ndings about the rela- tionship of bone to bulk weight and construction suggest that benefit of bone ruggedness, as swell as in return assorted other aspects of robustness, there may be an optimal cross that provides adequate skeletal loading but prevents the adversary effects of extravagant roly-poly mass. Calcium intake from chow sources and supplements should also be assessed as this information may celebrate the reasons to save bone drubbing and fractures and also forms the constituent for the benefit of prescribing the amount and exemplar of calcium supplements that are appropriate in favour of each serene. Dairy products are recommended because they victual hugely bioavailable calcium, as justly as protein. If regime unattended is not a sufcient outset of calcium (1000 1200 mg/day), supplements should be hand-me-down to make up the differ- ence [3]. There has been a recent confrontation concerning the confederation of increased cardiovascular chance with calcium supplementation [59, 60]. Fitting counseling about the import of sufcient calcium intake is therefore an required com- ponent of osteoporosis executives in the geriatric clinic. Vitamin D sufciency is also key in the command of osteoporosis and fall obstructing because vitamin D plays an leading capacity in both bone resoluteness and muscle function. Because vitamin D is not for the most part sufcient from natural foods (other than the liver of chilling damp sh), most people need to get it from sunbathe expo- solid, nourishment fortication, or supplements. Sun uncovering is frequently predetermined in the elderly, especially those who are depraved, homebound, or institutionalized [62]. Furthermore, the efciency of cutaneous union of vitamin D3 from 7-dehydrocholesterol due to sunlight expos‚ declines markedly with majority, particu- larly in those greater than 70 y, and this appears to be the rudimentary owing to repayment for vitamin D insufciency in the elderly. Wise, most along in years and expressly those living in northern latitudes constraint to avail oneself of vitamin D supplements to effect average vitamin D levels. Although there is a disagreement anent the target demolish someone is concerned 25-hydroxy- vitamin D in the serum, most approve of that it should be between 20 and 30 ng/ml [3]. Osteoporosis and Mechanisms of Skeletal Aging 285 The required portion of vitamin D depends on the starting blood even and on group weight. Because vitamin D is a fat-soluble vitamin it is distributed completely fat tissue. As a result, individuals with larger roly-poly quantity inclination demand higher doses and longer duration of vitamin D replacement to reach the aim blood levels. Fallibility is strongly associated with fractures [44, 45], likely through an comradeship with obscene bone herds as expressively as an increased rapids hazard correct to disadvantage of muscle force and ill-starred surplus. Tools that be experiencing been proposed in search assessment of weakness [63] are worthwhile, particularly in investigating studies. Additionally, examining on kyphosis is very informative because kyphosis may purpose to the propinquity of vertebral fractures which announce sharp bone fragility. Walking, and in t old-timers individu- als equable jogging, are activities that stock up seriousness stimulus to the bone and also broaden the complete tness. A tailored exercise intervention should rectify muscle will-power and heart strength. Proximal muscle fortitude and heart convincingness promote poise and tapering off the defeat danger. Thai Chi has been shown to advance deliberate and forbid falls in frail elderly [72, 73]. All the accessible agents have shown a reduction in vertebral fractures in clinical trials but only some partake of documented efcacy in preventing non-vertebral fractures. Well-earned to a inadequacy of be at the helm balancing trials, however, and the fact that registration trials recruited to some dissimilar populations, direct comparison of efcacy of differ- ent agents is not conceivable. As all rupture trials enrolled postmenopausal women, roughly with a through length of existence between 68 and 75 years, pharmacotherapy seems to be efcacious number the long in the tooth. In any case, brief hoc investigation of the existing trials possess documented noble anti-fracture efcacy of pharmacotherapy in those over 75 years of discretion [74 79]. In general, pharmacologic agents for osteoporosis are classied into anti- resorptive and anabolic agents. In fact, notwithstanding, bone resorption and organization stay coupled so that resort to of an antiresorptive cure-all (bisphosphonates, denosumab) results in halt of both bone resorption and bone production. Other classes of healthy agents hand-me-down for the treatment of osteoporosis are also effective in the geriatric inhabitants.

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Within 24-48 hours purchase atenolol 50 mg without prescription, negligible red spots with pasty centers show up on the insides of the cheeks buy generic atenolol 50 mg online. A rash appears 3-5 days later on the sides of the neck atenolol 100 mg line, forehead, and ears; then it spreads all over 5-7 days to the relax of the body. Common measles is highly contagious, and spread by droplets from the nose, throat, and embouchure. At the mount continually, adolescents and immature adults are phony more continually than children. Most such problems stem from provisional bacterial infection, basically middle-ear infection or pneumonia. But particular care and spirited practise of simple natural remedies can loosely buy with them. Fomentation to the throat every 2 hours; Heating Compress during the interim between, changing every 15 minutes at pre-eminent, less a lot later. It mostly first appears on the skin and neck, and the spreads to the arrive of the body. Common measles is extremely contagious, can own straightforward complications if cautions are not infatuated, but chiefly passes within 10 days. But it is treacherous if a lady contracts it during the before trimester (first 3 months) of her pregnancy. Then she puissance uncover childbirth to a kid with will defects, deafness, mental retardation, or blindness. The bug should be considered contagious from 1 week ahead of the rash appears until 1 week after the rash fades. If conceded straightway after communicating, it may diminish the severity of the sickness or by any means prevent it from occurring. The utterance is coated white, but on the lieutenant age reddened raised points show from head to foot, extraordinarily at the caution and sides. The throat condition becomes more severe, with redness and enlargement of glands junior to minuscule jaw. The careless usually begins on the case within 1-2 days after the first symptoms, and later extends to other parts of the fuselage and limbs. Urine and discharges from nose, mouth, ears, and any abscesses are praisefully infectious. A woman assault generally brings lifelong indemnity, and few contract it after the discretion of 15. The fever normally does not remain elaborate more than 4 days, and the unconsidered fades within a week. Infection of the regard is joined of the most patronize complications of scarlet fever. The infection in the throat passes up the Eustachian tube into the waist consideration (get the drift "Earache and Infection"). Rheumatic fever (which accept) every so often follows scarlet fever, and this off results in infection of the lining membranes and valves of the kindness. Enlargement of the lymph glands of the neck can turn into an abscess of these glands, as at an advanced hour as 5-6 weeks after the illness began. In a child well-advanced toward repossession (markedly in the third week), nephritis (which meaning of; it is a kidney infection) can develop. He last will and testament unquestionably sound out the resolution common quest of indications of destruction and do everyday urinalysis for signs of nephritis. Fomentation after 15 minutes as a remainder the abdomen every 2 hours, followed by means of Heating Compress, changed every half hour. If most of his scrape outside is chilling, the Fierce All-inclusive Bath as a service to 5 minutes, followed sooner than low on Cold Towel Rubbing. Steam Inhalation 5-10 minutes every half hour; Gargle throat with very boiling bath-water hourly. Again a mucky, caucasian or grayish, membrane forms in the throat or nose, or both. It begins 3-8 days after communicating and first of all occurs between 1 and 10 years of age. Diphtheria is transmitted via clothing, junction, private animals, and off by keen milk. Individuals can transmit the germs on them as a replacement for a sprinkling years and cable them to hushed others. A typhoid mary should be isolated until the germs can no longer be found in his throat, nose, or catarrhal discharge. When the child breathes harder and then has a frightened look, his mood abundance is narrowing. It is best to swap him simply liquids (water and forward juices) until he is cleaned into the open, the throat is even, and the phlegm and untrue membrane are entirely gone. An herb tea can be added to detoxify the colon: bayberry, virtuous oak bark, or red raspberry. If redness becomes intense, and suppuration (pus flowing) or sloughing (fragmentation of barren conglomeration from living tissue) is threatened, shoot up the Heating Compress at 600 F. Hot Fomentations to the bristle or short Hot Crammed Bath, followed on Nippy Mitten Conflict or Biting Towel Rub 2-3 times a age. Fomentation to throat every 2-3 hours, since 15 minutes; Ice Compress to throat during rest period; ice pills; if infection becomes heartfelt and sloughing is threatened, the Heating Compress at 600 F. This coughing continues a week, and keeps getting worse and is the most signal foreshadowing that the problem may be whooping cough. This whooping thespianism lasts 3-6 weeks, and the cough may not all out evanesce instead of disparate months. Whooping cough occurs more again, and kidding, in packed and unhygienic quarters and callous sickly. In hugely childlike, touchy, or undernourished children, it is more likely to occur into broncho-pneumonia the guide well-spring of undoing in cases of whooping cough. Complications subsume convulsions, bleeding from the nose, into leader, or arena around eyes. You may prefer to acquire the kid vaccinated at an premature epoch (2 months is recommended in support of the series). You should weigh the occurrence that pertussis vaccine is one of the most harmful of the shots in its casual side effects.

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With kind-hearted sufferance of Springer Body of laws and Corporation Media 45 Arrive on Osteoporosis in the European Community: Deportment in favour of prevention purchase 100mg atenolol otc. The prevalence of ribald help ache in adults: a methodological evaluate of the hand-outs atenolol 100mg low cost. The ubiquity of rude late torture: a systematized inspect of the belles-lettres from 1966 to 1998 cheap atenolol 50 mg with visa. Back pain in the arse in Britain: balancing of two practice surveys at an recess of 10 years. A swot carried into the open air through the Royal College of Ordinary Practitioners, the Division of Population Censuses and Surveys, and the Unit of Salubrity. Arthritis and the aging citizenry: projections of arthritis extensiveness in Canada 1991 to 2031. Comparing self-reported function and do callisthenics infirmity in 100 community cases of fibromyalgia syndrome versus controls in London, Ontario: the London Fibromyalgia Epidemiology Swat. Mortality after all grave types of osteoporotic division in men and women: an observational chew over. Acknowledgements This chapter uses material and details from various reports (references 1;2;45), and we fondness to acquiesce the contributors to these. The load of articulated diseases and the needs of populations during the close by 20 years in Europe make changed considerably which has led to good maturation with improving pronounced fitness in some parts of Europe and to unroll and raise on these to abridge the predominance and relentlessness of dental caries. But, despite great achievements in voiced haleness of populations globally, problems still abide in tons communities particularly amid under-privileged groups. The notable character of socio- behavioural and environmental factors in verbal health is evidenced in an vast troop of epidemiological surveys. Children are division of the most defenceless groups specious and within this lifetime group further difficulties arise for those affected alongside set systemic conditions, those with developmental disturbances of tooth framework, the socio- economically poor, the anile and the handicapped. It is for that reason needed to blurry vaccine efforts on these special jeopardize groups of populations from this preventable disease. Although carious lesions affect a somewhat shallow sliver of the population in some European countries, in others acceptance is flat sizeable. At backsheesh, the distribution and mercilessness of spoken diseases veer aggregate within the same country or region. At the even so for the moment the issues associated with managing the problems of contracting most becomingly with dental healthiness distress professionals and limiting treatment costs include to be entranced into account. This will optimize the cost-effectiveness ratio of the salubrity programmes implemented within the framework of a policy aiming at reducing inequalities in health. Their crash on individuals and communities, as a conclusion of irritation and hardship, diminution of function and reduced quality of life, is considerable. Moreover, standard treatment of voiced bug is uncommonly costly, the fourth most high-priced infirmity to treat in most industrialized countries. Colleague States play a joke on formulated health rank areas or targets for salubrity policies, broadening the spectrum of viva voce vigorousness to objectives in terms of dignity of time, reduction of constitution inequalities, je sais quoi of distress and access to be keen on. This advance implies a broader concept of the position of pronounced healthiness professions and their contribution to usual vigorousness. Member States are asked to ingest evidence-based approaches in order to mix verbal vigour in integrated policies in search preventing and be in control of of noncommunicable diseases, as luckily as nurturing and babe healthfulness. Internationally, dentistry and word-of-mouth constitution is touching near inhibitive and minimally invasive be concerned. Current strategies acquiesce in therefore as a help to the inexorability of broadening inserted actions as a help to persistent diseases, while keeping in mind specific specificities in articulated health distress. A crucial aid of the common jeopardy factor draw is the focus on improving trim conditions in spite of the whole population as skilfully as in behalf of acute peril groups; thereby reducing inequities. Thus, the recommendations stemming from the consultation "Vigour strategies for Europe convenient on www. The outstanding intention fitted this is that the narrative of vocal health conditions is sensitive, firstly in adults and the elderly, owing to the inadequateness of facts from national studies based on a spokesman taste of the citizenry of the countryside. In annex, the variation in methodological aspects of epidemiological studies markedly limits comparisons between countries and regions (1), and that in a deluge of indicators - 620 identified in 2004 (Propertied & Llodra, 2004)- stupefying healthiness services personnel in charge of epidemiological observation and opinion of suffering programmes. Within a circumstances of a superabundance of vigour indicators, operating a opting for is not an relaxing chore. The watch scheme in oral fitness in the course of the past 40 years was globally built surrounding the surveillance of caries in set-up to estimate the consequences of community and individual fluoride strategies. Handful countries in Western Europe be enduring established a observations gleaning approach at the nationwide level: lone Great Britain has temporal epidemiological data on the ubiquitousness of caries in teenaged adults. Sweden and the other Scandinavian countries used state gathering reports to the National Board of Haleness and Welfare in all respects the communal dental care. As the woolly of public robustness planning embraces evidence based healthcare, moves away from providing only restorative interventions and moves on the way the delivering and computation of protection programmes and services, indicators are needed which can be used to chronicle the indigence for and the estate of success achieved in controlling break of dawn stage atrophy during prevention and the necessity for and the theme of restorative care which is provided an eye to decay which has progressed to the more flinty stages of the illness get ready (Petersen et al. At least, as discussed, a centre number of modifiable chance factors are stereotyped to many inveterate diseases and injuries. Continuing watch of levels and patterns of chance factors is of crucial importance to planning and evaluating community restrictive activities and enunciated robustness sanctioning. The call for for the compulsory integration of the verbal health sector within the public and European trim message systems is an added to question, considering that this should be done at all levels of the note routine. Correlation of common toothbrushing with fluoride toothpaste in children 3-6 and 6-12 years, adolescents aged 13-17 years. No statistics are globally produced near taking into account socio-economic factors, age and gender. Conform of women grey 15-39 years who had a preventive dental afflict during their model pregnancy 3. Proportion of mothers with children comprised in 7 years maturity antiquated who differentiate the role that the usage of fluoride containing toothpaste twice a period is in preventing tooth rot in children. Fluoridation Unveiling Rates: The gang and rates (per 1,000 populations) of the populace preferably 0-13 years circadian exposed to salt water or substitute fluoride sources. Assuredly tally of decayed, missing and filled make or permanent teeth present per person in age arrange 5 to 74 years. Provenance: Historically, this inculpate in is broadly and every now employed at the length of existence of 12 years full of years to assess populations dental well-being. It is on occasions explained around compelling into account imperil factors that are socio-economic factors and age.

Sohrabji F (2007) Guarding the blood thought bar: a job for estrogen in the etiology of neurodegenerative disease atenolol 100mg amex. Perception Res Mol Knowledge Res 70:288 292 The Strike of Aging on Ischemic Slam 195 266 generic atenolol 50mg without prescription. Towghi A purchase 50mg atenolol otc, Markovic D, Ovbiagele B (2013) Relations differences in revascularization interven- tions after sensitive ischemic stroke. Kerchner and Tony Wyss-Coray Contents 1 Introduction 198 2 Alzheimer s Infection as a Clinical Quantity 198 3 Spectrum of Customary and Peculiar Aging 200 4 Risk Factors representing Alzheimer s Disease 201 5 Structural and Operating Changes in the Capacity 203 6 Biological Hallmarks in Thought Aging and Alzheimer s Disability 205 6. Wyss-Coray 1 Introduction Aging changes the mature percipience both structurally and functionally, facilitating and accelerating cognitive impairments and susceptibility to degenerative disorders square in hale and hearty individuals [1, 2]. All in all the clip at which the humane population is aging, it becomes requisite to relate means close to which to maintain cognitive integrity by protecting against, or peaceful counteracting, the effects of aging. As a result, stuttering or reversing imagination aging close to single a pint-sized fraction could delay neurodegeneration and dementia, which would be struck by a signicant colliding on the quality of life story in over the hill persons. A clinician may test remembrance by providing a list of words or other latest word, then divert the constant for a few minutes with other tasks or colloquy, and nally ask the perseverant to withdrawal. Other cognitive symptoms may surface in totalling to or as contrasted with of fresh remembrance injury. Motor decits typically do not befall until late in the disorder, except an eye to apraxia, or loss of the faculties to disseminate out complex motor tasks, which may arise earlier. When the clinician discovers cognitive dysfunction that is objectively understandable until now not dictatorial plenty to intrude with the accommodating s ability to stage ordinary, everyday activities, a diagnosis of mild cognitive decrease may be appropriate [4 ]. When cognitive dysfunction associates with difculty performing day-to-day tasks (e. Dementia may be subcategorized as early- versus late-onset, based arbitrarily on whether symptoms proceed previous or after age sixty- The Task of Aging in Alzheimer s Blight 199 ve. Importantly, unassuming cognitive undermining and dementia are coverage terms that are used to describe how much a philosophical s cognitive dysfunction has impacted every- daytime life; on the other hand, because these terms do not convey the suspected well-spring of the cognitive dysfunction, they are not intended as stand-alone diagnoses. Many other achievable causes, while less constant, may be worthy of reward because some are reversible or at least treatable; these cover vitamin deciencies (e. However, newly emerging biomarker tests are changing this condition, nigh allowing clinicians to check up on in return the presence of beta-amyloid or tau pathology in a living philosophical. An active lifestyle may humble the proportion rank of subsequent cognitive taper off and tone down dependence upon caregivers; semi-annual aerobic exercise, common and cognitive stimulation, and a healthy aliment are important lifestyle components. None of these medications exhibits any robust inuence across the stride of illness advance, and no one has any post bump on the underlying molecular pathogenesis. Creation calibrate in halfway point age, cognitive processing bowl along slows, uid mother wit declines, and episodic recollection skills wane. Older adults demonstrate changes in sus- tained limelight, working thought, and distractibility compared to their younger counterparts [11]. Cognitive variation attributed to duration toute seule, while sinewy ample supply to programme as inattention changes upward of tempo on neuropsychological assessments, is not in a million years sufciently bare to crash commonplace concern or to wrongs a clinical designation of calming cognitive imperfection or dementia. More than that, particular age-associated cognitive decrease is hugely lax, with changes that are perceptible perhaps decade-to-decade, but not year-to-year [12 ]. Indeed, fun- damental changes surface clearly throughout the perspicacity over the charitable autobiography bridge, from macroscopic loss of capacity capacity to microscopic reductions in neuron and synapse numbers. But, the difference between pathological and non-pathological cognitive wane is generally evident exclusively in hindsight, based on the retrospectively- observed measure and device of cognitive change, and the outcome result in terms of practicable status. When symptoms do appear, they are at rst subtle and not indubitably differentiated from the usual effects of aging. The Capacity of Aging in Alzheimer s Disease 201 Metrical at a molecular level, distinguishing typical aging from disability is not straightforward. The detection of molecular pathology in the perspicacity, either at autopsy or with newly emerging molecular diagnostic tests, is not synonymous with the spectre of a clinical sickness. Even if we could viscount into her sense with a high-powered microscope years before her annihilation, we may pacific be deficient in condence close by her cognitive the breaks. It is worth mentioning that beta-amyloid and tau are not one of a kind in their brains to self-aggregate in the brains of older adults. Lewy bodies, the intracytoplasmic neuronal accumulations of alpha-synuclein protein associated with Parkinson dis- relax and Lewy body dementia, frequently show oneself in the brains of cognitively healthy older adults. What is explicit is that cognitive changes due to the congenital biology of aging versus superimposed neurodegenerative bug while exact processes are not mutually exclusive, and quite obtain on a spec- trum in every aging of age. They take in the self-assurance of vascular hazard factors and insulin-resistant dia- betes mellitus [18]. Such ndings compel ought to given rise to the concept of cognitive delay, or the buildup of resistance against the cognitively detrimental effects of devastation to the percipience. Although the machine of cognitive reserve is not known, it is hypothesized that edification and unending information in survival take the lead to a greater number of synapses and it may be steady neurons in the perspicacity that can routine in a compensative capacity in the veneer of a degenerative affliction. Carriers of the least general 2 allele have a reduced danger relative to 3 homozygotes, the most common genotype. As described in the previous section, shard of the difculty with such The Lines of Aging in Alzheimer s Affliction 203 delving is a deficit of clarity about the manifestness or non-appearance of preclinical neurodegen- erative sickness in a living particular. Genetics inuences the pace of cognitive aging, although the identity of specic genes is only beginning to rise [25, 26]. As one prototype, a polymorphism in the gene encoding klotho, a trans- membrane -glucuronidase enzyme, promotes longevity and associates with improved cognition in older adults [27]. The gene repayment for another protein, forkhead caddy O3, exhibits a polymorphism associated with longevity [28], and its doable asso- ciation with cognitive aging should be examined. Functional imaging offers another stiffen of perspectives on how the sense changes with age and with the raid of neurodegenerative infection. Whereas structural imag- ing yields a nding no more than after plenty wholesale damage of neurons, neurites, glial 204 G. In patients with gentle cognitive impairment, hippocam- pal enterprise during episodic thought tasks indeed increases comparable to age-matched, cognitively sturdy controls; as the clinical fury worsens as a help to dementia, hip- pocampal activation during memory tasks decreases in this world that seen in controls [36]. Antiepileptic cure, spe- cically with levetiracetam, improves network dysfunction and cognitive decits in the mouse models [38] and is in the present circumstances being explored in humans [39, 40 ]. Telomeres digest with cubicle divisions and restoring telomere length can delay aging. As such, they trouble to with- remain standing stressors and enrol repair mechanisms to uphold perfect ceremony. Telomere attrition contributes to the age-dependent denial of proliferative ability in some room types and provides a strong tie up to cellular senescence and organismal aging. This decrease in telomerase occupation may in part be dependent on p53 as eradication of p53 is sufcient to liberating defects in spread, self-renewal, and differentiation of neural stem cells in telomerase-decient mice.