Aging deeply influences several morphologic and functional features of the
peripheral nervous system (PNS). Morphologic studies have reported a loss o
f myelinated and unmyelinated nerve fibers in elderly subjects, and several
abnormalities involving myelinated fibers, such as demyelination, remyelin
ation and myelin balloon figures. The deterioration of myelin sheaths durin
g aging may be due to a decrease in the expression of the major myelin prot
eins (P0, PMP22, MBP). Axonal atrophy, frequently seen in aged nerves, may
be explained by a reduction in the expression and axonal transport of cytos
keletal proteins in the peripheral nerve. Aging also affects functional and
electrophysiologic properties of the PNS, including a decline in nerve con
duction velocity, muscle strength, sensory discrimination, autonomic respon
ses, and endoneurial blood flow. The age-related decline in nerve regenerat
ion after injury may be attributed to changes in neuronal, axonal, Schwann
cell and macrophage responses. After injury, Wallerian degeneration is dela
yed in aged animals, with myelin remnants accumulated in the macrophages be
ing larger than in young animals. The interaction between Schwann cells and
regenerative axons takes longer, and the amount of trophic and tropic fact
ors secreted by reactive Schwann cells and target organs are lower in older
subjects than they are in younger subjects,The rate of axonal regeneration
becomes slower and the density of regenerating axons decrease in aged anim
als. Aging also determines a reduction in terminal and collateral sprouting
of regenerated fibers, further limiting the capabilities for target reinne
rvation and functional restitution. These age-related changes are not linea
rly progressive with age; the capabilities for axonal regeneration and rein
nervation are maintained throughout life, but tend to be delayed and less e
ffective with aging.