10 - Cognitive Health & Aging Flashcards
5 Different Functions of the Brain
1) Cognitive health: thinking, learning, remembering
2) Motor function: ability to control movements and balance
3) Emotional function: ability to interpret and respond to emotions
4) Tactile function: ability to feel and respond to touch (pressure, pain, temperature)
5) Sensory function: ability to use the other sense (sight, hearing, taste, smell)
The 3 D’s Of Cognitive Impairment
- not a normal part of the aging process
- the incidence of the 3 D’s increases with age
- all lead to cognitive and behavioural changes
What is Depression?
- known as major depression, major depressive disorder, or clinical depression
- Common mood disorder
- affects how a person feels, thinks, and handles daily activities, such as sleeping, eating, or working
Type of Depression
- Major depression: loss of interest in activities or depressed mood most of the time over the last 2 weeks, to the extent that symptoms impair everyday activities
Depression in Older Adults
- <20% of older adults in Canada have depression
- almost 1/2 ofolder adults living in residential care facilities had a diagnosis and/or symptoms of depression
- The symptoms of depression impacted residents’:
- physical Health (e.g. Unstable health conditions)
- Socialization (e.g. Conflict/ withdrawal)
- Functional Health (e.g. Decline in self-sufficiency)
- Quality of Life (e.g. Pain or serious health challenges)
- physical Health (e.g. Unstable health conditions)
What are the Causes of Depression?
- no singular cause
Predisposing Factors
- Brain chemistry
- Genetics
- Certain medical conditions (e.g. thyroid dysfunction)
- Certain medications
- Social Isolation
- History of depression
- Widowed/divorced
Precipitating Factors
- Recent bereavement
- Stressful life events
- Chronic stress
- Persistent sleep challenges
S & S of Depression in the Older Adult
- Does not get dressed
- Loss of interest in previously enjoyed activities
- Expresses consistent feelings of sadness
- Sleep dysfunction (too little or too much)
- Eats more or less than typical
- Difficulty concentrating
- Lacks energy
- Difficulty remembering things
- Isolates oneself
- Talks about self-harm or suicide
- Somatic symptoms (insomnia, loss of appetite, persistent pain)
How to Diagnose Depression
A comprehensive assessment
1) Patient interview
2) Medical history
3) Physical & cognitive assessment
4) Medication review
5) Family/caregiver review, if possible
6) Depression screening tool e.g.
7) Geriatric Depression Scale Short Form (GDS-SF)
How to treat Depression?
Common treatments include:
- Psychotherapy
- Medications
Other actions that improve symptoms of depression include:
- Regular physical activity
- Eating a nutritious diet
- Avoiding alcohol
- Social interaction with friends and family
- Proper sleep hygiene
Consequence’s of Depression
- Functional decline
- Delayed recovery from an illness
- Malnutrition
- Decreased quality of life
- Increased risk of substance use
- Increased risk of suicide
Prevalence of Dementia
- Prevalence of dementia increases with age, doubling approx. every 5 years for ppl between ages of 60- 95 years
- prevalence is 25% for those older than 85 years
- Stroke doubles the chances of developing dementia
- Mitigating stroke risk is the most immediate and effective strategy to reduce the rates of both stroke and dementia
Who is most likely to have dementia?
- Women are more likely than men
- prevalence of dementia is higher among racial minorities
- prevalence of dementia and a younger age of onset is higher among Indigenous peoples
- Indigenous men are more likely than women
- These differences are caused by the increased vulnerability associated with: ______________________(need this answer)
Early Signs of Dementia
- Memory loss
- Misplacing items often
- Forgetting names of familiar things
- Repeating themselves without noticing
- Hesitating to try new things
Typical VS. Untypical Signs of Dementia
Typical
- Forgetting which word to use
- Making a bad decision
- Poor judgments/decisions a lot of the time
- Problems taking care of the monthly bills
- Losing track of the date/time of year
- Trouble having a conversation
- Misplacing things often/unable to find them
Untypical
- Losing things from time to time
- Missing a monthly payment
- Forgetting which day it is (remembering later)
Modifiable Risk Factors
- LDL cholesterol
- Health weight/treat obesity
- High alcohol consumption
- Treatment of vision loss
- Quality education
- Hearing aids
- Use of helmets
- Exercise
- Cigarette smoking
- Hypertension ???
- Social isolation ???
What is Dementia
- the correct term is Neurocognitive Disorder
- it is a disorder on neuro-cognition
- thinking, remembering, and reasoning will be disorganized
What are the 4 Types of Dementia
1) Alzheimer’s disease
2) Vascular dementia
3) Lewy body dementia
4) Frontotemporal dementia
What is Alzheimers?
- Can take a long time to recognize as something other than normal aging
- Apathy & depression may be the first/earliest signs of AD (up to 3 yrs b/f dx)
- Early symptoms: memory loss, may include word-finding problems, vision or spatial issues, and impaired reasoning or judgement
- Common to take up to 4 yrs from the first symptom to seeking help
- Stigma associated with dementia contributes to the delay in seeking help
What is Vascular Dementia?
- known as multi-infarct dementia, post-stroke dementia, or vascular cognitive impairment
- Consists of a group of heterogeneous disorders arising from cerebrovascular insufficiency or ischemic or hemorrhagic brain damage
What is Lewy Body Dementia?
- Characterized by a combination of cognitive impairment, psychosis, and features of parkinson
- Memory loss might not be evident at first
- Hallucinations are common and occur often through out the day
- Movement problems and altered gait
- Sleep disorders
- Dysregulation or autonomic body functions: changes in blood pressure or incontinence
- Less common/widely underdiagnosed condition
- Many are diagnosed as having other types of dementia (most commonly AD or PD) if they present with movement problems
- Memory impairment is milder, and impaired executive function is common
- includes severe sensitivity to neuroleptics
Why is it important to diagnose LBD early?
- Early and accurate diagnosis is essential, as neuroleptics can cause a severe worsening of movement and a fatal condition known as neuroleptic malignant syndrome (severe fever and muscle rigidity, can lead to kidney failure)
What is Frontal-Temporal Dementia?
- Shrinkage of the frontal and temporal anterior lobes of the brain
- linked to several chromosomal mutations: 30 - 40% have family members with a neurodegenerative disease
- Mean age onset between 52 and 56 yrs
- Rapid disease progression, poor prognosis
- Often not accurately diagnosed
- Early symptoms are often related to changes in personality and inappropriate social behaviour (different from AD)
- There are no approved medications that slow the progress of FTD
Symptoms of FTD
- Behavioural changes/challenges…
- Inappropriate actions
- Lack of empathy
- Poor judgment
- Apathy
- Aphasia
- Poor Hygiene
- Impulsive
- Movement disorder
- Speech and language problems
Nursing Interventions for Dementia Care?
- Create meaningful moments and activities
- Structure daily living to maximize remaining abilities
- Monitor the general health and impact of dementia acute and chronic medical conditions, paying attention to the person’s experience of pain and mental health
- Create opportunities for social engagement, freedom of choice, self-expression, spirituality, and creativity
- Support advance care planning
- Educate caregivers in the areas of problem solving, long-range planning, emotional support, and accessing resources and respite
Nursing Implications: Caring for a Client with Dementia
Person-Centered Care
- Foster client’s abilities & control
- Ensure client’s safety
- Maximize quality of life
- Prevent avoidable disability
- Support proper nutrition
- Create opportunities for meaningful interaction
- Developing therapeutic relationships
Minimize Stressors
- Pain
- Depression
- Loss of control/restraints
- Communication difficulties
- Hunger, thirst, need to use the washroom
- Loneliness
- Fatigue
- Depersonalized care
What are the 7 A’s
1) Anosognosia
2) Aphasia
3) Amnesia
4) Agnosia
5) Apraxia
6) Altered perception
7) Apathy
What is Sundowning?
- Agitated at night, no sleep, climbing out of bed, pacing, wandering
What risks does this present?
Does the hospital environment help/hinder?
How to minimize? Restraints?
What is Delirium?
- a complex neuropsychiatric syndrome marked by an acute onset, fluctuating course, altered level of consciousness, inattention, and disorganized thinking
- It is acute and typically lasts for hours to days, though it may persist for weeks or even months
- Symptoms fluctuate throughout the day
Can often be prevented
Clinical Features of Depression
Onset
- variable; can appear abruptly
- coincides with life changes
Course
- diurnal effects; worse in the morning
Duration
- S&S present for at least 2 weeks (many persist)
Alertness
- normal
Attention
- minimal impairment
- distractible
- poor concentration
Orientation
- selectively intact (“I dont know”)
Memory
- selective or patchy impairments
Thinking
- intact
- themes of helplessness, hopelessness, guilt
- rumination
Perception
- rarely impaired
- hallucinations absent except in severe cases (psychosis)
Clinical Features of Dementia
Onset
- chronic, progressive decline
Course
- long, progressive, stable loss over time
Duration
- chronic (months - years)
Alertness
- normal until late stage
Attention
- generally normal
- can decline with disease progression
Orientation
- increasing impairment overtime
Memory
- recent memory impaired
- remote memory is increasingly impaired with disease progression
Thinking
- difficulty with abstract thinking
- poor judgement
Perception
- can be longstanding (dementia w/ lewy bodies)
- can occur at late state of illness (alzheimers)
Clinical Features of Delirium
Onset
- acute
Course
- short, fluctuating and worse at night
Duration
- typically short (hours to < 1 month)
- can be persistent
Alertness
- lethargic or hyper-alert; fluctuates
Attention
- inattention, unfocused, distracted; fluctuates
Orientation
- may be impaired; fluctuates in severity
Memory
- recent memory impaired
Thinking
- disorganized; disconnected; tangential; rambling; incoherent
Perception
- acute onset hallucinations
- delusions and illusions are common
Incidence and prevalence of delirium
- Approximately 50% of hospitalized adults may experience delirium
- Over 40% of residents in long-term care facilities experience delirium at some point
- Within acute care and LTC, delirium is unrecognized in many individuals
Consequences of Delirium
- Distress for the individual and their family/friends
Delirium during hospitalization is associated with:
- high morbidity and mortality
- functional decline
- increased postoperative complications
- increased length of hospital stay and hospital readmissions
- increased services after discharge
- long-term cognitive decline
- high rates of institutionalization
- although delirium is considered a reversible cause of altered mental status, many elderly with delirium never return to their baseline cognitive status, especially in the presence of pre-existing dementia
Subtypes of Delirium
1) Hyperactive delirium: - characterized by heightened arousal, restlessness, agitation, delusions, and/or aggressive behaviour
2) Hypoactive delirium: - characterized by sleepiness, quieting of symptoms, and/or disinterested behaviour
Most common type of delirium in older adults
3) Mixed delirium:
- characterized by alternating hyperactive and hypoactive states
How to Prevent Delerium
Assessment (assess risk factors)
- Planning (tailored, non-pharma prevention)
- Implementation
- Ongoing assessment at least daily
Risk factors for Delirium
Predisposing Risk Factors
- age 65 and older
- male
- visual/hearing impairment
- reduced mobility and history of falls
- dehydration
- malnutrition
- certain meds (polypharmacy and psychoactive)
- co-existing medication conditions
Precipitating Risk Factors
- emotional stress
- pain
- surgery
- severe illness
- prolonged sleep deprivation
- neurological infections (ie. stroke)
- infections
- admission to ICU and/or use of restraints
Risk Factors for Delirium Severity in Long-Term Care Homes
Absence Of
- Adequate nutrition
- Aids to orientation
- Family member
- Glass of water
- Reading eyeglasses
Presence Of
- Antipsychotic prescription
- Bed rails and other restraints
- Dementia
- Depression
- Hearing impairment
- Pain
Preventative Interventions for Delirium
1) Cognitive Impairment, Dementia, Disorientation
Intervention
- use clear communication
- implement environmental aids (sufficient lighting, signage, clocks, calendars)
2) Sensory Deprivation
Intervention
- implement cognitively simulating activities
3) Sleep deprivation and disturbance
Interventions:
- avoid medical intervention during sleeping hours
- use non-pharmacalogical methods to promote sleep
- reduce noise/light during sleeping hours
