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