Aging and Cognition

Question 1

Why is aging not a disease?

Answer 1

aging is a natural physiological process. diseases are often much more common in later life.

Question 2

Why are stereotypes problematic and what are some examples?

Answer 2

health beliefs can influence behaviour which causes health problems. but to overcome stereotypes can also have unrealistic expectations, and not sure how to deal with problem. stereotypes relatimg to cognition and mental health; all old ppl suffer from rigid thinking. as ppl age, their ability to learn stops. it is easier to learn new things then recall things from the past. forgetfulness is likely to indicate onset of early dementia. everyone who gets old will develop dementia and depression.

Question 3

How is aging associated with increased heterogenity?

Answer 3

bc as we age ppl go through diff courses in life, ie diff health status, cognition, organ fxn, physical performance for everyone.

Question 4

What is cognition and how is it affected by aging?

Answer 4

cognition is thinking, learning, and memory. cognitive impairment with age is not normal. but it is common, especially in oldest old. the causative factors are disease, disuse (so not learning new things and challenging brain), aging process

Question 5

What are the 5 aspects of cognition?

Answer 5

1. fluid and crystallized intelligence 2. memory 3. attention 4. orientation 5. executive skills/fxn

Question 6

What is intelligence and aging?

Answer 6

crystallized is wisdom which we accumulate through aging, pass along traditions, historical stories, rituals, etc. increases with age. fluid is speed and accuracy at processing info. decreases with age be of loss of myelin sheaths

Question 7

What are the different kinds of memory and how are they impacted by age?

Answer 7

Temporal: primary; registration and immediate recall (not affected by aging), STM; recall in a matter of minutes ie smthn discussed earlier in day (affected by age) Working; ability to manipulate and act on memory ie cooking and driving (affected by age), Prospective; ability to remember to do smthn in future ie take meds (affected by age), LTM; permanently stored very durable ie smthn that happened as kid (not affected by age)

Question 8

What are the different types of information in memory?

Answer 8

Episodic; everyday memory ie episodes/events. Semantic; cumulative knowledge about the world in general ie vocab improves. Procedural; performance based ie riding a bike (usu stays same with age)

Question 9

What is attention and orientation and how are they affected by aging?

Answer 9

Attention is the ability to focus on a task or activity (increases with age). divided attention; is when we have to split our attention btwn two activities ie driving and talking (decreases with age). Orientation is knowing who we are, where we are and when. its also visuospatial skills, so the ability to understand space. Orientation can affect gait pattern and balance.

Question 10

What are the executive skills/fxn and their changes with aging?

Answer 10

things like planning, sequencing, judgment/insight, working memory, and understanding others. declines with age bc theres a decrease in the number of cells in the brain

Question 11

What are the ten health problems listed with aging? How does mental health factor in?

Answer 11

Depression, dementia, delirium, incontinence, orthostatic hypotension, falls and dizziness, osteoperosis, polypharmacy, pain in the elderly, failure to thrive, frailty, elder abuse. top three are all mental health issues, problems are often not distinct entities.

Question 12

What are some common mental health issues?

Answer 12

its the same issues one has when they were younger, its unusual to have a new onset in later life. anxiety, personality traits and disorders. grief is more common due to repeated deaths of loved ones. Caregivers are also frequently OAs, which is a burden and a stressor. Also adjusting to new roles, such as not working anymore, volunteering, planning, not knowing what to do. There are also psych consequences to illnesses such as thyroid disease, stroke, disability, multimorbidity. as there are physical changes that come with these.

Question 13

What are the differential diagnosis within aging of mental health and disability?

Answer 13

1. normal aging 2. mild cognitive impairment 3. dementia 4. delirium 5. depression

Question 14

what is normal aging?

Answer 14

no consistent, progressive loss of memory function. decline in speed of processing. some decline in how hard or fast we can process new information. reminders still work. absence of many effects on ADL or IADL. so should be able to have independence and functional ability still. minimal cognitive and functional impairments.

Question 15

What is mild cognitive impairment?

Answer 15

memory deficits with no impairments in other domains. no fxnl impairments. 10-15% a year progress to alzheimers disease. so getting increases in impairment with age.

Question 16

What is dementia?

Answer 16

an acquired syndrome of decline in memory and other cognitive functions that substantially affect daily life. progressive and disabling. different than normal cognitive lapses. Not an inherent part of aging.

Question 17

What is the difference btwn the prevalence and incidence of dementia?

Answer 17

Prevalence is the proportion of ppl that have it in a specific pop, so more women have it bc there are more older women. Incidence is the amount of new cases reported in a specific pop, so women are only slightly higher.

Question 18

What are the impacts of dementia?

Answer 18

Economic: 100 billion dollars lost annually bc of caregivers being occupied and pts also leaving workforce etc. also insurance usu only covers half of costs dod becomes burden on the family. Emotional: 50% of caregivers develop depression. also direct emotional toll on pts.

Question 19

What are the risk factors for dementia?

Answer 19

Definite: physical activity, genetics/heredity, APOE4 allele (lypo-protein), age, down syndrome. Possible: head injury, less years of education, obesity/diabetes, cardiovascular disease, late onset of major depression.

Question 20

What are the major types of dementia?

Answer 20

1. alzheimers disease 2. vascular dementia 3. Parkinsonian syndrome; parkinsons dementia, and lewy body dementia 4. frontotemporal dementia 5. mixed dementia

Question 21

What is Alzheimers disease?

Answer 21

Onset: gradual Cognitive symptoms: difficulty with memory, and learning new information, disturbed executive function. Motor symptoms: rare early, apraxia later (so cant get motor pathways, or mvmts so forgetting how to reverse car, brush teeth etc). Progression: gradual over 8-10 years. Lab tests: normal Imaging: MRI t olook at global atrophy

Question 22

What is odds ratio and confidence interval? how do these things relate to PA, age, and education with alzheimers?

Answer 22

Odds ratio is the odds of smthn happening, so the measure of an outcome given the exposure. Confidence interval is the variance seen with observation. so how many ppl smthn applies to. With PA, odds ratio decrease the more you od, and so does CI. with education, OR decreases with more done, but confidence interval doesnt really change. with age, OR increase and so does CI.

Question 23

What is vascular dementia?

Answer 23

Onset: sudden/stepwise. happens bc of stroke and ischemia. cognitive symptoms: depends on anatomy of ishemia. Motor symptoms: depends on ischemia Progression: pregresses stepwise id increase in ischemia Lab tests: normal Imaging: cortical or subcortical changes on MRI

Question 24

What is Lewy body dementia?

Answer 24

Onset: gradual but slower then AD. Cognitive symptoms: memory, visuospatial, hallusinations, fluctuations. Motor symtoms: parkinsonian Progression: gradual but faster then AD Lab tests: normal Imaging: global atrophy

Question 25

What is frontotemporal dementia?

Answer 25

Onset: gradual, usually 60+Cognitive symptoms: executive: disinhibition, apathy, behaviour changes. Motor symptoms: none, but maybe with ASL. Progression: gradual but faster then AD Lab tests: normal Imaging: MRI of atrophy in frontal and temporal lobe

Question 26

How can we prevent Dementia?

Answer 26

might not be possible/dont really know. statins, lowering amount of lipids in system (for and aganst evidence), physical activity, mental stimualtion (use it or lose it)

Question 27

What are the 6 pillars of a brain-healthy lifestyle?

Answer 27

1. regular exercise 2. healthy diet 3. quality sleep 4. mental stimulation 5. stress management 6. active social life

Question 28

What is the epidemiology of depression among older adults?

Answer 28

the % of ppl with the most depression is actually young ppl. could this be bc older adults just arent getting diagnosed? OAs with mild/minor depression are 12-15%. major depression increases for those who are hospitalized or nursing home residents.

Question 29

What is the DSM-4 diagnostic criteria for major depression?

Answer 29

gateway symptoms; depressed mood, loss of interest or pleasure (anhedonia). other symptoms; apetite change or weight loss, insomnia or hypersomnia, psychomotor agitation or retardation, loss of energy, feelings of worthlessness or guilt, difficulty concentrating, making decisions, recurrent thoughts of suicide or death (suicidal ideation)

Question 30

What are the differential diagnoses of depression?

Answer 30

medical illness can mimic depression. ie thyroid disease, and conditions that promote apathy. Dementia has overlapping symptoms; impaired concentration, lack of motivation, loss of interest, apathy, psychomotor retardation, sleep disturbance. Bereavement (grief); most disturbing symptoms are gon within 2 months, not associated with marked functional impairment.

Question 31

What are the diagnostic challenges of dementia in a medical setting?

Answer 31

symptoms of depression and physical disorders often overlap; ie disturbed sleep, fatigue, diminished appetite. seriously ill or disabled ppl may focus in thoughts of death or worthlessness but NOT suicide. side effects of drugs for other illnesses confused with depressive symptoms.

Question 32

Why is diagnosis of depression difficult in older adults?

Answer 32

more often report somatic symptoms such as pain, head hurting. less often to report depressed mood, guilt. mask depression bc preoccupied with phys concerns

Question 33

Who is suicide more common with?

Answer 33

males vs females, older men vs younger men, indigenous vs non-indigenous

Question 34

What are normal thoughts of death vs abnormal?

Answer 34

expect death, and accept it as normal part of life, be ready for death. not normal to desire death, or have suicidal plans/ideations

Question 35

What are the risk factors for depression?

Answer 35

age, male, new illness, living alone, substance use, fxnl deterioration, poor vision

Question 36

What is the incidence of delirium among older patients?

Answer 36

high, 1/3 of older pts presenting to the ED. 1.3 of inpatients aged 70+ on general medical units half of whom are delirious on admission.

Question 37

What are the consequences of delirium?

Answer 37

10-fold risk of death in hospital, 3-5-fold risk of nosocomial complications, prolonged stay, post-acute nursing-home placement. poor functional recovery and increased risk of death up to 2 yrs following discharge. persistence of delirium= prolonged long-term outcomes

Question 38

What are the different types of delirium?

Answer 38

hyperactive or agitated delirium (agressive, loud, visibly disturbed) - 25% of all cases. mixed. hypoactive delirium (dont show any of previous symptoms) - over 50% of all cases but less recognized and appropriately treated so poorer prognosis

Question 39

What are the predisposing factors to delirium?

Answer 39

advanced age, dementia, male, fxnl impairments in ADL, history of alcohol abuse, medical comorbidities, malnutrition, sensory impairment (vision or hearing loss)

Question 40

What are the keys to affective management of delirium?

Answer 40

ID and treat reversible contributors; optimize meds, treat infections, pain, fluid balance disorders, sensory deprivation. Maintain behavioural control; behavioural and pharmacologic interventions. anticipate and prevent complications; urinary incontinence, immobility, falls, pressure ulcers, sleep disturbance, feeding disorders. restore fxn; hospital environment, cognitive reconditioning ADL status, family education, discharge planning. the best management is Prevention

Question 41

What are the distinguishing signs of delirium?

Answer 41

acute onset, cognitive fluctuations over hours or days, impaired consciousness and attention, altered slee pcycles.

Question 42

Commonalities btwn symptoms of depression and dementia?

Answer 42

impaired concentration, lack of motivation, loss of interest, apathy, psychomotor retardation, sleep disturbance

Question 43

What are the differences btwn depression and dementia?

Answer 43

ppl with depression; demonstrate decreased motivation during cognitive testing, express cognitive complaints that exceed measured deficits, maintain language and motor skills