Aging and Neurocognition

Question 1

What is Senescence? What is aging like during this period?

Answer 1

Final natural life stage of our lifespan

Aging during senescence can include changes in:
observable features (skin texture and tensility, thinning of hair, gait change)
Sensory changes (hearing loss, loss of taste, awareness of one’s body and surroundings)

Question 2

What are the two types (classes) of Neurocognitive Disorders?

Answer 2

Delirium
temporary or transient confusion or disorientation symptoms

Mild/Major Neurocognitive Disorders
progressive, gradual irreversible deterioration of cognitive abelites

Question 3

Older term for Neurocognitive Disorders

Answer 3

“organic” mental disorders

organic to mean brain damage
we now realize that this definition is the one that is brain damaged

Question 4

History of Delirium

Answer 4

Hippocrates referred to “phrenitis” in 500BC as a type of fever or head trauma that caused mental problems
“Delirium” was used by Celsus around 100 AD to describe mental disorders related to fevers or head trauma
”to wander”, “to leave home”, “silly talk” are all potential roots of the word

Question 5

Key Features of Delirium (4)

Answer 5

disturbance of consciousness
disturbance of cognition
limited course
external causation

Represents about 10% of acute care cases in emergency rooms
Is a VERY important condition to catch because of its mortality predictive rates
40-50% of people who experience delirium die within one year

Question 6

Criteria of Delirium

Answer 6

Disturbance in attention by reduce awareness of the environment
Develops over a short period of time
Additional disturbance in cognition
Disturbance is a DIRECT consequence of a medical condition, substance, toxin etc.

Question 7

True or False: Delirium is an aging neurocognitive disorder.

Answer 7

False!

Common in people who overdose on various substances (any age)

More common in seniors because seniors tend to eliminate/process substances slower in the body
Also more common in seniors because of increased infection rates, sleep deprivation, stress, etc

Question 8

Treatment for Delirium

Answer 8

Rapid treatment improves long term outcomes and reduces mortality rate

Begins with an assessment of potential cause
If substance withdrawal, could prescribe haloperidol (an antipsychotic medication)
If infection or brain injury, give treatment for the infectious agent or anti-inflammatory medications
When cause unknown, prescribed haloperidol and olanzapine (anti-psychotics)
Increase family/peer support during times of confusion, increase routine/structure, memory aids
= improve symptoms while medications take effect

Prevention is most effective!! Psychoeducation for the patient and family (particularly for seniors), frequent medical checks, particularly when using new substances or feeling ill, proper sleep, nutrition, and hydration

Question 9

Characteristics of MAJOR Neurocognitive Disorders

Answer 9

gradual deterioration of the brain functioning that affects:
Judgment
Memory (i.e., agnosia, the inability to recognize and name objects, or facial agnosia)
Language
Many other advanced cognitive processes/skills

Question 10

Characteristics of MILD neurocognitive disorder

Answer 10

Mild neurocognitive disorder was created to focus attention on the early stages of cognitive decline and thus refer to changes that are often less severe and do not interfere with their lives (little functional impairment)

less severe cognitive decline, less impairment

Question 11

True or False: Only seniors suffer from mild/major neurocognitive disorder

Answer 11

False

Can occur at any age, but more common among adults 65+ and likelihood increases with age thereafter
Affects approximately 7% of Canadians 65+
Often results in death; perhaps because of inactivity combined with deteriorated brain-body organization (i.e., reduced immunity can result in increased infections)

Question 12

Criteria of MILD neurocognitive disorder

Answer 12

Modest decline cognitive decline in one or more cognitive domains
Does not interfere with independence

Question 13

Criteria for MAJOR neurocognitive disorder

Answer 13

Significant cognitive decline in one or more cognitive domains
Deficits interfere with independence
Do not occur exclusively in the context of delirium

Question 14

Conditions that lead to Mild/Major Neurocognitive Disorder

Answer 14

Alzheimer’s Disease

Vascular Neurocognitive Disorder

Other medical conditions:
HIV infection
Huntington’s Disease
Prion Disease

Question 15

Alzheimer’s Disease: explain relation to M/MND, cause and survivalbility

Answer 15

Increasing memory impairment and other behavioural/cognitive decline
Symptoms often worsen in evening/night (sundowner syndrome)
Accounts for most Mi/Ma ND
Often only diagnosed during autopsy, but research has made progress on diagnosing over long periods of observation of memory, language, visuospatial skills
Causes are being extensively researcher
Progressive brain damage from neurofibrillary tangles
Amyloid plaque build-up
Average survival time is 4-8 years, but some can live dependently for 20 years (especially those diagnosed earlier in their 40s or 50s)
Higher education predicts better outcomes (mental reserves?)
Perhaps more neuronal connections means there must be MORE breakdown before problems occur
e.g., cerebral reserve hypothesis

Question 16

Vascular Disease: What is it?

Answer 16

“vascular” here refers to blood vessels which can get blocked or damage in the brain
Marked by decline in processing speed and executive function
Onset more sudden than Alzheimer’s
While strokes are a common cause of death among seniors, surviving often involves significant cognitive impairment

neurocognitive impairment after stroke

Question 17

Impact of HIV on neurocognitive abilities?

Answer 17

Not because of co-occurring infections, but the HIV itself
Marked by decline in processing speed, attention, memory, and clumsy/repetitive movements
Sometimes referred to as subcortical dementia because of damage to regions beneath the cortex
Creates less functional impairment and more mental health symptoms like depression and anxiety

Question 18

Huntington’s Disease

Answer 18

Genetic disorder affecting motor movements caused by ONE specific gene
Chorea = involuntary limb movements
Typically results in death within 20 years of first signs
About 43% of people with Huntington’s may eventually develop Mild ND

Question 19

Prion Disease

Answer 19

Prions are proteins that reproduce and damage brain cells
No treatment available as the protein lacks DNA/RNA and thus always leads to death
Hard to contract (must either eat another person or tainted blood transfusions)

Question 20

What is the neurocognitive disorder that is caused by substance use or medication use?

Answer 20

Substance/medication-induced neurocognitive disorder
Can be caused by prolonged substance use (worsened by poor quality diet)
50-70% of chronic heavy alcohol users can show cognitive decline
7% of those with alcohol use disorder meet criteria for ND
Can be related to many substances (alcohol, overdosing prescriptions, gasoline, methamphetamines)