Cognitive and Psychological Issues Flashcards
What is executive function?
Higher order cognitive skills
- sequencing
- self awareness
- planning
- organizing
- evaluating
Cognitive flexibility
- knowing how to adapt to situations
Decision making
- financial (are you getting a good deal, forward planning)
Ability to regulate emotion
Feedback utilization
Self perception
Standardized test for cognitive issues
MMSE
- Not sensitive to address the suitable changes associated with aging
- EF more of a predictor of function
3 approaches to assess executive function
Neuropsychological approach: relationship between impaired brain areas and behavior
- MRI’s other “hard” diagnostic tools
Cognitive approach: focus on specific cognitive process that make up EF
- Don’t usually have a baseline, so how do we know?
Functional approach
- Kettle Test
- Multiple Errand Test
What is metacognition?
Knowing what you know and what you don’t know
Self awareness of your intellect
What is the MMSE?
The MMSE consists of 11 simple questions or tasks grouped into 7 cognitive domains:
1) Orientation to time
2) Orientation to place
3) Registration of three words
4) Attention and calculation
5) Recall of three words
6) Language
7) Visual construction
Levels of impairment have been classified as:
None: score = 24-30
Mild: score = 18-24
Severe: score = 0-17
Common executive function assessments
Trail Making Test
Verbal Fluency Test
VFT Animals Category
Clock Draw Test
Digits Forward and Backward subtest (Digits Span Test)
Stroop Test
Wisconsin Card Soring Test
Behavioral Assessment Of the Dysexecutive Syndrome
Kettle Test
Multiple Errand Test
Executive Function Test
3 approaches to EF intervention
- Cognitive
- Exercise
- Social Engagement
Cognitive intervention for EF
Think, “If you don’t use it, you loose it”
Several studies looked at video games that required (Tetris, Rise of Nations, Cooking task)
- Problem solving
- Memory
- Sequencing
- Shifting attention
They all saw an increase in cognitive skills (per standardized testing) in as little as 4-6 weeks
However, the link to actual FUNCTION is very weak AND how long does the effect last is uncertain
These studies were virtual (video game), but it is likely the same could be accomplished through real life tasks (occupations)
Exercise interventions for EF
Connection between physical ability and cognitions
Multiple studies have shown that with increase physical activity and exercise, cognition improves
Most effective time line is 31-45 min sessions 3-5 times per week
Correlation between walking speed decline and cognitive decline
Social engagement interventions for EF
Idea that elderly clients who are socially engaged maintain or improve cognitive function
Problem based learning
Fits well with OT interventions because it is more function based
- Plan a fundraiser
- Bible study
- Volunteer at school
- Pickle ball
Functional, occupation-based tasks provide the vehicle for improving cognition
Why do we see a decline in cognitive ability with aging?
Multiple reasons
- changes in technology
- culture
- removed from experience
Benign cognitive decline: typical and mild
- ARCD: Age Related Cognitive Decline
Malignant Cognitive decline: atypical, disease or disorder driven
Types of dementia
Alzheimer’s
Vascular
Lewy body
Frontotemporal
Huntington’s
Mixed
Medication induced
CVA, TBI
Characteristics of alzheimer’s
Slow progression
No disturbance of consciousness
No other disorders or medication that may cause the symptoms
Symptoms don’t go away
Hallucinations in late stages
Must have impairment in at least 2 of the following areas:
- memory
- language (aphasia)
- praxis (apraxia)
- recognition (agnosia)
- executive function (impaired judgement)
Signs of alzheimer’s
Memory loss
Challenges in planning/problem solving
Difficulty completing familiar tasks
Confusion with time or place
Trouble understanding visual images and spatial relationships
New problems with words in speaking/writing
Changes in mood/personality
Decreased/poor judgement
Withdrawal from work/social activities
Misplacing things
Early stage Alzheimer’s
Symptoms are mild and characterized by general forgetfulness
Role of OT:
- structure
- cuing
Symptoms include:
- forgetting recent material
- trouble organizing/planning
- forgetting where valuable have been placed
- trouble managing money
- forgetting recent evens
- trouble with challenging tasks
- wandering and becoming lost in familiar places
Middle stage Alzheimer’s
Symptoms are more disabling and additional care may be needed
Symptoms include:
- delusions, compulsions, or repetitive behavior
- agitation, restlessness, and anxiety
- needs assistance with getting dressed
- bowel and bladder function issues
- trouble learning new things
- problems with reading and writing
- loses track of time or surroundings
- sleep disturbances
Late stage alzheimer’s
Symptoms are significant and apparent
Symptoms include:
- significant personality and behavior changes
- loss of ability to hold a conversation
- difficulty moving, eating, and swallowing
- loss of bladder and bowel
- lack of awareness of recent activities or surroundings
- highly susceptible to infections like pneumonia
Stage 1 Alzheimer’s
Normal behavior with no impairment
No noticeable symptoms or problems
Stage 2 Alzheimer’s
Very mild decline or changes
Minor memory problems may appear, like forgetfulness, which may also be due to normal aging
