Cognitive changes Flashcards
What are normal brain changes that occur in the older adult?
- Decrease in brain weight
- Gyral atrophy
- Ventricular dilatation-increase in CSF
- Decrease in brain metabolism
- No cortical neuron loss
- Neuronal loss in subcortical regions
- Loss of Purkinje Cells
- Myelin loss
- Impaired myelin integrity
- Neuritic plaques
- Loss in dendritic population
What are normal neurochemical changes in the older adult?
Decline in ACH
Dopamine
Others
What are treatable conditions that can “look” like dementia?
- Delirium
- Depression (Pseudo-dementia)
- Normal Pressure Hydrocephalus (NPH)
- Brain tumor
- Inflammatory pathology
- Endocrine, hormonal, metabolic dysfunction
- Paraneoplastic syndrome
- UTI
SUDDEN, rapid change in mental function; Typically secondary complication - Illness, Surgery, Polypharmacy; Comorbidities increase risk; Increases length of stay
delirium
Generic term, not a specific disease; Group of symptoms caused by disorders of the brain; Most commonly affect memory and language; ACQUIRED and PERSISTENT; Major cause of disability in elderly
dementia
How is dementia diagnosed?
2 or more brain function are significantly impaired without loss of consciousness (Generally Memory) and 1 or more of:
- Communication and language
- Ability to focus and pay attention
- Reasoning and judgment
- Visual perception
What are diseases that cause symptoms of dementia?
- Alzheimer’s disease
- Vascular dementia
- Lewy body dementia
- Frontotemporal dementia
- Huntington’s disease
- Creutzfeldt-Jakob disease
What are the characteristics of dementia?
- Impairment of short-term memory*** - Declarative (more impacted) and Procedural
- Impairment of long-term memory
- Impairment of abstract memory
- Impairment of judgment
- Personality changes
Progressive dementia characterized by slow decline in memory, language, visuospatial skills, personality, and cognition
Alzheimer’s disease
- most common form
- nonreversible
- amyloid beta protein in brain that should not be there
- plaques and tangles stop the appropriate nutrient production in the brain; portions essentially die off
What are the 3 stages of AD?
- Pre-Clinical AD - Pathological Changes but asymptomatic
- Mild Cognitive Impairment due to AD - Notable deficits does not affect independent functioning
- Dementia due to AD - Notable deficits does affect independent functioning
What are the contemporary guidelines to dx AD?
- 3 stages of AD
- biomarkers
- The DSM-5 replaces the term “dementia” withmajor neurocognitive disorderand mild neurocognitive disorder.
- Persons with major neurocognitive disorder exhibit cognitive deficits that interfere with independence
- Persons with mild neurocognitive disorder may retain the ability to be independent
What are risk factors for AD?
- Age. Genetics/family history
- Smoking and alcohol use
- Atherosclerosis
- Cholesterol
- Plasma homocysteine
- Diabetes
- Mild cognitive impairment
- Down syndrome
What are the 10 warning signs according to the Alzheimer’s association?
- Memory Loss
- Difficulty performing familiar tasks
- Problems with language
- Disorientation to time and place
- Poor or decreased judgment
- Problems with abstract thinking
- Misplacing things
- Changes in mood or behavior
- Changes in personality
- Loss of initiative
What are the S and S of depression?
- Changes in mood or behavior
- Changes in personality
- Loss of initiative
- Memory loss
What is the pharmacologic treatment of AD?
- Cholinesterase inhibitors (Aricept) - prevent breakdown of acetylcholine; Delay worsening of symptoms for 6-12 months
- Neuropeptide-modifying agents (Mentamine) - Can treat severe Alzheimer’s - Regulates activity of glutamate; Slows progression
- Combination of 2 most effective - Others - Antidepressants, Antipsychotics, Mood stabilizers
What are non-pharmacological management strategies for AD?
- Communication and Behavioral - Redirection; Validation
- Environmental Design - Safe and Secure, Well lit (avoid sun downing), Allow for exploration (AKA wandering); Use of facilities to promote continuation of ADL’s; Adapt environment
- Exercise - Better cognitive function and decreased decline; Maybe even improvement in memory; Positive effects (Strength, sleep, endurance, ADL function, balance, mood)
- Restraint Release/Fall Prevention
- Positioning
- CAREGIVERS
What are caregiver roles?
- Managing and taking meds
- Helping person to adhere to prescribed regimens
- Help with ADL’s
- Help with behavior management
- Finding and using support services
- Arranging for paid in home, ALF, or SNF
- Hiring and supervising caretakers
- Family Management - Ie communication among family members
What are the goals of rehab management in someone with AD?
- Maintain optimal level of function for as long as possible - Restore and compensate
- Maximize opportunities (especially for learning) in early and possibly middle stages of dementia.
What is PT management in AD?
- Assist pt., family, and caregivers
- Maximize functional abilities
- Slow physical decline
- Functional, meaningful, pleasant and safe activities - Adapt environment
- Over/under stimulation
- Safety
- Lack of structure
- Lack of routines
What are general principles for working with pts with AD?
- Simplify
- Listen
- Explain
- Educate
- (don’t) Reorient
- Slow Down
- Avoid Change
- Touch
- Encourage
- Respect Dignity
What are communication approaches?
- Don’t reorient
- redirect - distract/ alternative activity or topic
- validate - art of assisting the psn to feel that the problem and the responses to the problem are acknowledged and understood
What movement disorders are seen in AD?
- Bradykinesia
2. Apraxias
What are gait deviations in individuals with AD?
↓ gait velocity
↓ step &/or stride length
↑ stance time &/or total double limb support time
↑ variability of stride length & width
↑ variability of stride time
What are motor learning principles for people with AD?
- Exploit Implicit Learning
- Optimize early phase for skill teaching
- Blocked** vs. Random
- Constant** vs. Variable
- Train to specific & relevant functional task(s); do not expect transfer of training
- Appropriately challenge
- Eliminate / minimize the possibility and/or impact of errors during learning
What are evidence based outcome measures to use with people with AD?
6 meter walk
TUG
6 minute walk
Gait Speed
What are some other strategies for treating someone with AD?
- cognitive training - Activities to stimulate thinking, memory and concentration; Mixed Evidence; Most effective in early stages; Do during PT intervention
- Music therapy - Increase cognitive function, attention, communication and speech
- Aroma therapy - safe, well tolerated; lavender = relaxing, peppermint = exciting
- Massage - hand, foot back, 3-5 minutes effective; trial 1st, may be overstimulating; reduces agitation ST
- Pet therapy - limited evidence
What are the impacts of lifestyle and diet on AD?
- Reduced risk from eating fish frequently and a diet high in unsaturated fats
- No association between risk of dementia and mid-life intakes of antioxidants
- Women with a graduate degree had decreased odds of cognitive decline
- Participation in leisure activities have lower risk of dementia
What are the impacts of vascular disease on AD?
- Function of neurons in key parts of the brain increased along with improvement in cardiovascular fitness
- Heart disease and stroke contribute to development and severity of AD - AD 60% higher in individuals with stroke
- High blood pressure during mid-life increased risk of dementia later in life
- Women with diabetes performed worse on cognitive tests than those without diabetes
- Strong evidence that diabetes is a risk for dementia
What is correlated with reducing risk for AD?
Physical activity!
- and cognitive engagement
- Mediterranean diet may help
