Cognitive Changes with Aging Flashcards
Developmental life span approach to aging
Cognition is a lifelong process
Basic cognitive processes
Foundational for higher order thought
Include sensory processes, perceptual processes, attention, short-term memory, working memory, and long-term memory
Higher-order cognitive processes
Include executive functioning, problem-solving, everyday cognition, language production and speech comprehension, wisdom, and expertise
Changes in sensory processes
Decreased auditory and visual processing
Changes in perception
Decreased auditory and visual processing
Changes in attention
No difference in sustained (focused) attention
Potentially decreased selective attention in older adults
Significant decline in alternating and divided attention
Sustained (focused) attention
Ability to concentrate on a single task for any period of time
Selective attention
Ability to focus on a task while simultaneously suppressing irrelevant distracting stimuli
Alternating attention
Ability to switch between tasks
Divided attention
Ability to pay attention to two tasks at once
Changes to short-term memory and prospective memory
Possible changes
Changes to episodic memory
A significant decline
Changes to sensory and procedural memory
Minimal to no changes
Sensory memory
Brief store of sensory information before transferring to short-term memory
Short-term memory
Stores information for 15-20 seconds without rehearsal
Working memory
Stores, maintains, and actively manipulates information
Long-term memory
Storage of information for an extended period of time
Includes explicit and implicit memory
Explicit (declarative) memory
Recollection of facts and events
Includes:
Semantic memory: understanding of meanings, understandings, and conceptual facts of the word (episodic memory can inform semantic memory)
Episodic memory: Memory of autobiographical events and understanding how, where, and when it occurred
Implicit (procedural) memory
Stores information for motor-based skills and behaviors, habits, emotional associations, priming, and classical conditioning
Prospective memory
Ability to remember future tasks without a memory aid
Normal cognitive changes
Slower thought processes
Caution and hesitation
Difficulty with name-face recognition
Past recognition with prompting
Occasional word finding difficulty
Able to find misplaced items
Abnormal cognitive changes
Thinking and actions are not the same
Problems with initiating tasks
Cannot place people
Past and present indistinguishable
Personality changes
How can we optimize cognitive aging
Physical activity
Mentally stimulating activities that are novel, mentally challenging, or learning a new skill
Social engagement: regular contact with family and friends, participation in hobbies and leisure activities with others, and social support from external sources
Subjective expression of illness
Individuals’ care needs and support will differ from person to person
Environmental Press Model
Interactions between an individual’s abilities and the fit with their environment will determine performance
Lack of fit to the environment such as overstimulation or understimulation produce boredom, social isolation, apathy, symptoms of depression, and frustration
Mild cognitive impairment
Transitional state between normal aging and pathological decline
Presents with an elevated risk of progression to Alzheimer’s Disease
Cognitive decline in complex attention, executive function, learning and memory, or language
Decline may be reported by individual, knowledgeable informant, or concern of clinician based on testing
ADLs are intact but require more effort
Amnestic Mild Cognitive Impairment
Primarily affects memory and the individual may begin to forget information that they would previously have recalled
Nonamnestic mild cognitive impairment
Affects thinking skills other than memory, including the ability to make decisions, judge time or sequence steps for complex tasks, or visual perception
Intervention for mild cognitive impairment
Memory support systems such as notebooks, calendars, lists, apps with reminders
Physical exercise and active lifestyles
Multicomponent programs such as memory training, external aids, and stress reduction
Progression to dementia
Preclinical: Before changes in cognition and everyday activities are detected
Mild cognitive impairment leading to Alzheimer’s Disease: Cognitive symptoms emerge but function is still relatively unimpaired
- Not everyone with MCI develops AD
Alzheimer’s Disease: Day to day function is impaired
Dementia
Multiple cognitive and intellectual deficiencies and decline involving memory, problems with language, impairment of motor skills, inability to recognize familiar people or objects, and impairments in planning, organizing, and abstract reasoning
Memory change in dementia
Individuals will first lose memory of higher order IADLs and then BADLs
Working memory is affected first which leads to difficulties recalling new information and using it
Semantic memory is more stable but later stages of disease will impact ability to recall nouns, verbs, and names
Procedural memory is most durable
Types of dementia
Lewy Body
Vascular
Frontotemporal dementia
Alzheimer’s Disease
Lewy Body Dementia
Young onset (50-55 years)
Affects 50% of patients with Parkinson’s Disease
Progressive and gradually worsening
Symptoms
- Falling
- Rigidity
- Difficulty swallowing
- Incontinence
- Parkinson’s like symptoms (shuffling gait, tremors, rigidity, flat affect)
- Auditory or visual hallucinations
- Fluctuating cognition with variable attention and alertness
Vascular dementia
Caused by stroke, uncontrolled hypertension, heart diseases, diabetes, peripheral vascular disease, smoking or genetics
Sudden onset
Symptoms (vary based on part of brain affected)
- Emotional and energy changes
- Cognition changes: Decrease in judgment, memory, disorientation, and word-finding
- Variable and inconsistent behavior
Symptoms of frontotemporal dementia
Affect/personality changes
Rude and mean behavior
Language loss
Alzheimer’s Disease
Progressive neurodegenerative disease characterized by loss of function and death of nerve cells in several areas of the brain
No known cure
Most common form of dementia
Cause of Alzheimer’s Disease
Age (65+, risk doubles every 5 years)
Family history
Genetics
Diagnosis of Alzheimer’s Disease
Rule out any other potential causes of confusion such as medication, hearing or vision loss, depression, alcohol, thyroid problems, UTIs, vitamin deficiency, or delerium
Physical and medical history
Blood work
Neurological exam
Medication review
CT scan, MRI, PET scan, spinal fluid test of plaque and tangle proteins
Neuropsychological testing
Intervention for Alzheimer’s Disease
Medication
Address safety (environment), cognitive functioning, functional mobility, self care, caregiver coping and support, and behavioral management
Compensatory environmental modifications
- Remove clutter
- add signs
- Adaptive equipment that helps and does not involve new learning
Involve caregivers
Cover mirrors in bathrooms in later stages
Use old learning proverbs, songs, and memories
OT clinical strategies for Alzheimer’s Disease
Address cognitive processes while actively participating in occupational performance
Practice and rehearse
Relate to previous knowledge
Present information directly
Make interventions fun and interesting
Decrease distractions
Consider habits and timing of activities
Utilize as many senses as you can
Make interventions relaxing
Break down tasks
What does Allen’s Cognitive Assessment (Allen’s Battery) include?
Allen Cognitive Level Screen
Allen Diagnostic Module
Routine Task Inventory
Cognitive Performance Test
Allen’s Cognitive Levels
Level 1: Automatic reactions
Level 2: Postural actions
Level 3: Manual actions
Level 4: Goal directed actions Developmental age of 4-10 to 12 years
Level 5: Exploratory actions (may have mild cognitive impairment) Developmental age of Teens to early 20s
Level 6: Normal planned actions
Allen Cognitive Level 4
Able to perform goal directed activities and spontaneous actions
Unsafe performance of activities
Visual cues
Performs one step directions
Able to do repetitive tasks
Utilizes procedural memory
BADLs are intact
Can use strategies for sequencing
One hour attention span
Allen Cognitive Level 3
Able to complete functional actions
Safety issues
May be disoriented x3 and gets easily lost
Partially completes task
Can complete tactile activties
Does well with repetitive/procedural tasks
Short attention span (30 minutes) but can extend to external environments
Developmental age of 18 months - 3 years
Allen Cognitive Level 2 (late stage)
Able to complete postural actions (sits, walks)
Performs repetitive actions (pacing)
Safety concerns
Very short attention span (5-15 minutes)
Some assistance with ADLs
Developmental age of 12-18 months
Allen Cognitive Level 1 (End Stage)
Able to complete automatic reactions
Developmental age of an infant
Communication with Alzheimer’s Disease
Redirect if upset
Agree with person ( if that is their reality then it is real)
Behavioral challenges in Alzheimer’s Disease
Sundowner Syndrome
Rummaging, Pillaging, and Hoarding
Pacing and wandering
Catastrophic behaviors
Strengths often retained by persons with dementia
Emotions
Sociability
Long term memory
Humor
Sensory awareness
Movement
Music
Over learned skills
