Cognitive Impairments in Older Adult Flashcards
what are normal age related cog changes
everyone experiences minimal, slight cog changes
- ex: BSF
no decline in function and social skills or judgement
no change in personality
not true memory loss
what is benign senescent forgetfulness (BSF)
normal memory loss w/o functional decline
- may need more cues for recall
what is a mild cognitive impairment (MCI)
may have some abnormal cog measures compared to age-related norms
- still have normal ADLs and can function
- may have memory complaints
what does a MCI inc the risk of
developing dementia and a higher fall risk
what is the preclinical stage of dementia
silent phase
- brain changes w/o measurable sx
individual may notice
- not detectable on tests
what is the MCI stage leading to dementia
cog changes are of concern to individual/family
one or more cog domains impaired significantly
preserved ADLs
what are characteristics of dementia as a stage of cog decline
cog impairment severe enough to interfere w everyday abilities
what are 3 aspects of cog that remain relatively stable
memory
language
social cog
what is implicit memory
unconscious influence of previously encountered info on subsequent performance
how do we expect implicit memory to be impacted by aging
should be stable with only slight changes
- pts should express appropriate emotion, accurately remember their past, process current info, and make appropriate decisions
what aspects of cog show gradual and linear declines throughout lifespan (4)
processing speed
encoding info into episodic memory
short term memory
executive functioning
in absence of pathology, an older person may demonstrate what cog characteristics indicative of aging
slower processing time
need more rehearsal
- to encode into long term memory
dec ability to multi-task
difficulty finding alternate methods of problem solving
what are the 3 main cognitive impairments in older adults
depression
delirium
dementia
what is memory
process of remembering that begins w a sensory event that is seen, heard, experienced or felt
- sensory memory is brief
how can memories be encoded into short term memory
if sensory memories are attended to, encoded via attention or focus
what is short term memory
combo of short term storage and executive processes
limited - holds 5-9 items at a time
how are short term memories encoded into long term memory
repetition and rehearsal
what are the 2 main types of long term memory and examples of each
implicit
- procedural tasks and actions
- retained thru motor learning
- ex: tying shoes, STS
explicit
- episodic
- semantic memory
- ex: facts, words
how can SLP and referral sources be helpful in adults w severe cog deficits
work a lot on procedural task memory
what is executive functioning
complex behavior that combines memory, intellectual capacity, and cog planning
what are components of executive functioning (6)
planning
active problem solving
short term memory
anticipating possible consequences
initiating an activity
able to monitor efficacy of self
what is executive dysfunction
dec in planning ability, working memory, inductive reasoning and ability to modify
what is a concern with executive dysfunction
inc fall risk
- issue w safety and insight
what is executive functioning’s relationship to motor function
challenges w executive function will result in difficulty w self-assessment to accurately reflect knowledge of performance
- required for motor learning
how is language impacted by normal aging
remains intact
vocab sustained
some features may show small decline >70yo
- identifying objects
- word generation in a category
how does attention change w normal aging
simple attention - shows only slight decline
complex - noticeable changes
how does complex attention change with normal aging
selective attention and divided attention show decline in older adults compared to younger
- dual tasks difficult
how can complex attention changes be utilized in a PT session depending on what you want to work on
can minimize environment directions to optimize learning
can inc distractions to challenge divided attention system during gait or other tasks
- good way to see an initial assessment too
what is social cognition
involves self-behavioral regulation and ability to understand mental states of others and societal expectations
how does social cognition change w normal aging and what are the implications
challenging to assess another person’s emotional state or discerning accuracy/falseness of another’s statements
decline in insight might be why they are more susceptible to abuse, neglect, and exploitation
what is perceptual motor function and how does it change w normal aging
processing speed for both cog activities and motor responses begin to decline gradually starting >30yo
what are the implications of normal aging on perceptual motor function
change in processing can result in challenges across other cog domains and function
- impact on balance regulation
- impact ability to identify LOB - impact ability to create appropriate motor response after tripping
incidence/rates of depression in older adult
similar to other ages
more common in females until age 50-60yo
- once in 80s, same incidence b/w men and women
how does depression present in older adults
loss of motivation
loss of energy
loss of health
no longer interested in social groups
geriatric depression scale scoring
0-9 normal
10-19 mild
>/= 20 severe
what are the 2 Qs in the 2 Question Depression Test
- during past month, have you been bothered by feeling down, depressed, or hopeless?
- during past month, have you been bothered by little interest or pleasure in doing things?
when should you implement the 2 Q depression test and what do you do w the results
use as a screening tool for completing GDS (short or long form) and/or referral
what is a consideration when assessing sx of the 3 Ds (depression, delirium, dementia)
all have very similar sx, need to tease out which one
what is delirium characterized by
disturbed consciousness, cog function, or perception
who is at the highest risk of delirium and why
hospitalized older adults
- risk inc w inc severity of illness
see more pathological cog changes when taken out of routine
** importance of establishing a baseline cog level **
what does delirium place the pt at higher risk for
higher mortality
longer recovery
what are the causes of delirium
URI, UTI, PNA
- can see overnight change
meds
surgery/anesthesia
untreated pain
what is the key feature of delirium to differentiate from dementia
disturbance develops over short period of time
delirium = acute
what are key features of delirium (5)
- disturbed attention/awareness
- disturbance develops over short period of time
- additional disturbance in cog (memory deficit, disorientation)
- disturbed attention, awareness, and cog aren’t better explained by another pre-existing, established or evolving neuro-cog disorder & not d/t severely dec level of arousal
- caused by physio consequences of another med condition, substance intoxication, withdrawal
how is the delirium rating scale utilized
score the severity of delirium
can use repeatedly throughout stay to monitor progression or regression of delirium
what is dementia
clinical syndrome of cog and functional decline, usually of a chronic or progressive nature
why/when is dementia considered a major neurocognitive disorder
cog deficits must be sufficiently severe to cause impairment in occupational or social functioning and must represent a decline from previously higher level of functioning
what are the 4 common subtypes of dementia and which 2 are most most common
**alzheimers dz
** vascular dementia
dementia w lewy bodies
frontotemporal dementia
what postop pts is the risk of developing delirium highest (2)
s/p hip fx
s/p vascular surgery
how does age in men and women factor into the prevalence of dementia
the longer you live –> inc exposure to environmental toxins
- higher in women than men bc women live longer
if men >65yo, can assume they have healthier CV profile and lower risk of dementia
what contributes to the societal cost of dementia
inc prevalence
cost of illness
amt of informal care available
what are 3 dementia cog assessments
MMSE
MOCA
SLUMS
what are the categories that the mini mental state exam (MMSE) assesses (5)
orientation
registration
attention & calculation
recall
language
what is the cutoff score for dementia in the MMSE
23
what are the 7 categories assessed in the montreal cog assessment (MOCA)
visuospatial
naming
attention
language
abstraction
delayed recall
orientation
what is normal on the MOCA
> /= 26
what are the norms based on in the saint luis university mental status (SLUMS) and what are they
based on high school education
27/30 = high school ed norm
25/30 = < high school ed norm
what is the most common form of dementia
alzheimers
what is alzheimers dz closely associated with
advance aging
- associated but not normal
why is there a push for early detection testing for alzheimers dz
neuropathologic changes may precede clinical sx by as much as 20yrs
what are the most common pathologic changes associated w development of alzheimers
amyloid plaques and neurofibrillary tangles
–> presence activates cytokine storm and chronic inflammation
what are amyloid plaques which are found in alzheimers
protein fragments (B-amyloid peptides) mixed w additional proteins, remnants of neurons, and bits/pieces of other nerve cells
what are neurofibrillary tangles which are found in alzheimers
abnormal collections of tau protein (-> think CTE)
clumps together and causes neurons to fail and die
what changes in acetylcholine levels are seen in alzheimers and what is the significance of this
inadequate levels of ach
ach is the neurotransmitter which transfers the info from one neuron to another via synaptic connections
what are the 2 visible changes on imaging with alzheimers
- dec synaptic density
- volume loss in the entorhinal cortex
where is there significant atrophy of synaptic density d/t alzheimers
inferior prefrontal cortex
what is the significance of volume loss in the entorhinal cortex d/t alzheimers
entorhinal cortex is an important relay b/w hippocampus and association cortices
-> neg impact on hippocampus
hippocampus is critical for encoding –> episodic memory frequently affected
what is brain-derived neurotrophic factor (BDNF), why is it important, and what is it linked to
important signaling molecule that regulates synapses and lead to learning and memory
vital role in neuronal growth, development, and survival
linked to alzheimers and other neurologic disorders
- trickle down effect and linked to CV health and chronic inflammation
what happens when BDNF and neural growth factor (NGF) are inhibited
stimulates molecular events typical of alzheimers
- inc in amyloid beta plaques
what happens if BDN and NGF signaling is interrupted
sets up toxic mechanisms that induce death and loss of neurons
–> results in brain tissue atrophy
what are general observations of alzheimers dz on the brain
not as voluminous
- lot of space in skull
not as much fluid
when is considered an early stage of alzheimers
2-4yrs leading up to and including dx
what are 6 common sx of early stage alzheimers dz
low energy
emotional lability
slow reactions
word finding difficulties
names of things
heightened anxiety
when is considered middle stage of alzheimers
b/w 2-10yrs after dx
what are 4 common sx of middle stage alzheimers
difficulty recognizing familiar people
difficulty w decisions
writing illegibly
more self-absorbed
(overall hard time interacting and understanding environment around them)
when is considered late stage alzheimers
terminal phase
- life expectancy 1-3yrs
what are 6 common sx of late stage alzheimers
apathetic
remote
may become incontinent
weight loss
unable to walk/communicate
difficulty swallowing
how is the use of physical restraints linked to the primary goal of acute care settings
goal = avoid falls
don’t have capacity for 1:1 care for all fall risks
who are physical restraints appropriate for
dec awareness
fall risk
for their safety
what is a physical restraint
any manual method or physical or mechanical device, material, or equipment attached to or adjacent to resident’s body which individual can’t remove easily, that restricts freedom of mvmt or normal access to one’s body
what are 5 considerations with implementing physical restraints
informed consent
risk vs benefit
determination of competency
resident’s rights
risk reduction
what are 3 physical restraints that are adjacent to the patient (not attached)
bed alarm
chair alarm
defined perimeter mattress
what are the benefits of physical activity in dementia
may delay progresssion
dec isolation
dec risk of falls
inc confidence
inc self-esteem
inc mood
what are 4 main challenges when trying to implement physical activity into someone w alzheimers
- behavioral challenges (anger, aggression, inappropriateness)
- ask family/support system ab pt
- memory deficits
- communication
what are strategies to manage behavioral challenges when implementing physical activity in pt w dementia
plan ahead
distractions
simple treatment - functional
promote sense of security
allow them sense of control
calm manner
what are questions to ask family/support system ab a pt w dementia
what did they use to do
interests
what agitates them
what comforts them
what is their normal routine
what are strategies to manage memory deficits when implementing physical activity in pts w dementia
consistent therapy routine
redirect
use verbal and tactile cues
handouts for caregivers
simple, 1-step commands
demonstrations
what are strategies to manage communication deficits when implementing physical activity in pt w dementia
speak clearly and slowly
- give them 10-15sec to process and respond
be aware of body language
get down at pts level
don’t rush treatment
MUSIC!!
