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Cognitive Impairments in Older Adult Flashcards

1
Q

what are normal age related cog changes

A

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

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2
Q

what is benign senescent forgetfulness (BSF)

A

normal memory loss w/o functional decline
- may need more cues for recall

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3
Q

what is a mild cognitive impairment (MCI)

A

may have some abnormal cog measures compared to age-related norms
- still have normal ADLs and can function
- may have memory complaints

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4
Q

what does a MCI inc the risk of

A

developing dementia and a higher fall risk

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5
Q

what is the preclinical stage of dementia

A

silent phase
- brain changes w/o measurable sx

individual may notice
- not detectable on tests

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6
Q

what is the MCI stage leading to dementia

A

cog changes are of concern to individual/family

one or more cog domains impaired significantly

preserved ADLs

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7
Q

what are characteristics of dementia as a stage of cog decline

A

cog impairment severe enough to interfere w everyday abilities

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8
Q

what are 3 aspects of cog that remain relatively stable

A

memory
language
social cog

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9
Q

what is implicit memory

A

unconscious influence of previously encountered info on subsequent performance

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10
Q

how do we expect implicit memory to be impacted by aging

A

should be stable with only slight changes
- pts should express appropriate emotion, accurately remember their past, process current info, and make appropriate decisions

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11
Q

what aspects of cog show gradual and linear declines throughout lifespan (4)

A

processing speed
encoding info into episodic memory
short term memory
executive functioning

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12
Q

in absence of pathology, an older person may demonstrate what cog characteristics indicative of aging

A

slower processing time

need more rehearsal
- to encode into long term memory

dec ability to multi-task

difficulty finding alternate methods of problem solving

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13
Q

what are the 3 main cognitive impairments in older adults

A

depression
delirium
dementia

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14
Q

what is memory

A

process of remembering that begins w a sensory event that is seen, heard, experienced or felt
- sensory memory is brief

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15
Q

how can memories be encoded into short term memory

A

if sensory memories are attended to, encoded via attention or focus

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16
Q

what is short term memory

A

combo of short term storage and executive processes

limited - holds 5-9 items at a time

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17
Q

how are short term memories encoded into long term memory

A

repetition and rehearsal

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18
Q

what are the 2 main types of long term memory and examples of each

A

implicit
- procedural tasks and actions
- retained thru motor learning
- ex: tying shoes, STS

explicit
- episodic
- semantic memory
- ex: facts, words

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19
Q

how can SLP and referral sources be helpful in adults w severe cog deficits

A

work a lot on procedural task memory

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20
Q

what is executive functioning

A

complex behavior that combines memory, intellectual capacity, and cog planning

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21
Q

what are components of executive functioning (6)

A

planning
active problem solving
short term memory
anticipating possible consequences
initiating an activity
able to monitor efficacy of self

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22
Q

what is executive dysfunction

A

dec in planning ability, working memory, inductive reasoning and ability to modify

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23
Q

what is a concern with executive dysfunction

A

inc fall risk
- issue w safety and insight

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24
Q

what is executive functioning’s relationship to motor function

A

challenges w executive function will result in difficulty w self-assessment to accurately reflect knowledge of performance
- required for motor learning

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25
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
26
how does attention change w normal aging
simple attention - shows only slight decline complex - noticeable changes
27
how does complex attention change with normal aging
selective attention and divided attention show decline in older adults compared to younger - dual tasks difficult
28
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
29
what is social cognition
involves self-behavioral regulation and ability to understand mental states of others and societal expectations
30
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
31
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
32
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
33
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
34
how does depression present in older adults
loss of motivation loss of energy loss of health no longer interested in social groups
35
geriatric depression scale scoring
0-9 normal 10-19 mild >/= 20 severe
36
what are the 2 Qs in the 2 Question Depression Test
1. during past month, have you been bothered by feeling down, depressed, or hopeless? 2. during past month, have you been bothered by little interest or pleasure in doing things?
37
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
38
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
39
what is delirium characterized by
disturbed consciousness, cog function, or perception
40
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 **
41
what does delirium place the pt at higher risk for
higher mortality longer recovery
42
what are the causes of delirium
URI, **UTI**, PNA - can see overnight change meds surgery/anesthesia untreated pain
43
what is the key feature of delirium to differentiate from dementia
disturbance develops over short period of time delirium = acute
44
what are key features of delirium (5)
1. disturbed attention/awareness 2. disturbance develops over short period of time 3. additional disturbance in cog (memory deficit, disorientation) 4. 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 5. caused by physio consequences of another med condition, substance intoxication, withdrawal
45
how is the delirium rating scale utilized
score the severity of delirium can use repeatedly throughout stay to monitor progression or regression of delirium
46
what is dementia
clinical syndrome of cog and functional decline, usually of a chronic or progressive nature
47
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
48
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
49
what postop pts is the risk of developing delirium highest (2)
s/p hip fx s/p vascular surgery
50
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
51
what contributes to the societal cost of dementia
inc prevalence cost of illness amt of informal care available
52
what are 3 dementia cog assessments
MMSE MOCA SLUMS
53
what are the categories that the mini mental state exam (MMSE) assesses (5)
orientation registration attention & calculation recall language
54
what is the cutoff score for dementia in the MMSE
23
55
what are the 7 categories assessed in the montreal cog assessment (MOCA)
visuospatial naming attention language abstraction delayed recall orientation
56
what is normal on the MOCA
>/= 26
57
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
58
what is the most common form of dementia
alzheimers
59
what is alzheimers dz closely associated with
advance aging - associated but not normal
60
why is there a push for early detection testing for alzheimers dz
neuropathologic changes may precede clinical sx by as much as 20yrs
61
what are the most common pathologic changes associated w development of alzheimers
amyloid plaques and neurofibrillary tangles --> presence activates cytokine storm and chronic inflammation
62
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
63
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
64
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
65
what are the 2 visible changes on imaging with alzheimers
1. dec synaptic density 2. volume loss in the entorhinal cortex
66
where is there significant atrophy of synaptic density d/t alzheimers
inferior prefrontal cortex
67
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
68
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
69
what happens when BDNF and neural growth factor (NGF) are inhibited
stimulates molecular events typical of alzheimers - inc in amyloid beta plaques
70
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
71
what are general observations of alzheimers dz on the brain
not as voluminous - lot of space in skull not as much fluid
72
when is considered an early stage of alzheimers
2-4yrs leading up to and including dx
73
what are 6 common sx of early stage alzheimers dz
low energy emotional lability slow reactions word finding difficulties names of things heightened anxiety
74
when is considered middle stage of alzheimers
b/w 2-10yrs after dx
75
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)
76
when is considered late stage alzheimers
terminal phase - life expectancy 1-3yrs
77
what are 6 common sx of late stage alzheimers
apathetic remote may become incontinent weight loss unable to walk/communicate difficulty swallowing
78
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
79
who are physical restraints appropriate for
dec awareness fall risk for their safety
80
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
81
what are 5 considerations with implementing physical restraints
informed consent risk vs benefit determination of competency resident's rights risk reduction
82
what are 3 physical restraints that are adjacent to the patient (not attached)
bed alarm chair alarm defined perimeter mattress
83
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
84
what are 4 main challenges when trying to implement physical activity into someone w alzheimers
1. behavioral challenges (anger, aggression, inappropriateness) 2. ask family/support system ab pt 3. memory deficits 4. communication
85
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
86
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
87
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
88
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!!

Lifespan (20 decks)

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