Cognitive impairments in the older adult Flashcards
1
Q
Depression
A
- 40% of hospitalized adults are clinically depressed
- Often neglected in part due to overshadowing by numerous physical/functional difficulties
- Clinically significant depression in the older adult ranges between 10% to 43%
2
Q
CHARACTERISTICS & ASSESSMENT
A
- Conspicuous characteristics include depressed mood, feelings of sadness, hopelessness, loss of interest and pleasure in previously pleasurable activities.
- Psychopathology or clinical depression includes: Difficulty concentrating, impaired memory, indecisiveness, perceived lack of competence in control, low self-esteem/worthlessness, apathy and excessive guilt.
3
Q
DIAGNOSTIC STANDARDS
A
- Diagnostic and statistical manual of mental disorders (DSM V)
- 2 Diagnoses relevant to depression and the older person are major depressive episode and adjustment disorder with depressed mood
4
Q
MAJOR DEPRESSIVE EPISODE
A
- Criteria include: Depressed mood, loss of pleasure in all activities and associated symptoms for a period of at least two weeks.
- ASSOCIATED SYMPTOMS:
- Significant weight loss/Weight gain
- Insomnia/hypersomnia,
- Diminished/hyperactive motor activity
- Fatigue/energy loss
- Sense of worthlessness
- Inappropriate guilt
- Decreased concentration
- Recurrent thoughts of death/suicide ideation or attempt.
***** A minimum of five of these symptoms are required for a definitive diagnosis of major depression
5
Q
ADJUSTMENT DISORDER
A
- “Maladaptive reactions to an identifiable psychosocial stressor that occurs within 3 months of the onset of the stressor”.
- Examples ?????
- Clinically significant symptoms/behaviors: Impaired social &/or occupational functioning, extreme distress in excess of a normal and expected reaction.
- Acute = symptoms are less than 6 months
- Chronic = symptoms are greater than six months.
6
Q
UNIQUE FEATURES of DEPRESSION
A
- Increased suicide rate in the elderly
- 75% of seniors who committed suicide had seen their physician within one month prior.
- Depression rates are between 15 to 25% higher in for institutionalized than community dwelling Seniors.
- Depression can imitate dementia and both manifest depressive symptoms.
- Geriatric psychiatrists recommend that while both depression and dementia can coexist in the same person, depression should be addressed first as it can be reversed.
- Depressed seniors incur 50% higher health care costs.
- Poorly managed pain in the elderly is linked to increased levels of depression
- Females have higher rates of depression however the rates equalize after the age of 80.
*
7
Q
Assessment of Depression
A
- Geriatric Depression Scale (GDS)
- Sensitivity = 84%, Specificity = 95%
- Patient Health Questionnaire (PHQ-9)
- Establish a Referral Network
8
Q
COGNITIVE DECLINE & DEMENTIA
A
- A continuum of normal aging changes > mild cognitive impairment (MCI) > stages of dementia
- MCI & Dementia are considered pathologic
9
Q
Normal Cognitive Aging
A
- Cognition changes gradually and deficits there and are more noticeable after the age of 50.
- Cognitive changes are typically mild and impact upon vision, verbal memory, visual spatial abilities, short-term memory, and naming of objects.
10
Q
COMPONENTS OF COGNITION
A
- Normal cognition includes memory, language, perception, reasoning, perceptual speed, spatial manipulation, and executive skills.
- Collectively they form the concept of “Intelligence“
- CATEGORIES OF INTELLIGENCE :
Crystallized
Fluid
Expertise
Creativity
Wisdom
- Executive functioning: combination of memory, intellectual capacity, and cognitive planning.
- Executive dysfunction can increase the risk for falls.
- Memory-4 types include:
1. Working or short term
2. Episodic
3. Semantic (language-based). May or may not be impaired in cognitive dysfunction pathologies.
4. Remote or long term - Personality: Most reliable evidence indicates that personality types are stable throughout the lifespan.
- Cognitive Reserve
11
Q
COGNITIVE RESERVE
A
- Individuals with less cognitive reserve typically demonstrate increased signs of cognitive disease throughout the aging process.
- Low IQ & low level self – assessment of school performance in adolescence is associated with an increased risk for Alzheimer’s disease.
- Sedentary/Passive intellectual behavior and regular exposure to theatrical television watching increases the risk of developing Alzheimer’s disease.
*** Adults 40-59 years old watching television had an increased risk of developing Alzheimer’s disease by 1.3 times for every hour of television watched.
12
Q
ALZHEIMER’S DISEASE
A
- Alzheimer’s disease most prevalent and accounts for 60 to 80% of those with dementia.
- 5.3 million Americans suffer from Alzheimer’s disease
- 5.1 million are 65 and older with 1 in 8 (13%) having AD.
- On average those diagnosed with Alzheimer’s disease live between 8 to 10 years following their diagnosis. Some live as long as 20 years beyond diagnosis.
- Those with Alzheimer’s disease often die of aspiration pneumonia due to the effects of dysphagia.
- Early onset AD occurring between the ages of 30-60 is rare and accounts for only 5% of those with AD.
13
Q
RISK FACTORS for DEVELOPING AD
A
- Advancing age is the single most significant risk factor.
- Familial history
- Hispanics and African-Americans are between 1.5-2 times more likely than whites to develop AD.
- Comorbidities including high blood pressure and diabetes increase risk.
- Women>Men however may be due to the fact that women typically live longer.
14
Q
CLINICAL PRESENTATION
A
- Early stages: memory impairments, lapse of judgment, subtle changes in personality. The individuals awareness of their cognitive decline will often result in depression.
- Mid stages: memory and language further deteriorates, increased difficulty with IADL’s (Financial and medication management dysfunction), this orientation to time and place, delusions, and hostility behaviors.
- Late stages: Progressive deficits in motor control & function. Advancing emotional/behavioral/personality dysfunction.
