Lecture 27: Cognition in the Older Adult Flashcards
Fluid intelligence declines in adulthood
* problem solving, spatial manipulation, meantal speed
Mild decline in executive function
Memory is slowed, but intact
Slipperly slope of cognitition, if you start higher up on that slope even if you decline w/ age you’ll still be in a decent spot
Common mental health concerns:
Depression
* Adjustment disorder
* Dysthymia
* Major depression
NOTE: Alzheimers disease, vascular dementia, lewy body dementia all fall under dementia
What is a condition between normal aging and dementia?
Mild cognitive impairment
* so its not actually dementia but its not normal either
15% of the popultaion has it
They have a heightened risk for developing dementia
What 4 thigns make up mild cognitive impairment?
1) Memory complaints - have to tell you that they’re having issues w/ memeory
2) Normal ADLs
3) Normal general cognitive functioning
4) Abnormal cognitive measures - ways to measure this are clock test, recall test, moca
No current treatment, dx may cause anxiety (because you may feel like you can interact w/ other people, you’re just a little bit slower)
Sudden rapid change in mental fucntion. Most common complication of medical illness or post OP
Delirium
70-87% of older adults in ICU
Management = treat underlying cause
PT implication - be able to recognize the symptoms and differentiate from dementia, in order to treat ASAP
* Minimize bed time
* Ambulation
* Avoid restrains
What causes dementia?
* most commonly affects
* at least one of these 5 things
Caused by pathological loss of synaptic connection
Most commonly affects memory and language
At least one of the following - aphasia, apraxia, agnosia, or a disturbance of executive function
Cortical dementia - problems with memeory, language, thinking, and social behavior and primarily affects the cortex
problems with memeory, language, thinking, and social behavior and primarily affects the cortex
Cortical dementia
Changes in emotions and movement in addition to memory
subcortical dementia
What is the most common form of dementia?
Alzheimers disease
aprroximately 13% of individuals over 65 years of age have AD
NOTE: Alzheimers and releated dementias will have motor impaired as well. Later they lose mobility and won’t be able to communicate (also feeding problems - not hungery)
Less options = better (if they arent wearing pants just get them a pair, dont let them choose multiple pairs)
What is the second most common form of dementia
* which sex gets it most
vascular dementia
* men > women
Vascular dementia
* whats it most releated to
* what is onset like?
* Whats the tell tail sign?
causes: HTN, multiple infarcts, smoking, hypercholestermia, DM, cardiovascular and cerebrovascular disease
* releated to more cardiovascular pathologies - vasculature is hit w/ atherosclerosis which causes decreased BF to the brain
Issues w memory, abstract thinking, judgement, impulse contorl, and personality
* this is because that BF issue can be anywehre in the brain
Abrupt onset, fluctuating course, emotional abilit
Emeotional ability = tell tail sign
* think laughing when its inappropriate
Mangement: treat underlying cause
* typically a cardiovascular issue
What disase has fluctuations in alterness and attention, disorganized speech, staring. recurrent visual hallucations. Parkinsons motor symptoms - rigidity and loss of spontaneous movement
Lewy body dementia
spontaneous mvoement = just starting to walk w/o trying
NOTE: its called lewy body because they can see the little plaque formations
Wht is the most common psychological mood problem in older adults?
Depression
So this is essentailly saying taht we are allowed to screen mental health pathologies
* think intake form having the question “thoughts of suicide etc…” - soemtimes it might just be soemthing like “im depressed because I cant swim because my shoulder hurts”
what disase does the older adult experience more cognitive symptoms (memory issues) versus affective symptoms (sadness)
* which sex more?
Late life depression (note this is not that they’ve had it their entire life, but that they’ve aquired it in later life)
* so its more memory than sadness - think more word finding problems as well
Incidence: due to underdiagnosing of depression in older adults, it is hard to come up with an accurate number of new cases if depression in older adults
Aprrox 6.7 to 7.5% of older adults report an episode of major depression within one year (note these rates are going to be higher in inpatient / facilities)
Rates are still higher among medical inpatients and residents in long-term care, rising with increasing disability and frality. Women expereince 1.7 times the risk as men
Do developing countries or developed countries have more late life depression?
* what is it globally?
Developing countries have more depression (40%) opposed to developed countires (18%)
WHO estimated 10-20% globally
NOTE: could be partly because lots of your peers are dying / you’ve had to stop work etc///
Which theory states that depression could be caused by a lack of interpersonal and communication skills, social support, and coping mechanisms
Psychosocial theory
note: if older adult has more resilience in earlyer life they tend to have less depression because they can cope w it better later in life
social isolation is another factor that goes into this
* think younger adult who has anxiety so doesnt put themself in those social areas and now lacks social skills which leads to more social isolation
People w/ depressive disorder have a 40% greater chance of premature death than their counterparts. Note this is not only due to sucide
* because of other comorbidities that happen w/ mental health disorder - often can greatly impact your immune system
black/hispanic less likey to be screened for or diagnosed w/ depression. Probs due to not wanting to disclose or talk about mental health disorders. Culterally its not openly talked about. And health providers might not want to ask this kind of people these questions
so its expensive
hospitailizations/prescription drug costs
major depressive disorder = across the lifespan
Adjustment disorder = primarily older adults but can happen w/ the younger population as well
Episodic memory and executive function = show gradual decline over many years but accelerate later in life
combined these can lead to a misdiagnosis of dementia
memory as you age shouldnt be altered but slowed. but should stay relatively the same
polyphamcy = multiple medications interacting in a way that has severe side effects / adverse effects
assessment of depression
these are the 2 questions that you ask to get converstation going if needed
* these questions tell the severity of symptoms, they do not diagnose depression. The issue is when this becomes too severe and leads to a diagnosis of depression
common depression scales
depression scales often used to screen for dementia (because they’re correlated)
patients w/ depression have reduced functional capcity, so they have to exert a greater effort for minor day tasks. It takes more mental / physical energy to do things if they have depression. can be as simple as brushing teeth or taking a shower
These adults have higher disability, and utilize health care services more
They have a reduced response to rehabilitation
They have a higher risk of developing new illnesses, mortality, and use of health care resources
some medications used for depression
this often cause drowsiness / insomina
screening tools for depression/dementia
Research shows that presence and severity of cognitive status is NOT a factor to deny rehab
* So we shouldnt say “whats the point in working w/ them because theres no carryover” - research shows that cogntiive status does not support denying therapy - we can still do education to family / pt (some of it is bound to stick) - and keep going over the same stuff over and over, it may just take a lot longer
Blocked practice is the best for those that have dementia
depression management
one step commands are the best w/ people who have dementia
* dont say “nose over toes, lean forward then sit up, that has lots of commands”
Group training is great for older adults
* often these peoples circles get really small - its good to get them new friends
Maybe simplify environment for people who have dementia
want exercise to be functional / fun, not just 10 sit to stands
* this should honestly be applied to everyone - were not just personal trainers that just give a list of exercises
