Lecture 27: Cognition in the Older Adult

Question 1

Fluid intelligence declines in adulthood
* problem solving, spatial manipulation, meantal speed

Mild decline in executive function

Memory is slowed, but intact

Question 2

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

Question 3

Common mental health concerns:

Depression
* Adjustment disorder
* Dysthymia
* Major depression

NOTE: Alzheimers disease, vascular dementia, lewy body dementia all fall under dementia

Question 4

What is a condition between normal aging and dementia?

Answer 4

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

Question 5

What 4 thigns make up mild cognitive impairment?

Answer 5

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)

Question 6

Sudden rapid change in mental fucntion. Most common complication of medical illness or post OP

Answer 6

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

Question 7

What causes dementia?
* most commonly affects
* at least one of these 5 things

Answer 7

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

Question 8

problems with memeory, language, thinking, and social behavior and primarily affects the cortex

Answer 8

Cortical dementia

Question 9

Changes in emotions and movement in addition to memory

Answer 9

subcortical dementia

Question 10

What is the most common form of dementia?

Answer 10

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)

Question 11

What is the second most common form of dementia
* which sex gets it most

Answer 11

vascular dementia
* men > women

Question 12

Vascular dementia
* whats it most releated to
* what is onset like?
* Whats the tell tail sign?

Answer 12

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

Question 13

What disase has fluctuations in alterness and attention, disorganized speech, staring. recurrent visual hallucations. Parkinsons motor symptoms - rigidity and loss of spontaneous movement

Answer 13

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

Question 14

Question 15

Question 16

Wht is the most common psychological mood problem in older adults?

Answer 16

Depression

Question 17

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”

Question 18

Question 19

what disase does the older adult experience more cognitive symptoms (memory issues) versus affective symptoms (sadness)
* which sex more?

Answer 19

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

Question 20

Do developing countries or developed countries have more late life depression?
* what is it globally?

Answer 20

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///

Question 21

Which theory states that depression could be caused by a lack of interpersonal and communication skills, social support, and coping mechanisms

Answer 21

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

Question 22

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

Question 23

so its expensive

hospitailizations/prescription drug costs

Question 24

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

Question 25

polyphamcy = multiple medications interacting in a way that has severe side effects / adverse effects

Question 26

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

Question 27

common depression scales

Question 28

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

Question 29

some medications used for depression

this often cause drowsiness / insomina

Question 30

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

Question 31

depression management

Question 32

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

Question 33