Unit 3 - Ageing and Cognition

Question 1

What is a FOOSH?

Answer 1

Fall On an OutStretched Hand

Question 2

List 3 examples of early signs of dementia

Answer 2

1. Seemingly erratic or illogical behaviour patterns that weren’t there before
2. Starting yet never finishing tasks, both on own merit and when asked to do so
3. General forgetfulness, concerning both dates/times and verbal recall

Question 3

What age-related factors can lead to increased risk of fractures after a fall?

Answer 3

• The risk of fractures following a fall also increases with age as the bone structure becomes less robust
• Osteoporosis

Question 4

Fill in the blanks:

“… leads to wider synaptic gaps and more issues with synaptic transmission”

What aspect of function can this impact?

Answer 4

The loss or thinning of CNS Myelin and shrinkage of dendrites

Motor control - causes slower movements

Question 5

Name one age related change in the CNS that affects vision

Answer 5

The reduction of viable optic nerve fibres leads to reduced efficiency in perceptual processing, especially when combined with age-related changes in the eyes such as changes in shape/opacity of lens and changes in retina

Question 6

Name one age related change in the CNS that affects memory

Answer 6

Caused by loss of viable nerve fibres and loss/death of brain cells in relevant areas

Affects prospective and more generally STM the most

Question 7

Name one age related change that affects hearing

Answer 7

Cell loss/death within inner ear leads to issues with hearing higher pitched noises and possible impairments in discrimination of speech produced sounds

Question 8

List the six areas of cognitive function which are screened for during relevant assessments such as Dementia

Answer 8

1. Arousal and orientation
2. Attention, working memory, processing speed, and psychomotor function
3. Executive function
4. Language
5. Visuospatial function
6. Memory function

Question 9

Define arousal and orientation.

How could you assess it in the context of cognitive testing?

Answer 9

Arousal is concerned with the way and rate in which we respond to stimulus. Orientation is concerned with the ability to identify oneself and to know the time, the place, and the person one is talking to.

A = We can generally assess this informally by passively observing the SU, as it's how they respond to you.
O = Asking SUs about their knowledge regarding current location, aspects of time, persons present, and situation .

Question 10

Define attention, working memory, processing speed, and psychomotor function.

Answer 10

These are “interrelated concepts” which are represented “diffusely in the brain” and generally decline during normal ageing.

Question 11

Define executive function.

How could you assess it in the context of cognitive testing?

Answer 11

Refers to activities which are typically the responsibilities of the frontal lobes/systems, such as planning, organisation, inhibition, shifting from one task to another, fluency, and abstract reasoning.

Informal assessment can include “observing for signs of inhibition”, such as frequent interruptions and/or inappropriate comments made during social interaction(s). More formally, EF can be assessed through tasks such as “alternating between stating the letters of the alphabet starting at A and ending at Z and counting numbers from 1 to 26” and recording their ability to do so.

Question 12

Define language.

How could you assess it in the context of cognitive testing?

Answer 12

This includes language used, comprehension of language used by others and talking/verbal processes themselves.

Can be as simple as asking an SU a question and observing how they interpret the question and respond to it

Question 13

Define visuospatial function.

Answer 13

Cognitive processes necessary to “identify, integrate, and analyse space and visual form, details, structure and spatial relations” in more than one dimension.

Needed for movement, depth and distance perception, and spatial navigation.

Question 14

Define memory function.

How could you assess it in the context of cognitive testing?

Answer 14

The capacity to store, retain, and recall information and experiences.

All cognitive screening tools provide objective assessment of memory and include tasks on which the patient is asked to learn and recall (or recognise), after a delay in which the patient is mentally engaged and not allowed to rehearse the presented materials, a verbally presented word list or story, or to redraw a previously copied figure.

Question 15

Define frailty

Answer 15

A syndrome which means those who are defined as this, if some things were to happen to them, they would be less likely to fully recover

Based on Clinical Ax

Question 16

What is multi-morbidity?

Answer 16

Having more than 2 chronic conditions

Question 17

What changes occur to the cardiovascular system during ageing?

Answer 17

• Hypertension
• Thickening of heart walls
• Generally, more stress is put on the heart

Question 18

What is metabolic syndrome?

Answer 18

Cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes.

These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels

Question 19

Define dementia

Answer 19

Dementia is an umbrella term, a syndrome that describes the signs and symptoms of several diseases that are linked to the degeneration or death of brain cells.

Diagnostic guidelines define dementia as a decline in memory and thinking. This in turn impacts on activities of daily living and is progressive in nature. Dementia mainly affects older people although its onset can be under the age of 65 years

Question 20

Define type 2 diabetes

Answer 20

The exact causes of type II diabetes are not known and probably vary for different individuals. Environmental factors, including obesity, inactivity, and diet appear to be factors in its development because its incidence is rapidly increasing. Age 40+ = higher risk

Defects in insulin secretion and insulin action (either of which may be the main feature) and liver glucose production result in the high blood glucose. Over many years, diabetes causes a variety of effects on different parts of the body associated with damage to blood vessel walls.

Question 21

Define Osteoporosis

Answer 21

Osteoporosis is a health condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a bone to break (fracture).

Losing bone is a normal part of ageing, but some people lose bone much faster than normal. This can lead to osteoporosis and an increased risk of broken bones.

Question 22

Why does ageing cause musculoskeletal problems

Answer 22

Muscle fibres reduce in number and shrink in size. Muscle tissue is replaced more slowly and lost muscle tissue is replaced with a tough, fibrous tissue. Changes in the nervous system cause muscles to have reduced tone and ability to contract.

Question 23

How could you assess visuospatial function in the context of cognitive testing?

Answer 23

Brief assessments of visuospatial abilities are included in all of the standardised mental status examination tools. a basic screen for visuospatial problems may include instructing the patient to copy predrawn shapes on a page, starting with simple shapes and progressing to more complex shapes, building shapes with triangles or blocks, and drawing a clock.

Simple visual perception can be tested by asking the patient to count the number of irregularly spaced dots on a card without using any fingers to point or count.

More complex visual perception, attention, and integration can be tested by showing the patient a picture and asking him to describe what he sees.