Week 4 Flashcards
T/F: Normal aging includes an increased ability to problem solve and increased reasoning, verbal skills, speed of processing, psychomotor skills, and memory.
False. Normal aging leads to cognitive changes in problem solving memory, psychomotor, verbal skills, reasoning, speed of processing, verbal skills, memory
What is very long term memory (remote) and how does it change with age?
Ability to remember experiences from childhood. Usually pretty stable with age
What is working memory and how does it change with age?
Simultaneously holding information in head (storage) and using it to perform a task (processing). Overall retained over time, but may decrease a little with age. Decrease in storage capacity has been documented, which may contribute to overall decline in memory with age
Well learned knowledge that you remember over a long period of time
Long term memory
How does long term memory (secondary memory) change with age?
A. Tends to largely decrease with age
B. Tends to increase with age
C. Remains pretty stable with age
C. Long term memory remains pretty stable with age. However, there may be issues moving from STM to LTM (encoding process). It may take a while to code this information.
Following through with steps to get to a tv program is an example of…
Problem solving memory
T/F: The verbal performance split in the WAIS (Weschsler Adult Intelligence Scale) dictates that the verbal scale (vocab, general info, verbal comprehension and reasoning) shows earlier and more significant decline than performance scale (speed and accuracy in problem solving) and perceptual abilities
False. Performance scale (speed and accuracy in problem solving) and perceptual abilities show earlier and more significant decline than verbal scale
Involves physical action and declines with age, usually in the early 50’s.
psychomotor skills. Done repeatedly over time and usually you don’t have to think about doing it e.g., riding a bike, tying shoes.
This is ability to process info. Begins to decline in the 50’s.
Speed of processing
Difficulty following and remembering content of a fast-paced tv program or movie is an example of decline in…
Speed of processing!
T/F: Large changes in verbal skills tend to develop in later life
False. Minor changes in verbal skills begin later in life
T/F: With aging, there is commonly a decline in speed and efficiency of problem solving
True.
T/F: Reasoning is thought to be retained with age.
True. While tests show that older adults do worse than younger adults on reasoning, this may say more about outside factors e.g., test, testing environment
T/F: Some research shows a slowing down in intelligence starting at 25 and continuing through the 70s and 80s
True
The ability to adapt to and use new information (new information, problem solving, reasoning). How does this change with age?
Fluid Intelligence. May be decline with age.
Practical skills and knowledge of the person accumulated over a long period of time e.g., social roles, how to act in social situations. Change with age?
Crystalized intelligence. Remains stable with age
The Ability to quickly and accurately compare letters, numbers, objects, pictures, or patterns is _________. How does this change with age?
Perceptual speed. The ability to compare things slows with age (cognitive slowing)
T/F: Abstract reasoning is retained with age
False. Abstract reasoning (measures your lateral thinking skills or fluid intelligence, which are your ability to quickly identify patterns, logical rules and trends in new data, integrate this information, and apply it to solve problems) slows with age, but must take testing factors into account
T/F: The ability to focus on and attend to info (attention) is essential in memory
True
Changes in memory and other areas of cognitive function that may be seen in healthy, older adults of at least avg. intelligence functioning
Mild Cognitive Impairments, previously known as age-associated memory impairments. Impairments involves relatively deficient performance in learning and recalling info, with complaints of memory impairments in daily life. ADLs relatively well preserved
T/F: Many older adults with mild cognitive impairments remain stable without developing dementia
True
T/F: Overall, cognitive function declines in older adults throughout the lifespan
False. Overall, there is a relatively stable cognitive function in older adults throughout the lifespan. Must consider context.
T/F: Current research in industrial gerontology shoes little decline overall in the performance of healthy older adults in the workplace
True. Increasing job satisfaction, job involvement and commitment, and decreased turnover rates associated with aging worker
The greatest amount of age related vocational deficits are seen in which jobs?
Greatest amount of age related vocational deficits seen in physically challenging jobs e.g., manual labor, some blue-collar jobs.
Where is the least decline in vocations visible?
Least decline where skills and info require formal education e.g., teaching
T/F: Studies show that older workers are usually unable to meet demands of work, despite if physically able and adequate time allowed for acquisition of new info and skills
FALSE. More training or time to adapt will help them integrate newly learned habits into routine
This is a term used to account for situation in which there is a lack of environmental demand, thus causing a decline in intelligence and secondary memory
Use it or lose it, baby!
T/F: Birth year/cohort can have effects on cognitive abilities or test performance
True. E.g., educational opportunities, life experience, access to medical care, occupational opportunities
Concept suggesting that some people have more reserve capacity in cognitive function, allowing them to delay signs of cognitive loss due to normal aging or conditions like alzheimers
Cognitive reserve
What may increase cognitive reserve capacity?
Cognitively stimulating activities e.g., reading or playing car games, learning new things, read new books
Which of these cognitive instance will most likely not affect vocational performance?
A. Decline in fluid intelligence (obtaining new info and adapting to it)
B. Increased cautiousness
C. Decreased processing speed (using info to perform tasks)
D. Decline in secondary memory (long term)
E. Crystallized intelligence
E. Crystallized intelligence. This is retained with age.
Job training for adults should include:
Training sessions must involve info of relevance and interest to older adult, feedback on success to bolster self-confidence and maintain motivation, more time to learn new skills, mnemonic strategies to enhance material to be learned
What kind of strategies can be helpful for older adults to overcome memory changes?
Mnemonic strategies. They can help increase coding from STM –> LTM so the individual can better adapt to new work.
T/F: In healthy older adults with normal cognitive changes, deficits in ADLs and IADLs are inevitable
False. It is not likely that cognitive changes bring about significant deficits in ADLs and IADLs. Normal age-related changes shouldn’t affect someone who has been performing the same activity for 40-50 years.
What is the exception to the rule that activities should not be affected by normal cognitive changes associated with aging?
If cognitive changes including slowing processing speed and memory changes, participation in activities may be affected e.g., trouble with challenging card games like bridge/cribbage. However, these changes shouldn’t lead to an inability to engage in activities. Instead, may use adaptive strategy e.g., making motes, additional time, engage in meaningful activity
T/F: It is almost impossible for older adults to learn new leisure and recreational skills
False! There is no reason adults cannot learn new skills or info to engage in new leisure activities.
How can leisure activities help to maintain cognitive functions in older adults?
Leisure activities that stimulate the older adult on a social, cognitive, and physical note can help maintain cognitive functions
If a person gives up something he/she truly loves, it could be a sign of…
Major depression or cognitive decline/dementia
How does free recall change with age?
With age, free recall may decline (one’s own ability to retrieve info without a cue)
How do changes in one’s ability to recall vs. recognize differ?
With age, free recall (one’s ability to to retrieve info without cue from memory) may decline. But recognition remains relatively intact. For example, person may recognize someone easily, but not necessarily recall their name. They recognize person by sensing individual and comparing it to own memory bank to see if match and recognize person instantly, but can’t recall from memory who person is.
What sort of formal and informal methods of interventions/adaptations may help compensate for age-related memory changes?
- Memory aids e.g., reminders, lists, med management devices
- Formal training, however follow through with strategies is low
Changes in this area of cognition may affect these daily activities:
- Difficulty remembering newly learned facts e.g., phone numbers, associating faces and names (memory recall)
- Problems in workplace if job requires high level of memorization
- Misplacing objects, forgetting appointments
Age-related changes in memory may affect these daily activities
Changes in this area of cognition may affect these daily activities:
- Some difficulty following and remembering content of fast-paced TV programs or movies
- Could lead to difficulties in reaction time or decision making while driving
Slowed processing speed may affect these daily activities
Chunking/grouping list is an example of this memory strategy
Internal memory strategies
Mnemonic phrases and rehearsing info is an example of this kind of memory strategy
Exteral memory strategy
Defined as deterioration in cognitive functioning that renders a person unable to meet diverse intellectual demands in everyday life
Dementia
T/F: Dementia is always progressive and acute
False. Dementia may be progressive or plateau or be static. Some can be treated. Also may not be acute, but insidious/gradual
T/F: Dementia is a normal part of aging.
False. It is not a part of normal aging. One is unable to function normally in the world. It is a clinical diagnosis with social implications (socially constructed).
Reasons for extended care placement for a person with dementia may include:
- Caregiver burnout (common)
- require skilled care that can’t get at home, but $$ at institution
T/F: Memory complaints are the first sign of dementia
False. Person may just believe they forgot something, especially if their complaints are not legitimized via tests/ assessments. May also be due to anxiety or depression.
Common general signs of dementia include:
- Retention of specific cognitive abilities contrasted with deterioration of others
- Behavioral symptoms e.g., mood changes, agitation, psychotic symptoms
- Maybe wandering and aggression
- Personality changes
- Decreased perceptual skills (interpreting info)
- decreased problem-solving skills
- Decreased short term memory
All of the following are general signs of dementia except:
A. Retention of specific cognitive abilities contrasted with deterioration of others
B. Behavioral symptoms e.g., mood changes, agitation, psychotic symptoms, agression
C. Wandering
D. Personality Changes
E. Decreased perceptual skills (interpreting info)
F. Decreased problem-solving skills
G. Decreased Long-term memory
H. Decreased short term-memory
G. Decreased Long-term memory
The most prevalent form of dementia
Alzheimer’s Disease (AD)
What is the cause of AD
Beats me! Unknown.
Predispositions to AD include:
- Increasing age
- Female
- Family history
- Ethnicity
This type of dementia requires both episodic (past personal memories) and recent memory impairment during insidious onset as well as one other cognitive domain (e.g., aphasia, agnosia, apraxia, executive dysfunction)
Alzheimer’s Disease
Aphasia: trouble understanding speech
Agnosia: inability to recognize things
Apraxia: motor sequencing problems
Vascular Dementia (VaD) is caused by…?
VaD is caused by cerebral vascular damage
When AD and VaD coexist, it is called________
Mixed dementia
In this type of dementia there are changes to white matter and lacunar infarcts, as well as hippocampal formation atrophy, which are indicators of cerebrovascular disease, which can lead to dementia
Vascular Dementia (VaD)
Those with this disease demonstrate perseverating behaviors and difficulties with verbal fluency
Vascular Dementia (VaD)
Hallmark features of Vascular Dimentia (VaD) include:
Dysexecutive symptoms rather than memory
:trouble with planning, sequencing, speed of mental processing, attention
-Also, perseverating behaviors and difficulty with verbal fluency
Are men or women more at risk for AD?
Women
Are men or women more at risk for vascular dementia (VaD)?
Men
Men, stroke, hypertension, and advancing age are more at risk for this disease?
Vascular Dementia (VaD)
This disease occurs when lewy bodies (round neurofilament inclusion body that holds damaged nerve cell deposits) are found in the brain
Dementia with Lewy Bodies (DBL)
Round neurofilament inclusion body that holds damaged nerve cell deposits
Lewy Body
Dementia with Lewy Bodies often co-occur with what condition?
Parkinsonism (movements often seen during Parkinson’s). Rigid in joints and bones, impairs movements, bradykinesia (slow movements)
Potential signs of this condition include:
- Parkinsonism
- Cognitive fluctuations with prominent deficits in attention
- Visual hallucinations
- repeated falls
- nonvisual hallucinations
- delusions
- syncope (fainting)
Dementia with Lewy Bodies (DBL)
This is the 3rd most common neurodegenerative dementia syndrome after AD and DLB
Frontotemporal Dementia (FTD)
Part of heterogeneous group of frontal lobe dementias that include focal conditions
Frontotemporal Dementia (FTD). Others include progressive aphasia, semantic aphasia, and frontol dementia with motor neuron disease
This form of dementia is marked by social inappropriate behaviors
Frontotemporal Dementia (FTD)
Signs of frontotemporal dementia (FTD) include all except which?
A. behavioral disturbances
B. changes in social awareness
C. evident changes in personality
D. lack of sympathy and empathy
E. poor hygiene and decreased independence with ADL
F. Loss of insight and difficulty with executive functioning
G. Visual hallucinations
H. Progressive aphasia (trouble finding words and expressing thoughts)
I. Semantic aphasia (decrease in understanding words and identifying objects)
J. Trouble with cued recall
G. Visual hallucinations
Many individuals diagnosed with PD develop ______?
Dementia. Usually develops about 10 years after PD
Parkinson’s disease with dementia (PDD) clinically looks very similar to _____?
Dementia with Lewy Bodies (DBL)
Signs of this form of dementia include:
-Slowed psychomotor speed
-difficulties with attention and initiating activities
-decline in delayed recall, semantic knowledge, frontal-executive functions, memory and
visuospatial functions
-lack of ability to coordinate movement
-Trouble with speech and language and visuospatial functions
-May need food tube, affects meal time dynamics
Parkinson’s Disease with dementia (PDD)
What should you look at to diagnose dementia?
- Once memory impairment established, assess which type of memory impairment: STM (immediate) or LTM (delayed memory)
- Other impairments present? Rule out depression, anxiety and delirium, medication-induced problems
- Do they effect the person’s everyday life activities? Any behavioral problems?
- Neuropsychological evaluations and neuroimaging used
- Earlier the diagnosis, the better the chance of treating with medications
What are the 5 stages of dementia?
- Pre-dementia: no symptoms, only see via autopsy
- Mild: word finding, recall, memory loss continues. Trouble remembering where put things, can make clinical dx., difficulty with work demands, may get lost in unfamiliar places, trouble remembering new info, maybe confusion and disoriented, may hide deficits, may repeat things, impaired comprehension
- Moderate: Can’t live alone b/c safety, changes in gait, may not recognize distant family/friends, trouble learning new things or coping with change, maybe loss of impulse control (sloppy manners, vulgar)
- Severe: Requires help with ADLs, incontinent, incoherent speech, trouble recognizing family/friends, progressively decreasing
- Terminal
In this stage of dementia:
- Difficulties in word finding, recall, and memory loss continues
- Trouble remembering where put things
- Can make clinical diagnosis
- Difficulty with work demands
- May get lost in unfamiliar settings
- Trouble remembering new information
- Confusion, disorder, may hide difficulties (still able to hide)
- May repeat things
- Impaired comprehension
Mild dementia
In this stage of dementia, there is no diagnosis and no symptoms. Only able to see via autopsy
Pre-dementia
In this stage of dementia:
- Can’t live alone b/c safety
- Changes in gait
- May not recognize distant family or friends
- trouble learning new things or coping with change
- may be loss of impulse control (sloppy manners, vulgar)
Moderate dementia
In this stage of dementia:
- Required help with ADLs
- Incontinent
- Incoherent speech
- Trouble recognizing family/friends
- Progressively getting worse
Severe Dementia
When working with those with dementia, remediation techniques for are likely to cause improvement in cognition
False. Remediation of cognition is not likely. Maintenance and modification are useful.
T/F: When working with those with dementia, modification techniques are often used.
True. Can help be safe in environment via adaptations, AE, compensate for losses and help them do things they want to
What is the role of OT for working with dementia?
- Educate family members
- Evaluate on strengths, impairments, performance areas needing intervention
- remediation of cognition not likely
- maintenance (can help determine what is working well and give supports to maintain) and modification (helps be safe in environment via adaptations, AE, compensate for losses so they can still do things they want to)
What is the role of OT in early stages of dementia?
- They have difficulty with higher-level executive skills
- Help with driving, work, home safety eval and intervention, establishing life legacy
What is role of OT in middle stages of dementia?
- Home safety
- Staying engaged in meaningful activities
What is the role of OT in late stages of Dementia?
- They have difficulty with BADLs
- Help decrease caregiver burden
- Enhance basic care
- Positioning
T/F: Assessing ADLs and IADLs is sufficient when working with an individual with dementia
False! The impact of ADLs and IADLs represent occupational and social functioning, but need to look at their pleasure and social connections.
T/F: it is relatively easy to operationalize occupational and social functioning in those with dementia
False. It is difficult. The level of impairment affecting one’s everyday life varies. One’s ability to participate varies.
Why should OTs be careful when utilizing groups for those with dementia?
All people with dementia don’t want to work on the same activities in therapy. Also be careful with pre-made kits, as they may not be meaningful to person
What is the problem with many assessments for dementia?
Test scores, reports, and assessments usually are not based on how the person does in occupation. Must make clinical judgment using observational skills as well. Also, must look at who is answering questions-may not be accurate based on who’s answering.
Why is it important to identify a person’s occupational baseline when considering dementia in an individual?
Must look at previous level of functioning and compare it to current functioning to see change. Is change due to dementia, or meds, depression, other? Ask family/caregiver clear and well-directed questions
In this method, those with dementia and caregivers share meaningful functional endpoints for improvement and worsening from personal experiences
• Can provide quantifiable outcomes to be used across tx groups
Goal Attainment Scaling (GAS). May be used when working with people with dementia
“Decline” in occupational or social functioning that is attributed to changes in his/her cognitive abilities is the diagnostic criteria for _____? Why is this definition problematic?
Dementia. But, problematic because the ability to define occupational and social functioning and measure them is limited
T/F: Clinical judgements about occupational and social functioning of individuals with dementia is often made on the basis of neuropsychological and cognitive test scores .
True. Problematic because not looking at the performance in everyday occupation
What is the most effective way to determine if diagnostic criteria are met for those with dementia?
Use an individualized approach to assessment that incorporates the use of dementia specific assessments and clinical judgments
To measure tx effectiveness in those with dementia, must must distinction between occupational performance potential and actual occupational performance. What are these?
Occupational Performance potential: what they are capable of doing
Actual occupational performance: what they actually do
When family members and caregivers may continue to restrict individual’s opportunities to engage in activities even though they can do them well
Tutoring effect. May occur with those with dementia
In designing a therapeutic environment, what you consider?
- Promote participation in meaningful occupations
- “Home-like” setting allows more privacy, choices, opportunities to participate in meaningful occupations and supports family members’ participation in residents lives
- Clear cues for washroom, room i.d. cues to promote independence
- Sensory elements may reduce agitation, anxiety, aggression
- Help train caregiver on compensatory behaviors, manage behavior, help know what to expect
In those with dementia, “problem behaviors” are…
Usually a sign of frustration, fatigue, fear, confusion, or pain–usually inability to express oneself is coined “problematic”
Recommended strategies for caregivers of those with dementia:
- Shifting roles and changing dynamics
- Learning more about dementia and effects of disease
- Offering resources and advocacy groups
- Caregivers need emotional and self-esteem support
- Support groups (often underutilized)
- Define “new normal”
- “just right challenge”-focus on what person CAN do
- Safety
- Help individual return safely home , home assessments to maneuver at home
- Let the loved one be the expect if they have long-term experience with activity
T/F: Support groups for caregivers caring for individuals with dementia are often utilized
False, support groups are often underutilized
Recommended daily strategies for those with dementia
- Maintain relationships with family and friends
- Continue to engage in meaningful activity
- Strategic time use and taking advantage of habits and routines
T/F: When working with a person with dementia, it is best to challenge them in tasks
False, avoid difficult activities that are too challenging
As an OT, how can you adapt an activity if it is too difficult for someone with dementia?
- Change how the task is completed/done
- Change the demand of the task
- Change aspects of the physical and social environment
- “Error-proof” the environment and grade activities
False: When working with an individual with dementia, it is best to ask open ended questions
Ask yes-no questions as they are less cognitively demanding
