Aging

Question 1

What are the two theories thought to explain aging?

Answer 1

Programmed theories
Damage or Error Theories

Question 2

Reasons why the brain is more susceptible to aging?

Answer 2

Slow, limited cell division
Damaged areas
High levels of energy production and usage results in more oxidative stress

Question 3

What are the structural changes to the brain (normal aging)?

Answer 3

Atrophy
Reduced capillary density
Metabolic changes

Question 4

What are atrophic changes with brain aging?

Answer 4

Loss of neurons
Decreased axon diameter
Reduced myelin sheath thickness

Question 5

What are vascular changes with brain aging?

Answer 5

Reduced capillary density
- Thickening of vessel walls and basement membrane

Question 6

What are metabolic changes with brain aging?

Answer 6

Reduced insulin receptor sensitivity (hippocampus)
Reduced glucose and oxygen use

Question 7

What type of brain matter decline with aging?

Answer 7

Gray = declines linearly
White = peaks in midlife before declining

Question 8

What’s a likely reason for age-related cognitive slowing?

Answer 8

Likely compounded by declining frontal lobe function and neuromuscular control

Question 9

Is age-related cognitive slowing part of normal aging?

Answer 9

Yes

Question 10

What type of activity is critical in maintaining cognitive performance?

Answer 10

Mental and physical

Question 11

Is the global cognitive assessment for specific testing?

Answer 11

No, a broad population-level screening

Question 12

2 main types of cognition?

Answer 12

Hot = emotions and motivation
Cold = information processing

Question 13

Who can administer the global cognitive assessment?

Answer 13

Any member of the health care team

Question 14

Is the global cognitive assessment diagnostic?

Answer 14

No

Question 15

Global Cognitive Assessments

Answer 15

Brief pencil/paper tests to assess general mental status
Used for population-level screening
Can be administered and interpreted of health care team (no level of training req)

Question 16

Common Global Cognitive Assessments

Answer 16

Mini-Mental Status Exam
Montreal Cognitive Assessment
Mini-Cog Test
Clock Drawing Test
AD8 Dementia Screening Tool

Question 17

What is executive function?

Answer 17

Ability to plan, organize, sequence and monitor goal-oriented behaviors

Question 18

How is executive function typically assessed?

Answer 18

By the change in performance from simple to complex conditions
Associated to falls and functional deficits

Question 19

3 main activities involved with executive function?

Answer 19

Updating ability
Shifting ability
Inhibition ability

Question 20

Shifting-Specific Executive Function

Answer 20

Reflect flexibility in transitioning to new task-set representations

Question 21

Updating-Specific Executive Function

Answer 21

May be related to information gating and retrieval from long term memory

Question 22

Clinical Manifestation of impaired inhibition

Answer 22

Impulsivity

Question 23

Inhibition

Answer 23

Suppression of an automatic or predominant response
Means by which habit and familiarity can be over-ridden

Question 24

Updating

Answer 24

Use of incoming information to update older, irrelevant information

Question 25

Updating is related to and associated with which 1) components and 2) activation areas of the brain?

Answer 25

Working memory and intelligence Associated with dorsolateral prefrontal cortical activation

Question 26

Shifting

Answer 26

Transfer of attention b/t multiple tasks or mental states

Question 27

What does shifting require?

Answer 27

Requires disengagement from irrelevant task set, with engagement of more relevant task set

Question 28

Clinical Manifestation of shifting issues

Answer 28

- Perseveration

Question 29

Test for Inhibition

Answer 29

Stroop Color Word Test

Question 30

Tests for Shifting

Answer 30

Navon (local/global) figures Trail making test

Question 31

Is there a brain region for multitasking?

Answer 31

NO, brain activity is task specific

Question 32

Dual Task costs

Answer 32

Can do two tasks at once but not well Disruption in task performance under dual-task conditions

Question 33

Multitasking Tests

Answer 33

Cognitive TUG (subtraction counting while walking) Walking and remembering test

Question 34

3 aspects of dementia

Answer 34

Significant decline in one or more cognitive areas Interference with everyday function Not explained by delirium or other mental disorder

Question 35

Examples of cognitive decline that can manifest with dementia

Answer 35

Learning + memory Executive function Language Complex attention Perceptual-motor Social cognition

Question 36

Common age-related cognitive changes

Answer 36

"tip of the tongue syndrome" Decline in working memory Slower processing Stable vocabulary No appreciable interference with ADLs

Question 37

Best diagnostic test for dementia

Answer 37

Careful hx and physical and mental status exam by a knowledgeable physician