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Lifespan > Cognitive Impairments in Older Adult > Flashcards

Cognitive Impairments in Older Adult Flashcards

1
Q

what are normal age related cog changes

A

everyone experiences minimal, slight cog changes
- ex: BSF

no decline in function and social skills or judgement
no change in personality
not true memory loss

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2
Q

what is benign senescent forgetfulness (BSF)

A

normal memory loss w/o functional decline
- may need more cues for recall

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3
Q

what is a mild cognitive impairment (MCI)

A

may have some abnormal cog measures compared to age-related norms
- still have normal ADLs and can function
- may have memory complaints

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4
Q

what does a MCI inc the risk of

A

developing dementia and a higher fall risk

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5
Q

what is the preclinical stage of dementia

A

silent phase
- brain changes w/o measurable sx

individual may notice
- not detectable on tests

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6
Q

what is the MCI stage leading to dementia

A

cog changes are of concern to individual/family

one or more cog domains impaired significantly

preserved ADLs

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7
Q

what are characteristics of dementia as a stage of cog decline

A

cog impairment severe enough to interfere w everyday abilities

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8
Q

what are 3 aspects of cog that remain relatively stable

A

memory
language
social cog

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9
Q

what is implicit memory

A

unconscious influence of previously encountered info on subsequent performance

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10
Q

how do we expect implicit memory to be impacted by aging

A

should be stable with only slight changes
- pts should express appropriate emotion, accurately remember their past, process current info, and make appropriate decisions

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11
Q

what aspects of cog show gradual and linear declines throughout lifespan (4)

A

processing speed
encoding info into episodic memory
short term memory
executive functioning

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12
Q

in absence of pathology, an older person may demonstrate what cog characteristics indicative of aging

A

slower processing time

need more rehearsal
- to encode into long term memory

dec ability to multi-task

difficulty finding alternate methods of problem solving

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13
Q

what are the 3 main cognitive impairments in older adults

A

depression
delirium
dementia

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14
Q

what is memory

A

process of remembering that begins w a sensory event that is seen, heard, experienced or felt
- sensory memory is brief

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15
Q

how can memories be encoded into short term memory

A

if sensory memories are attended to, encoded via attention or focus

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16
Q

what is short term memory

A

combo of short term storage and executive processes

limited - holds 5-9 items at a time

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17
Q

how are short term memories encoded into long term memory

A

repetition and rehearsal

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18
Q

what are the 2 main types of long term memory and examples of each

A

implicit
- procedural tasks and actions
- retained thru motor learning
- ex: tying shoes, STS

explicit
- episodic
- semantic memory
- ex: facts, words

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19
Q

how can SLP and referral sources be helpful in adults w severe cog deficits

A

work a lot on procedural task memory

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20
Q

what is executive functioning

A

complex behavior that combines memory, intellectual capacity, and cog planning

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21
Q

what are components of executive functioning (6)

A

planning
active problem solving
short term memory
anticipating possible consequences
initiating an activity
able to monitor efficacy of self

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22
Q

what is executive dysfunction

A

dec in planning ability, working memory, inductive reasoning and ability to modify

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23
Q

what is a concern with executive dysfunction

A

inc fall risk
- issue w safety and insight

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24
Q

what is executive functioning’s relationship to motor function

A

challenges w executive function will result in difficulty w self-assessment to accurately reflect knowledge of performance
- required for motor learning

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25
Q

how is language impacted by normal aging

A

remains intact
vocab sustained

some features may show small decline >70yo
- identifying objects
- word generation in a category

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26
Q

how does attention change w normal aging

A

simple attention - shows only slight decline

complex - noticeable changes

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27
Q

how does complex attention change with normal aging

A

selective attention and divided attention show decline in older adults compared to younger
- dual tasks difficult

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28
Q

how can complex attention changes be utilized in a PT session depending on what you want to work on

A

can minimize environment directions to optimize learning

can inc distractions to challenge divided attention system during gait or other tasks
- good way to see an initial assessment too

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29
Q

what is social cognition

A

involves self-behavioral regulation and ability to understand mental states of others and societal expectations

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30
Q

how does social cognition change w normal aging and what are the implications

A

challenging to assess another person’s emotional state or discerning accuracy/falseness of another’s statements

decline in insight might be why they are more susceptible to abuse, neglect, and exploitation

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31
Q

what is perceptual motor function and how does it change w normal aging

A

processing speed for both cog activities and motor responses begin to decline gradually starting >30yo

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32
Q

what are the implications of normal aging on perceptual motor function

A

change in processing can result in challenges across other cog domains and function
- impact on balance regulation
- impact ability to identify LOB - impact ability to create appropriate motor response after tripping

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33
Q

incidence/rates of depression in older adult

A

similar to other ages

more common in females until age 50-60yo
- once in 80s, same incidence b/w men and women

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34
Q

how does depression present in older adults

A

loss of motivation
loss of energy
loss of health

no longer interested in social groups

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35
Q

geriatric depression scale scoring

A

0-9 normal
10-19 mild
>/= 20 severe

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36
Q

what are the 2 Qs in the 2 Question Depression Test

A
  1. during past month, have you been bothered by feeling down, depressed, or hopeless?
  2. during past month, have you been bothered by little interest or pleasure in doing things?
37
Q

when should you implement the 2 Q depression test and what do you do w the results

A

use as a screening tool for completing GDS (short or long form) and/or referral

38
Q

what is a consideration when assessing sx of the 3 Ds (depression, delirium, dementia)

A

all have very similar sx, need to tease out which one

39
Q

what is delirium characterized by

A

disturbed consciousness, cog function, or perception

40
Q

who is at the highest risk of delirium and why

A

hospitalized older adults
- risk inc w inc severity of illness

see more pathological cog changes when taken out of routine

** importance of establishing a baseline cog level **

41
Q

what does delirium place the pt at higher risk for

A

higher mortality
longer recovery

42
Q

what are the causes of delirium

A

URI, UTI, PNA
- can see overnight change
meds
surgery/anesthesia
untreated pain

43
Q

what is the key feature of delirium to differentiate from dementia

A

disturbance develops over short period of time

delirium = acute

44
Q

what are key features of delirium (5)

A
  1. disturbed attention/awareness
  2. disturbance develops over short period of time
  3. additional disturbance in cog (memory deficit, disorientation)
  4. disturbed attention, awareness, and cog aren’t better explained by another pre-existing, established or evolving neuro-cog disorder & not d/t severely dec level of arousal
  5. caused by physio consequences of another med condition, substance intoxication, withdrawal
45
Q

how is the delirium rating scale utilized

A

score the severity of delirium

can use repeatedly throughout stay to monitor progression or regression of delirium

46
Q

what is dementia

A

clinical syndrome of cog and functional decline, usually of a chronic or progressive nature

47
Q

why/when is dementia considered a major neurocognitive disorder

A

cog deficits must be sufficiently severe to cause impairment in occupational or social functioning and must represent a decline from previously higher level of functioning

48
Q

what are the 4 common subtypes of dementia and which 2 are most most common

A

**alzheimers dz
** vascular dementia
dementia w lewy bodies
frontotemporal dementia

49
Q

what postop pts is the risk of developing delirium highest (2)

A

s/p hip fx
s/p vascular surgery

50
Q

how does age in men and women factor into the prevalence of dementia

A

the longer you live –> inc exposure to environmental toxins
- higher in women than men bc women live longer

if men >65yo, can assume they have healthier CV profile and lower risk of dementia

51
Q

what contributes to the societal cost of dementia

A

inc prevalence
cost of illness
amt of informal care available

52
Q

what are 3 dementia cog assessments

A

MMSE
MOCA
SLUMS

53
Q

what are the categories that the mini mental state exam (MMSE) assesses (5)

A

orientation
registration
attention & calculation
recall
language

54
Q

what is the cutoff score for dementia in the MMSE

A

23

55
Q

what are the 7 categories assessed in the montreal cog assessment (MOCA)

A

visuospatial
naming
attention
language
abstraction
delayed recall
orientation

56
Q

what is normal on the MOCA

A

> /= 26

57
Q

what are the norms based on in the saint luis university mental status (SLUMS) and what are they

A

based on high school education

27/30 = high school ed norm
25/30 = < high school ed norm

58
Q

what is the most common form of dementia

A

alzheimers

59
Q

what is alzheimers dz closely associated with

A

advance aging
- associated but not normal

60
Q

why is there a push for early detection testing for alzheimers dz

A

neuropathologic changes may precede clinical sx by as much as 20yrs

61
Q

what are the most common pathologic changes associated w development of alzheimers

A

amyloid plaques and neurofibrillary tangles
–> presence activates cytokine storm and chronic inflammation

62
Q

what are amyloid plaques which are found in alzheimers

A

protein fragments (B-amyloid peptides) mixed w additional proteins, remnants of neurons, and bits/pieces of other nerve cells

63
Q

what are neurofibrillary tangles which are found in alzheimers

A

abnormal collections of tau protein (-> think CTE)
clumps together and causes neurons to fail and die

64
Q

what changes in acetylcholine levels are seen in alzheimers and what is the significance of this

A

inadequate levels of ach

ach is the neurotransmitter which transfers the info from one neuron to another via synaptic connections

65
Q

what are the 2 visible changes on imaging with alzheimers

A
  1. dec synaptic density
  2. volume loss in the entorhinal cortex
66
Q

where is there significant atrophy of synaptic density d/t alzheimers

A

inferior prefrontal cortex

67
Q

what is the significance of volume loss in the entorhinal cortex d/t alzheimers

A

entorhinal cortex is an important relay b/w hippocampus and association cortices
-> neg impact on hippocampus

hippocampus is critical for encoding –> episodic memory frequently affected

68
Q

what is brain-derived neurotrophic factor (BDNF), why is it important, and what is it linked to

A

important signaling molecule that regulates synapses and lead to learning and memory

vital role in neuronal growth, development, and survival

linked to alzheimers and other neurologic disorders
- trickle down effect and linked to CV health and chronic inflammation

69
Q

what happens when BDNF and neural growth factor (NGF) are inhibited

A

stimulates molecular events typical of alzheimers
- inc in amyloid beta plaques

70
Q

what happens if BDN and NGF signaling is interrupted

A

sets up toxic mechanisms that induce death and loss of neurons
–> results in brain tissue atrophy

71
Q

what are general observations of alzheimers dz on the brain

A

not as voluminous
- lot of space in skull
not as much fluid

72
Q

when is considered an early stage of alzheimers

A

2-4yrs leading up to and including dx

73
Q

what are 6 common sx of early stage alzheimers dz

A

low energy
emotional lability
slow reactions
word finding difficulties
names of things
heightened anxiety

74
Q

when is considered middle stage of alzheimers

A

b/w 2-10yrs after dx

75
Q

what are 4 common sx of middle stage alzheimers

A

difficulty recognizing familiar people
difficulty w decisions
writing illegibly
more self-absorbed

(overall hard time interacting and understanding environment around them)

76
Q

when is considered late stage alzheimers

A

terminal phase
- life expectancy 1-3yrs

77
Q

what are 6 common sx of late stage alzheimers

A

apathetic
remote
may become incontinent
weight loss
unable to walk/communicate
difficulty swallowing

78
Q

how is the use of physical restraints linked to the primary goal of acute care settings

A

goal = avoid falls
don’t have capacity for 1:1 care for all fall risks

79
Q

who are physical restraints appropriate for

A

dec awareness
fall risk
for their safety

80
Q

what is a physical restraint

A

any manual method or physical or mechanical device, material, or equipment attached to or adjacent to resident’s body which individual can’t remove easily, that restricts freedom of mvmt or normal access to one’s body

81
Q

what are 5 considerations with implementing physical restraints

A

informed consent
risk vs benefit
determination of competency
resident’s rights
risk reduction

82
Q

what are 3 physical restraints that are adjacent to the patient (not attached)

A

bed alarm
chair alarm
defined perimeter mattress

83
Q

what are the benefits of physical activity in dementia

A

may delay progresssion
dec isolation
dec risk of falls
inc confidence
inc self-esteem
inc mood

84
Q

what are 4 main challenges when trying to implement physical activity into someone w alzheimers

A
  1. behavioral challenges (anger, aggression, inappropriateness)
  2. ask family/support system ab pt
  3. memory deficits
  4. communication
85
Q

what are strategies to manage behavioral challenges when implementing physical activity in pt w dementia

A

plan ahead
distractions
simple treatment - functional
promote sense of security
allow them sense of control
calm manner

86
Q

what are questions to ask family/support system ab a pt w dementia

A

what did they use to do
interests
what agitates them
what comforts them
what is their normal routine

87
Q

what are strategies to manage memory deficits when implementing physical activity in pts w dementia

A

consistent therapy routine
redirect
use verbal and tactile cues
handouts for caregivers
simple, 1-step commands
demonstrations

88
Q

what are strategies to manage communication deficits when implementing physical activity in pt w dementia

A

speak clearly and slowly
- give them 10-15sec to process and respond
be aware of body language
get down at pts level
don’t rush treatment
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Lifespan (20 decks)

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