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What is the normal physiology of cognitive changes?

Loss of synaptic connections
• Creates memory impairment (slowed but intact)
• Evidence of mild decline in executive functioning


What is the pathological physiology of cognitive changes?

• Certain growth factors in brain are inhibited
• Death and loss of neurons
• Dementia


What is the continuum of cognitive changes?

Normal Aging --> Mild Impairment --> Dementia

Not everyone follows the continuum


What are the most common types of dementia?

• Alzheimer’s Disease
• Vascular
• Lewy Body


What does dementia commonly affect?

Commonly affect memory and language


What are the other cognitive deficits seen with dementia?

• Aphasia
• Apraxia
• Disturbance of executive function


___ is the most common form of dementia

*Alzheimer’s Disease* is the most common form of dementia


What are the characteristics of Alzheimer’s Disease?

• Early onset (30-60 years of age)
• Late onset


What are the risk factors for Alzheimer’s Disease?

• Advancing age
• Positive family history
• Women > Men
• > African American and Hispanic populations


What are the clinical presentation for Alzheimer’s Disease?

• Memory impairment
• Lapse in judgment
• Personality changes
• Depression possible
• Language problems
• Difficulty with ADLs
• Visual spatial problems
• Short tempered, hostile
• Loss of motor function (swallowing, bowel/bladder)


___ is the second most common type of dementia

*Vascular Dementia* is the second most common type of dementia


What are the risk factors for Vascular Dementia?

• Smoking
• Hypercholesteremia
• Diabetes mellitus
• Cardiovascular disease
• Cerebrovascular disease


What are the clinical presentation for Vascular Dementia?

• Memory
• Abstract thinking
• Judgement
• Impulse control
• Personality changes
• Characterized more by abrupt onset, step by step
deterioration, fluctuating course, and emotional lability


What is lewy body dementia?

Progressive cognitive decline with
1. Fluctuations in alertness and attention
• May be drowsy or lethargic
2. Visual hallucinations
3. Parkinsonian motor symptoms


What are the clinical presentation for lewy body dementia?

- Gait and balance issues
- Visual spatial issues
- Poor executive functioning
- Sensitivity to antipsychotics
- May be depressed


What is delirium?

Sudden, rapid change in mental function
• Often confused with Dementia
• Usually short term, temporary


What is delirium associated?

• Medical illness
• Recovery from surgery
• Hospital admission


What are the clinical presentation for delirium?

- Shouting and resisting
- Refusal to cooperate with medical care
- Potential to be injured falling
- Combative
- Pulling of lines and tubes


What does the treatment of delirium focus on?

- Increased time OOB
- Walking
- Managing hydration
- Hypoxia
- Nutrition


What is a major depressive episode?

Depressed mood or loss of pleasure in all activities
AND at least 5 associated symptoms for at least 2 weeks that impact function, social, or occupational endeavors


What are the associated symptoms of major depressive episode?

- Weight loss
- Insomnia
- Hypersomnia
- Decreased or hyperactive motor activity
- Fatigue
- Loss of energy
- Feelings of worthlessness
- Excessive inappropriate
- Diminished ability to think or concentrate
- Recurrent thoughts of death
- Suicide ideation or attempt


What is an adjustment disorder with depressed mood?

Maladaptive reactions to identifiable psychosocial
stressors that occur within 3 months of onset of stressors


What does adjustment disorder with depressed mood do?

Impairs social or occupational function or marked
distressed in excess of normal or expected reaction.


What are the symptoms of adjustment disorder with depressed mood?

- Depressed mood
- Tearfulness
- Feelings of hopelessness


What are the characteristics of the Two Question Depression Test?

• “Over the past two weeks, have you ever felt down,
depressed, or hopeless?”
• “Have you felt little interest or pleasure in doing things?”

An answer of yes to these two questions indicates a need for referral or follow up with MD


What are the characteristics of the Geriatric Depression Scale?

30 questions, yes (1 point), no (0 point)
• Score greater than 10, need referral or follow up
• 0-9 normal, 10-19 mild depressive, 20-30 severe depressive


What are the characteristics of the Center for Epidemiological Studies Depression Scale (CES-D)?

• 20 questions
• Likert scale questions > 16 points may need referral
• The higher the number the more likely depression is an issue


Why is addressing depression in the aging population important?

• Suicide is more prevalent in the aging population (16%) than in the teenage population (14%)
• Highest suicide rates are in the greater than 65 year of age
• Aging adults may have been born and raised to feel that mental illness is stigmatized and emotions should not be emphasized, making them less likely to talk about it or seek help


What are the physical illness that aging adults may face that can increase the risk of depression?

• Restricted mobility
• Assistance with self care
• Dependency
• Feeling burdensome


What are the characteristics of depression and the older adult?

• Depression can lead to further reduction in functional capacity
• Depression can increase the risk of developing new illnesses