chap11 Cognitive development in the elderly

chap11 Cognitive development in the elderly

COGNITIVE SKILLS in elderly person

• Language

• Executive functions

• Orientation

• Memory

• Perception

• Attention

• Reasoning

• Praxes

•Language

Phonology, syntax, semantic capacity

Executive functions

Structured thinking, planning, organization

Orientation

Space, time, person, body schema

Memory

Episodic, short-term, long-term, working, semantic, procedural

Perception

Recognizing objects, discrimination, selection

Attention

Focal, active, selective

Reasoning

Categorization, similarities, differences, logic

Praxes

Organized movements, coordination

MOST COMMONLY USED QUESTIONNAIRES TO ASSESS COGNITIVE STATUS IN THE ELDERLY

• MOCA SCALE

• SEVERE MINI MENTAL STATE EXAMINATION (MMSE)

MONTREAL COGNITIVE ASSESSMENT (MOCA).

Validity of the Montreal Cognitive Assessment Scale (MoCA) to determine cognitive impairment in patients with schizophrenia.

SEVERE MINI MENTAL STATE EXAMINATION (MMSE)

Brief Assessment of cognitive status in late-stage dementia

How does memory change?

• Decreased brain volume

• Reduced neuroplasticity

• Alterations in neurotransmission

• Emotional and psychological effects

Decreased brain volume

• With age, there is a reduction in the volume of certain areas of the brain, such as the hippocampus, which is crucial for the training of new memories.

Reduced neuroplasticity

• The brain's ability to adapt to new experiences & learn decreases, affecting short- and long-term memory

Alterations in neurotransmission

• Decreases in certain neurotransmitters, such as acetylcholine, can negatively impact memory and attention

Emotional and psychological effects

Depression and anxiety, which may be more common in older age, can also affect memory.

Memory decline is individual

• not all people experience significant memory decline with ageing

• many can maintain effective cognitive skills throughout their lives.

• Mental, social & physical activity

are important factors which can help

• can help preserve cognitive function and memory in old age.

TYPES OF MEMORY

• EPISODIC MEMORY

• SEMANTIC MEMORY

• AUTOBIOGRAPHICAL MEMORY

• SENSORY MEMORY

EPISODIC MEMORY

• It stores facts & events that have happened to us throughout our lives, consciously mobilising & retrieving events linked to a time & place & actively retrieved using contextual information about when & how it happened.

Episodic memory in old ages

• Older people find it more difficult to retain and remember an event when the information or material they have to remember is not meaningful to them, is unfamiliar to them.

SEMANTIC MEMORY

• It constitutes objective, organised knowledge, referring to knowledge of the world that has been accumulated and organised conceptually rather than contextually.

Semantic memory in old ages

It is fairly well preserved in late adulthood.

AUTOBIOGRAPHICAL MEMORY

• A type of memory that refers to the ability to recall events from one's own life, combining elements of episodic and semantic memory.

Autobiographical memory in old ages

• Although some autobiographical memories may remain intact, ageing may affect the ability to recall specific details of more recent events.

SENSORY MEMORY

• It is the memory that retains sensory information briefly (milliseconds to seconds).

• It includes iconic (visual) memory and echoic (auditory) memory.

Sensory memory in old ages

• Generally, sensory memory remains relatively intact with ageing, although attention span & processing speed may decrease.

PROCEDURAL MEMORY

Memory of motor and executive skills to be able to perform a task.

Procedural memory in old ages

Subtle changes, not necessarily affecting autonomous life.

Failure in procedural memory: you know what a spoon is, but you do not know how to use it

Tips to maintain & improve memory skills

• socialize

• physical activity

• training the brain by using mnemonic strategies

• Do not believe in stereotypes about memory decline

• Compensation (use glasses or hearing aids, if these functions are impaired)

• Maintain a sense of control and confidence in your memory.

• Avoid distractions that divert your attention (selective performance → what is more important for your health)

  
  

mnemonic strategies

Mnemonics are tricks and techniques to help recall information that is difficult to remember

DEMENCIA

• COGNITIVE IMPAIRMENT

Dementia as a term

Impairment of ability that interferes with the psychosocial & functional development of the person.

• many diseases can cause dementia, but dementia is not a disease itself.

How does dementia impact?

• it is a set of symptoms which affect a person´s memory thinking & social skills, interfering with daily life

The conditions of dementia

• caused by various diseases affecting the brain, & is characterised by a progressive deterioration of cognitive functions.

Diseases related to dementia

• Alzheimer's disease

• Vascular dementia

• Dementia with Lewy bodies,

• Parkinson's disease

• Frontotemporal dementia

• Dementia associated with diseases such as HIV/AIDS or Huntington's disease.

different types of dementia

• DEGENERATIVE OR PRIMARY

• SECONDARY OR ASSOCIATED FORMS

• COMBINED OR MIXED DEMENTIAS

DEGENERATIVE OR PRIMARY

• Degenerative, progressive & irreversible

• They can not be treated

Example:

• Alzheimer's disease

• Lewi body disease

• Frontotemporal dementia

• Parkinson

(the proteins affected by these dementias are different)

SECONDARY OR ASSOCIATED FORMS

• Derived from cardiovascular or hypertensive diseases

• They can be treated

example:

• Vascular dementia

• Dementia due to Korsakoff's syndrome

• Dementia due to psychiatric disorder

COMBINED OR MIXED DEMENTIAS

• They are made up of factors of degenerative & associative form.

• The most common is vascular dementia with Alzheimer's disease.

COGNITIVE RESERVE

• brain's ability to delay the manifestation of symptoms of certain pathologies through stimulation

The factors that contribute to cognitive reserve are

• Physical exercise

• Leisure activities

• Occupational complexity

• Motivation

• Education

• Bilingualism

 Normal healthy old aged people & their brain

• Subtle changes and considerable variability from person to person

 Functional changes in old aged people 

• brain plasticity OR COGNITIVE RESERVE can reorganise neural circuits to respond to the challenge of biological ageing

COGNITIVE RESERVE two processes can occur:

Continued brain flexibility = increased prefrontal activity.

Compensatory processes = Reflection of the use of alternative cognitive pathways.

COGNITIVE INTERVENTIONS

• Non-pharmacological 

• REALITY ORIENTATION THERAPY

• REMINISCENCE THERAPY

• MUSIC THERAPY

• physical exercise, strength, balance and aerobic exercise

• INTERGENERATIONAL PROJECTS

• SENSORY STIMULATION

• NEW TECHNOLOGIES

Non-pharmacological interventions

• do not involve the use of medication

• Aim: improve the quality of life of people with dementia and other cognitive disorders.

• Focus on: emotional, social and cognitive well-being

Strategies of Non-pharmacological therapies

• cognitive stimulation,

• occupational therapy,

• reminiscence therapy

• benefits: Improving communication, reducing anxiety, depression, & promoting social interaction.

• help maintain an individual's functionality and independence for longer.

COGNITIVE IMPAIRMENT causes

• Organic cause

• Functional cause

Organic cause

• Neuronal death

• amyloid accumulation

• synapse loss

• neurotransmitters decrease

Pharmacological therapies

• applied for organic cause

Functional cause

• Absence of the use of a certain function

• cognitive, physical or social

Non-pharmacological therapies applied in the cause of

Functional cause

NON-PHARMACOLOGICAL THERAPIES SEEK TO

• ALLEVIATING (REDUCE) SYMPTOMATOLOGY

• IMPROVING THE QUALITY OF LIFE OF THE PERSON

• HELPING CAREGIVERS & THE FAMILY ENVIRONMENT

These therapies have no known adverse effect, therefore they are the most effective for cognitive impairment

Effectiveness of NON-PHARMACOLOGICAL THERAPIES

No drug shows benefits as varied & NO SIDE EFFECTS

• More effective in treating behavioural & psychological symptoms compared to drugs.

• benefits on cognition & functionality are also superior to those of pharmaceuticals

COGNITIVE STIMULATION

TRAINING COGNITIVE

• can be applied to people without cognitive impairment

• important to engaging emotions for meaningful intervention.

Cognitive rehabilitation is the principle of

• Neuroplasticity

• Reapply

COGNITIVE REHABILITATION

• aim: repair the various brain functions related to cognition

• Therapeutic type

• Individualised intervention (adapted to the characteristics of the person).

• Principle of re-training as we work on a function that was previously unaffected.

Cognitive rehabilitation can be applied to the people who needs

• Training for people with Cognitive Impairment

• Reapply due to Acquired Brain Injury

REALITY ORIENTATION THERAPY

• Help people stay connected to their environment and reduce confusion and disorientation.

• providing information about place and time, using visual tools such as calendars, clocks and family photos.

• aim is to reinforce the individual's perception of reality

• Benefits: peace of mind, & reduction in the distress associated with disorientation.

 techniques through which the person connects with situation in space, time and self-psychically.

• Trying to overcome confusion and disorientation in all three spheres

• Avoiding disconnection from family, social and personal environment

• Stimulating Communication and Social Interaction

• Promoting autonomy

REMINISCENCE THERAPY

• using photos to remember & share past experiences

• aims to foster communication and emotional connection

• Benefits: improve mood, strengthen personal identity & reduce anxiety & agitation.

• Help people feel valued and listened to.

This also involves episodic memory, autobiographical memory and semantic memory

MUSIC THERAPY

• uses music to address physical, emotional, social and cognitive needs of individuals.

• used to stimulate memory, improve communication and promote emotional expression.

• ability to evoke memories and emotions →beneficial for those struggling with memory loss

INTERGENERATIONAL PROJECTS

• promotes interaction between different generations → children and older people

• aim of generating emotional & social benefits for both parties.

• fosters connection, understanding, empathy between young and old people 

SENSORY STIMULATION

• activities and strategies involving the human senses

• Benefits: create & strengthen neural connections

• Stimulate the senses promotes neuroplasticity

• Improve memory and learning skills

• Calming and relaxing effects,

NEW TECHNOLOGIES

• Cognitive stimulation through new technologies

• designed to improve the mental and cognitive skills of people with dementia.

• Benefits ability to offer mental exercises adapted to the needs of the users, to keep the mind active and to provide an attractive and entertaining environment