Dementia and the aging brain (lecture 5, week 3)

what are some of the normal cognitive changes with the aging brain

making a bad decision from time to time, missing a bill payment or medication dose, forgetting the date but remembering later, periodic word-finding issues, misplacing items

what are some abnormal or pathological changes in the aging brain

demonstrating poor judgement or impulsiveness, profound difficulty in managing bills or meds, losing track of date or time of year and requiring prompting, misplacing items and being unable to find them

what are some causes to cognitive changes

mental illness, chronic pain or fatigue, vision or hearing impairments, medication side effects, chronic illness

is age a diagnosis

no! thus it cannot be responsible for causing a symptom

what is frailty

a clinically recognizable state of increased vulnerability resulting from decline in reserve and function across multiple physiological symptoms such that the ability to cope with everyday acute stressors is compromised

what are the 3Ds

delirium, depression, dementia

what is delirium

an altered state of consciousness characterized by episodes of confusion and disorientation. It can affect people of all ages but especially those who are frail and acutely ill.

what is the onset of delirium

actue

how long can delirium last

days to weeks

what are the symptoms of delirium

disorientation and disorganized thinking

what are the causes of delirium

sensory deprivation, unfamiliar setting, and sleep cycle disturbance

what is an outcome measure used in the hospital setting to assess for delirium

CAM-ICU

what does the cam ICU look at

acute change of fluctuating course of mental status, inattention, altered level of consciousness, and disogranized thinking

what is depression

a common but serious mood disorder that causes severe symptoms that affect how a person feels, thinks and handles ADLs.

what is the onset of depression

chronic

how long can depression last

months to years

what are the symptoms of depression

sad, anxious, empty mood, decreased motivation, sleep disturbance, difficulty concentrating , remembering, or making decisions

what is despair

sadness and hopelessness associated with tangible reasoning

what is dementia

a clinically defined neurobehavior disorder marked by general cognitive decline causing a loss of functional mobility and not due to a delirium state.

what is the onset of dementia

chronic

what is the duration of dementia

years

what are the symptoms of dementia

memory loss, poor judgement, verbal communication impairments, apraxia, wandering, personality changes

where do most people with dementia live

in low and middle income countries

what are non-modifiable risk factors for dementia

age and genetics

what are some modifiable risk factors for dementia

physical inactivity, smoking, alcohol, air pollution, TBI, social isolation, lower levels of education, obesity, hypertension, diabetes, depression, hearing impairment

what is alzheimer's disease

a type of dementia where there is tissue atrophy in the temporal lobe and hippocampus, progressing to the parietal lobe

what does Alzheimer's disease impact

memory, speaking, and Ach production. Can lead to sundowning or loss of inhibition

what is the amyloid cascade hypothesis

Alzheimer's disease is determines by the presence of senile place and extracellular deposits, neurofibulary tangles, intracellular tau binding

what is lewy body dementia

10-15% cases of dementia where the pathology is due to abnormal collections of lewy bodies in the neurons.

what does lewy body dementia impact

perception (visual and depth), hallucinations, sleep disturbance (nightmares), motor planning, bradykinesia, shuffling gait, tremors

what is vascular dementia

17-30% of dementia cases where the pathology is due to ischemia ot the brain tissue, often caused by a TIA or hemorrhage in the small blood vessels which can lead to ministrokes and have temporary, permanent, or no effect but lead to dementia.

what is the impact of vascular dementia

progressive onset as more CVAs occur, symptoms depend on the area of the brain impacted, severe mood disturbances noted. Should be cautious of cardiovascular health.

what is frontal lobe dementia

dementia that is rare, occurs earlier in age, occurs more locally in the frontal lobe

what does frontal lobe dementia impact

mood and behavior become more fixed and difficult to change, making them appear selfish and unfeeling. Speech deficits can be common with progression.

does frontal lobe dementia have an impact on memory

not usually

what are common behaviors of dementia

impulsiveness, preservation, anxiety, agitation, aggression, confabulation, sleep disturbance and wakefulness abnormality

what is mild cognitive impairment

an early stage of memory loss or other cognitive ability loss in individuals who maintain the ability to independently perform most ADLs.

Amnesic MCI

memory loss

no amnesic MCI

decision making, judgement, sequencing tasks, visual perception

what is altered mental status / encephalopathy

an acute change in mental status and functional mobility associated with change in medical status

what is the most common cause of mental status / encephalopathy

UTI. other causes may be PNA< covid - 19, sepsis, and infection

what is the clinical presentation of altered mental status / encephalopathy

confusion, disorientation, significant functional change from baseline, new / more frequent falls, low insight to new impairments, motor planning impairments

what are treatment goals for aging populations

balance impairments, strength impairments, AD needs, behavior impairments / reorientation

what are chunks

pieces of information that the human brain is capable of processing

how do cogitive impairments impact chunks

they start to lose them. An average healthy adult had 7 chunks.

how can you help the aging population through verbal communication

talk in low, loud, slow, and simple setences

how can you help the aging population through written communication

large font size, sample language, recruit helpers

what is the best way to treat those with dementia and apraxia

single step instructions, allow time for processing, and reduce distractions