Lifespan: Neurologic Changes with Aging

general loss, increased dendrite growth, shrinking of neurons

how might neurons be affected with age, based on their location?

complex attention

Sustained attention, selective attention, and information processing speed

Executive Function

Planning, decision-making, working memory, responding to feedback, inhibition, and mental flexibility

Learning and Memory

Free recall, cued recall, semantic and autobiographical long-term memory

Language

Object naming, word finding, fluency, and syntax

Perceptual-motor Function

Visual perception, perceptual-motor coordination

Social Cognition

Recognition of emotions, behavioral regulation, and understanding societal context

mild cognitive impairment (MCI)

people with this have more memory problems than normal for people their age, do not experience personality changes, they can carry out their normal ADLs

signs include losing things often, forgetting to go to events/appointments, and having more trouble coming up with words than other people of the same age.

dementia

global decline in cognitive capacity that will affect memory and 1 of the following: aphasia, apraxia, agnosia, executive functioning

involves a slow onset, and is associated with depression, delusions & irritability

getting regular exercise, not smoking, avoiding harmful use of alcohol, controlling their weight, eating a healthy diet, and maintaining healthy blood pressure, cholesterol and blood sugar levels.

how to reduce the risk of dementia through lifestyle

depression

Disturbance in mood with low vitality and self esteem

Symptoms include sadness, inability to perceive pleasure, crying

Associated symptoms - fatigue, insomnia, guilt, self blame, hopelessness, helplessness

can cause difficulty concentrating, memory issues and indecisiveness

declines in physical functioning

Depression and depressed mood predicts...

inflammatory markers & cortisol

Depressed individuals have increased levels of

cardiac disease

Depression and/or anxiety predicted development of

delirium

reduced consciousness level that causes Symptoms - Inattention, distractibility, drowsiness, befuddlement

Common associated symptoms - cognitive impairment, hallucinations,, mood lability, Slurred speech, Memory loss

it is usually a sudden onset of hours or days and is typically worse in the evening

1. Disturbance of attention and awareness

2. Disturbance develops over a short period of time

3. Additional disturbance in cognition (e.g., memory deficit, disorientation)

4. Disturbances in 1 and 3 that are not better explained by another preexisting, established, or evolving neurocognitive disorder, and do not occur in the context of a severely reduced level of arousal, such as coma

5. Evidence from the history, medical examination, and laboratory findings that the disturbances are caused by the physiologic consequences of another medical condition, substance intoxication, or withdrawal

key features of delirium

write down names of caregivers

stimulation activities

early mobility

sleep-wake cycle preservation

visual aids

hydration

how to prevent delirium

Stroke

Alzheimer's disease - Dementia

Certain vestibular disorders

Parkinson

Tremor - resting, postural, intention

as age increases, so does the susceptibility for these conditions

ischemic stroke

a type of stroke that occurs when the flow of blood to the brain is blocked

hemorrhagic stroke

occurs when a blood vessel in the brain leaks or ruptures; also known as a bleed

increases, decreases

Basal sympathetic activity _____ in old age.

Parasympathetic ______ decreases in old age.

Monitor vital signs.

Teach patient to monitor own vital signs.

Avoid quick changes in body position.

Adjust rate and intensity of exercise.

Use RPE scale

PT implications for those with autonomic nervous system changes with aging

selective attention

the focusing of conscious awareness on a particular stimulus

focused attention

Attending to a particular stimulus while ignoring others; it requires a high level of awareness.

sustained attention

the ability to maintain attention to a selected stimulus for a prolonged period of time

divided attention

concentrating on more than one activity at the same time

worse

Older adults perform _____ than younger adults on more complex tasks

1.Decrease rate of instruction of motor skills.

2.Allow for increased processing time.

3.Repeat often to compensate for memory deficits.

4.Facilitate learning by memory aids.

5.Make learning meaningful.

PT implications regarding cognitive system changes

fluid intelligence

capacity to use unique kinds of thinking to solve unfamiliar problems - believed to decrease with age.

crystallized intelligence

acquired through education and acculturation, remains stable through age 70.

intellectual function

show little or no decline except in perceptual-motor tasks, timed tasks, and short-term memory

short term memory

primary/working memory; declines & may be able to train

Processed in 10-15 seconds long-term storage or decay

Implicit - Procedural memory

How to do -

well protected from aging & brain damage

Explicit- Episodic memory

unique event memory

declines but can be reduced with cues

Explicit - Semantic memory

word recall, structured facts and meanings

Gradual declines very little

Approach person from front and smile

Use calm unhurried speech with persons name

Use touch to reassure and lead

Strategies to manage Sensory Memory Problems with Registration, Recognition

Present objects or written cues to focus attention

Use praise and compliments

Use familiar objects as reminders

Strategies to manage Sensory Memory - Strategies to support sensory memory

Use variety of cues, visual tactile, auditory

Use one step instructions

strategies to manage short term memory

Use same words to repeat the same message

strategies to manage problems with encoding

Neurological diseases

these associated with aging can be due to normal aging of the nervous system or be associated with aging of the cardiovascular system