N212 GERO LECTURE 2023

Structural Age-Related Changes of the Neurologic System  Cellular and Structural Changes O Neuron O Neurotransmitters O Neuroglia and Schwann cells O Cerebrospinal fluid and ventricular system O Hippocampus and the hypothalamic–pituitary–adrenal axis O Changes in the ability to consciously learn and retain new information easily O Specific aspects altered by the aging process are the explicit memory (e.g., delayed recall), the ability to learn new information quickly, memory storage, and memory retrieval O Change in balance and postural hypotension O Cellular and Structural Changes (Cont.) O Balance and motor function O Reticular formation and sleep patterns O Sensorimotor function O Assessment of Cognitive Function O Essential assessment in older adults O Mental status assessment: attention, memory, orientation, perceptions, thought processes, thought content, insight, judgment, affect (expression of emotions), mood (a person’s emotional state), language, and higher cognitive functions O Neurologic assessment: cranial nerves, gait, balance, distal deep tendon reflexes, plantar responses, primary sensory modalities in lower extremities, and cerebrovascular integrity O Complete neurocognitive examinations to establish baseline function and to detect potentially reversible conditions causing mental and behavioral disturbances O Selected Cognitive Function Screening Instruments O Functional assessment O Dementia Severity Rating Scale (DSRS) O Covers the areas of memory, orientation, judgment, community affairs, home activities, personal care, speech and language recognition, feeding, incontinence, and mobility or walking O Normal score instrument is 4 or less; score increases as older person’s cognition decreases O Mental Status Examination O Mini-Mental State Examination (MMSE) O Mini Cog—screens for cognitive impairment Page 1 of 24 N212 GERO LECTURE 2019.09.05 O Blessed Dementia Scale or Short Blessed Test (SBT) screening tool for the assessment of dementia; aging and depression effect responses O Blessed Orientation-Memory-Concentration (BOMC) O Depression assessment O The Beck Depression Inventory (BDI) is a self or caretaker-administered 21-item instrument that is helpful for uncovering depression and for rating severity and intensity O Cognitive Function and Memory in Typical Aging O Myth: forgetfulness as an inevitable consequence of aging O Fact: memory and delayed recall are not substantially decreased in older persons O Decline in cognitive function is effect of disease, not effect of normal aging process O Depression O As one ages, the rate of depression increases O Associated with higher suicide rates than in younger depressed population, 19% of all suicide deaths O Clinical manifestations O Fatigue; constipation; psychomotor retardation; depressed mood; loss of interest, energy, libido, or pleasure; changes in appetite, weight, and sleep patterns; and agitation; anxiety; or crying O First seen as cognitive impairment, particularly in areas of attention and concentration O Common response to serious illness of any kind O Normal losses that occur with aging and even retirement may trigger depression O Pseudodementia = depression masquerading as dementia O Pseudodelirium = acute confusion found to be due to depression O Delirium  Disturbance of consciousness (decreased awareness of the environment) with a reduced ability to focus, sustain, or shift attention  Cognitive changes (poor memory, disorientation, speech disturbance) or perceptual disturbances are distinct from a preexisting, established, or evolving dementia  The onset of the disturbance is rapid (hours to days ) and typically fluctuates over the course of the day  Occurs in all settings, underlying illness may cause the delirium  Emergent condition  DELIRIUM Risk factors  Advanced age, central nervous system (CNS) diseases, infection, polypharmacy, hypoalbuminemia, electrolyte imbalances, trauma history, gastrointestinal or genitourinary (UTI) disorders, cardiopulmonary disorders, and sensory changes  Symptoms of Delirium Fluctuate  Difficulty maintaining concentration or attention to external stimuli  language disturbance, including slurred, forced, or rambling speech  Disorganized thinking demonstrated by tangential reasoning and conversation often the presenting symptom  DELIRIUM Management  Focus on the timely identification