Understanding Cognitive Impairment
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Vol. 12, No. 2 7550 France Ave S Suite 210 Minneapolis, MN 55435-5624 952.525.0505 800.560.0961 Information and ideas for those [email protected] serving seniors. on Aging www.MatrixHomeHealthMN.com UNDERSTANDING COGNITIVE IMPAIRMENT One senior to another: “I’m always Second is the diminished ability for OTHER FACTORS AFFECTING thinking about the here-after.” “Why is abstract and complex COGNITIVE PERFORMANCE that?” asks the other. Replies the first conceptualization. Third is mental There are other significant factors senior, “I’m always going into another inflexibility, for example; difficulty in which can greatly affect cognitive room and thinking…..’What am I here adapting to new situations. And fourth performance. These include level of after?’ ” is general behavioral slowing. Age- consciousness, the abilities to pay While jokes about poor memory Related Memory Loss is non- attention, to concentrate, to can be funny, it is no laughing matter progressive, non-disease, age-related conceptually track data, and activity when memory actually fades. The decline in memory which can begin as rate. Executive functions are those stereotypical attitude that all seniors early as age 20 but more often activities which are important to initiate lose their memories is false; becomes noticeable in the over 50 a task and carry it to completion. This psychological studies show that population.1 includes goal formulation, planning, healthy, active people in their seventies carrying out goal-directed plans, and and eighties do not differ greatly in COGNITION INCLUDES MORE THAN doing so with effective performance. cognitive skills or abilities from younger MEMORY Emotional states can also affect people. Well retained skills include Most people do not realize that cognitive performance. In particular, reading, writing, vocabulary, word cognition, defined as “the mental anxiety can make it difficult to take in usage, and arithmetic ability. Cognitive process of knowing, including aspects information, encode it into memory and skills that decrease typically involve such as awareness, perception, manipulate the data accurately. speed, unfamiliar material, complexity reasoning, and judgment,” includes Depression has such a profound effect of task, and active problem solving. more than short-term memory. There on cognitive function that many times Normal intellectual decline in old are four defined classes of cognitive depressed people are thought to have age generally occurs in four areas. functions.2 Higher functions such as dementia. Many of the symptoms are The first is the ability to remember lists thinking are more fragile than more quite similar and it may take a of items greater than six or seven. concrete cognitive functions, and may specialist to determine that a become impaired more easily. depressive reason is the cause for low cognitive performance. Fortunately, FOUR CLASSES OF COGNITIVE FUNCTIONS depression is often treated successfully with full or partial resolution of the CLASSES DESCRIPTION OF COGNITIVE FUNCTIONS cognitive impairments. Receptive The taking in of information through the senses, especially Pain can affect cognitive function, Functions vision and hearing, but also smell, taste and touch. particularly severe, chronic pain which causes an individual to reduce normal Memory First step: Registration – new data is taken into the brain, activities. Also sleep deprivation due to and which results in immediate memory. pain or grief can affect a person’s Learning Second step: Rehearsal – or review of the data, encodes cognitive abilities. Medication is another major factor information into the longer-term memory. affecting cognition; particularly in Third step: Information retrieval – involves both recall, which seniors who on average consume six involves retrieving data from memory, and recognition, which is dependent on mental storage of data. more prescription drugs each. Many medications, such as those used for Thinking A complex cognitive function involving two or more bits of anesthesia, pain, sleep, anxiety, sedation and some psychiatric memory, and manipulating this data to reach conclusions about its relationship. conditions, have a sedating effect. Some drugs such as blood pressure Expressive Demonstrated through observable behaviors, which can be medication or antidepressants can Functions verbal, physical, or emotional. cause people to feel lightheaded. Some medications cause physical side effects which result in anxiety or physical limitations. A recent change in one’s cerebral blood vessel lasting less than correlation between social drinking and 8 environment is a frequent cause of a 24 hours and usually only moments. mild cognitive impairment. Specific temporary cognitive impairment known Symptoms can include impaired vision impairments in testing showed as delirium. In fact, 75% of people over in one eye, numbness and tingling on reduction in abstract reasoning 65 become confused at some point one side of the face, hand or arm, and (similarities) and mental flexibility during a hospital stay, and some speech impairment. People may have (problem-solving). In chronic remain confused until they are few or many TIAs, occurring frequently alcoholism, most impairments involve discharged to their home environment. or spaced out over months or years. tasks associated with frontal lobe Moving from a home of many years to The effect of these small infarctions is activity, i.e., mental flexibility and a new environment also tends to cause development of mild cognitive constructions. Short-term memory is 4 cognitive problems until the person impairments. But half of all TIA often severely impaired while long-term adjusts to the new living situation. patients ultimately sustain a major memory is intact. 5 stroke. Impairments noted on testing, Depression is the most common 9 MAJOR CAUSES OF COGNITIVE which depend on where the infarcts mental health disorder in the aged. In IMPAIRMENT occurred, appear in conceptual fact, white males over 65 have the Alzheimer’s Disease thinking, comprehension and memory. highest rate of successful suicide in the 10 Young onset Alzheimer’s Disease Multi-infarct dementia (MID) is the country . Depression usually has a is a condition which occurs in people result of accumulated TIAs which defined onset over several weeks as younger than 65, while the term cause enough damage to brain cells to opposed to the more insidious onset of Alzheimer’s Disease is used to permanently impair cognition in one or dementia. General symptoms include 6 describe the condition which occurs in more areas. Nearly all individuals with loss of appetite, disturbed sleep and people over 65. These together MID have, or had, inadequately treated lack of interest in activities. Structure account for an estimated 60 – 80% of hypertension. More men than women and content of speech remain intact. dementias. According to the have MID. It may be mistaken for General memory may be impaired, but 7 Alzheimer’s Association, the Alzheimer’s type of dementia , but the the individual is highly aware of his or prevalence of Alzheimer’s Disease by symptoms are significantly different. her impairments, which is not true of age in 2013 is as follows: There is usually an acute onset with individuals with an organically caused Age below 65 4.0% step-like deterioration. The severity dementia. Ages 65-74 13.0% may fluctuate hour-to-hour or day to Ages 75-84 44.0% night. Early in the disease, cognitive EVALUATING COGNITIVE 85 and over 38.0% deficits predominate while personality FUNCTION Early cognitive symptoms in deterioration lags behind. Motor Cognitive function is measured in Alzheimer’s dementias include failing abnormalities such as gait disturbance several different ways. The simplest recent memory, depression and and rigidity may occur. Impairments method of assessing cognitive abilities irritability. Early behavioral symptoms noted on testing depend on where is through administration of a often include social withdrawal, infarcts are occurring but are most standardized screening instrument. emotional blunting, agitation and often noted in word finding, conceptual This type of brief screening test can be inattentiveness. Impairments noted on thinking and short-term memory. given in 15 minutes in the clinic at the testing are found in attention, short- Cerebral vascular attack (CVA) or bedside, or in a client’s home. A much term memory, orientation, word finding stroke is the most serious of all more thorough neuropsychological and language disturbance. There may vascular events. This occurs when examination can often differentiate be intrusions or inappropriate there is obstruction (75% of the time) or which type of dementia is present. It is recurrence of a response from a rupture (25% of the time) of a cerebral given and interpreted by a PhD preceding test item and in conceptual blood vessel which causes brain psychologist who specializes in this functions. damage due to loss of oxygen and field and requires four to eight hours for Vascular Dementias glucose to brain tissue. The administration. Though this exam This group of dementias is caused consequences range from fatal to provides much more detailed by damage to brain cells through some degree of residual cognitive, information about cognitive function, impaired circulation to the brain. The physical and/or motor impairments. due to its length and complexity, it may subtler of these is caused by Impairments noted on testing depend not be suitable for people