Cognitive Disorder in Elderly Cognitive Disorders in Elderly

Sachiko Furuya

Cognitive Assessment & Lab

Kris Thomas, PhD

The research of this study is related to cognitive, dementia, Alzheimer disease, and depression issues with the elderly populations of the United States and in the world in general. Societies with a large number of elderly people such as the U.S.A. are increasingly focusing their efforts on improving the life standards of these people based on the types of services given to them. The well-being of those on palliative and hospice care is as important as the well-being of the family members of these patients. Although many health issues present themselves during the elder years of any patient, there is a lot of attention paid to cognitive and mood issues in this age group. The disorders and maladies that are relevant to this population include, among others, depression, dementia, mild cognitive impairment (MCI) and milder cases of Alzheimer's. It is argued that this population should receive the same standards of care that their younger counterparts with the same conditions receive to improve their quality of life. This report shall endeavor to answer a series of questions relevant to the above including the demarcation between individual results and group trends, the ethics of diagnosing patients properly, the proper administration of tests, how to interpret the results of those tests, and a few other important related topics.

Introduction

Regardless of the age of a given patient or person, the need for cognitive assessment often arises when it is clear that there is some sort of discord and problem with a person's mood, memory, emotions, and so forth. Hwang, Cha, and Cho (2015), "Alzheimer's disease (AD) is a common degenerative brain disease that causes dementia" (p. 2875). Depression and memory-related disorders are very serious problems with the elderly and their family. For example, an elderly person could begin to display symptoms of mental challenges all of sudden such as forgetting normal routines. These conditions are certainly prominent enough so as to present some major challenges to the patients as well as their providers and family members, and thus there needs to be an in-depth review of the implications and facts as they exist and are currently known. The problem is exacerbated if an elderly person is all of a sudden sullen, extremely quiet and otherwise withdrawn when compared to how they normally have been in recent weeks and months.

Aims of the Report

The purpose of this project is to identify key issues in the aging process and determine to what degree cognitive assessments are important and how cognitive assessments can help counselors mitigate some of the psychological symptoms of aging. This report shall endeavor to answer a series of questions relevant to depression, dementia, mild cognitive impairment (MCI) and milder cases of Alzheimer's in elderly persons, including the demarcation between individual results and group trends, the ethics of diagnosing patients properly, the proper administration of tests, how to interpret the results of those tests, and a few other important topics. What do we perceive are the primary strengths and limitations of cognitive assessment for the elderly, and how does a strong clinician balance the tension between idiographic (individual) and nomothetic (generalized) perspectives on cognitive assessment? This identification of primary strengths and limitations of cognitive assessment for the elderly help the researcher to understand how important the cognitive assessment test actually is. Such identification can "....help gain an in-depth understanding of behaviors found in human beings. When the behavior is fully understood, a person therefore becomes better able to identify the reason why people behave the way they do" (Henwood & Pedgeon, 2003, p. 133). Mental health counselors need to understand the importance of their patient's trauma, stresses, and reasons for using these substances

Literature Review

Neurodegenerative diseases causing dementia have the greatest impact on the elderly. Davis et al. (2005) stated, "Dementia usually develops over several years. Individuals, or their relatives, may notice subtle impairments of recent memory. Gradually, more cognitive domains become involved, and difficulty in planning complex tasks becomes increasingly apparent" (p. 2). One example of a problem could be that if a person in their sixties or seventies has been very sharp and on top of their daily affairs, then the person all of a sudden starts forgetting very basic and obvious things like paying the credit card or phone bills.

In short, when there is an obvious mental problem of any sort and/or there is a sharp departure from a person's normal behavior and mindset, this should precipitate a check of the person's cognitive...

Even better, there could also be a comparison to what has been measured and observed on prior occasions so that there is a reference point to draw against. There are also other rising symptoms that affect the elderly. To get a full and complete picture of the situation as it relates to cognitive/depressive disorders in elderly patients, it necessary to understand that elderly brains are at risk of most normal neurodegenerative diseases, including Alzheimer's disease, cerebrovascular disease, Parkinson's disease, and amyotrophic lateral sclerosis.
In other words, how does the clinician effectively assess the individual while at the same time situating the individual within a larger understanding of human intelligence and achievement? Clinicians making inferences about real-life performances of tests performed in a "test-taking" situation believe that the data is evaluating a person's functioning ability, and that there are prominent ethical issues to consider in the evaluation of the individual.

The aging process involves structures of the brain and a large number of nerve recognition changes. One study suggests a functional change and a relationship to chemistry. A change in conjunction with healthy aging provides an outline of healthy living (Myers, 2010).

Lee, Cho, Min, and Kim's (2015) study, "In particular, regular exercise results in improvements in cognitive function, as indicated by the reduced loss of frontal and temporal node tissue when the brain volume was measured using the magnetic resonance imaging "(p. 1909). People age in different ways, and as such the incarnations of aging also differ among individuals. As a person ages, the body's sensory functions respond accordingly. A person receives information through vision and hearing, and the body also processes information in the form of smell, taste, and touch. A person processes this environmental information in order to perform different daily tasks. Increased age impacts the functionality of these senses, and older people experience difficulty understanding and processing the information (Abby, 2010). Memory loss is also a factor and is common for the elderly, who often need reminders that they've already held certain conversations.

Davis (2015) stated,

Seven studies were selected: three in memory clinics, two in hospital clinics, none in primary care and two in population-derived samples. There were 9422 patients in total, but most of studies recruited only small samples, with only one having more than 350 participants. The prevalence of dementia was 22% to 54% in the clinic-based studies, and 5% to 10% in population samples. In the four studies that used the recommended threshold score 26 or over indicating normal cognition, the MoCA had high sensitivity of 0.94 or more but low specific of 0.60 or less. (p.2)

This Davis study very useful, and it is clear that if there is depression-related or cognitive impairment such as from dementia or even Alzheimer's, the protocol and norms for how that patient should be dealt with will obviously change.

Patient assessments must involve accurate diagnoses and should carefully consider the patient's situation, including functioning, culture background, and norms. As people age in different ways, the incarnations of aging also differ among individuals. As the age of a person increases, the body's sensory functions respond accordingly. A person receives information through vision and hearing, and the body also processes information in the form of smell, taste, and touch. A person processes this environmental information in order to perform different daily tasks. Increased age impacts the functionality of these senses, and older people experience difficulty understanding and processing the information (Abby, 2010). Part and parcel of doing the assessments the right way is to ensure that the counselor or other clinician completing any test is qualified and adept at giving that test.

Indeed, there are about twenty brief cognitive instruments that are used for reasons such as efficacy, ease of administration and familiarity with the instrument (Velayudhan et al., 2014). Even with the litany of examinations and tests that exist, some methods have more staying power than others. For example, the mental status examination (MSE) has been around for half a century and is heavily used in psychiatry, clinical psychology and general social work (Polanski & Hinkle, 2000).

At the same time, some realms and areas of mental health and cognitive disorders in general are less than settled. Just one example of this is the subject of what is known as Mild Cognitive Impairment (MCI). As recently as 2005, it was asserted that "MCI as an entity is evolving and somewhat controversial" (Nasreddine et al., 2005). Beyond that, some people with MCI actually regain some of their cognitive function, which goes against the…