Dementia in Older Adults Research Paper

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Abstract

This research-paper deals with the concept of senility using a broad frame of reference. Cognitive effectiveness and age-related cognitive decline or impairment have been the subject of much research, especially during the past decade or so. At this time, there is not a consensus regarding all ideas about screening for dementia and preventive treatment to delay progression of the disease. During the coming decade, more research findings will help to answer questions about the most reliable screening methods and the efficacy and ethics of using them. Controlled longitudinal studies will help to determine the value of pharmacological and nonpharmacological interventions. This research-paper explores the meaning of senility, what it is and what it is not, who is at risk, prevention, early and late recognition, comorbidities and misdiagnoses, interventions, and future prospects.

Outline

1. Senility: What It Is and What It Isn’t
2. Myths and Stereotyping
3. Extent of the Problem
4. Preventive Measures
5. Early and Late Recognition
6. Misdiagnoses and Comorbidities
7. Interventions and Caring
8. Future Prospects

1. Senility: What It Is And What It Isn’t

1.1. History

Senile dementia was mentioned in the writings of Hippocrates and Pythagoras during the Greco–Roman era. It was recognized by Bacon in 1290, by dePratis during the 1500s, and by Pinel during the 1800s when he reformed the treatment of the mentally ill. At the turn of the 20th century, Alzheimer defined clinical and physiological brain lesions of senile dementia, now referred to as Alzheimer’s disease.

1.2. Definition of Normal and Impaired Cognitive Functioning

It is important to differentiate between normal changes in aging cognition and senility or dementia. In normal aging, cognitive processes are slower and less accurate for more effortful or novel tasks than they are during younger years. Therefore, the older person may take longer to absorb the communication message, retrieve a thought, and respond. Memory is a special problem in aging because the older person takes longer to store information so that it may be recalled. Some have likened the aging brain to an overworked computer. The processor of the older computer is slow and the hard drive is overloaded with stored data, thereby making retrieval a more complex and longer process. Sometimes the files get disorganized, particularly when the computer is tired and overused. The new computer has a fast processor and little data stored in it so that retrieval is rapid. In terms of memory retrieval and learning new information, the older person processes information more slowly than does the younger person. The older person’s cognition may be likened to the old computer’s processor.

Working memory becomes less efficient in the older person. Working memory may be thought of as the ability to retain or temporarily store some information while at the same time accessing or using other information to perform a task. A complex environment, such as a loud and busy room, may interfere with working memory performance in the elderly. Working memory is needed in problem solving.

In terms of problem solving, the older person has more experiences to draw on, so decision making may be more effective in the older person than in the younger and less experienced person. Some refer to this as judgment or wisdom.

In dementia, there is a breakdown in several dimensions of cognition. Judgment is impaired and memory function is disrupted in terms of storage retrieval and planning for future conversations or decisions. Communication breaks down because the person is unable to problem solve or think ahead about the flow of words to use. Confusion and frustration may result, leading to behavioral and emotional changes.

In 1994, the American Psychological Association defined dementia as having the following deficits: memory impairment, cognitive disturbances (e.g., aphasia, apraxia, agnosia), and disturbances in executive functioning (i.e., goal setting) that result in significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning. According to this widely accepted definition, senility or dementia becomes a disability when social or occupational functioning is impaired.

2. Myths And Stereotyping

Unfortunately, ‘‘ageism’’ or labeling sometimes can cause an older person to be called senile or demented when perhaps he or she is only hard of hearing or has received a large volume of information rapidly so that there is not time to encode it for memory retention and recall. Such stereotypes are common and permeate our society.

Consider the example of an 85-year-old and a 35-year-old talking with a group about a party they had attended the previous night. Both met a number of new acquaintances, but each could recall only one or two new names. The older person was quickly labeled senile, whereas the 35-year-old was viewed as just not having paid attention.

3. Extent Of The Problem

There is a clear association between cognitive decline and aging. This association is confirmed with cross-national prevalence data. Because of longevity, an increased percentage of the population is seen as having cognitive decline compared with earlier generations when the life expectancy was shorter. In 1996, Sloog and colleagues reported that 1% of 65to 70-year-olds are diagnosed with moderate to severe memory disorders, whereas that number increases to 21% in 85-year-olds. Danish studies published in 2001 reported that among centenarians, 21% show no dementia symptoms, whereas 40 to 63% have mild to severe dementia.

3.1. Positive Risk Factors

There is much discussion that keeping an active mind deters memory and other cognitive function decline, although these approaches have yet to be tested longitudinally with large samples. Prevalence studies do indicate that a higher educational level, high occupational status and workplace complexity for older ages, an intact marriage to a well-educated spouse, a stimulating environment, and engagement in cultural and educational activities are associated with higher intellectual functioning into old age.

3.2. Negative Risk Factors

A number of disease conditions increase the risk of cognitive decline in individuals. Conditions such as a previous head injury, Parkinsonism, and multiple small brain infarcts or hemorrhages are common conditions that are likely to progress to cognitive impairment.

Major risks for dementia or cognitive decline are chronic diseases. Longer life expectancies are accompanied by increased prevalence of chronic conditions, resulting in more dementia in old age today than was the case during earlier decades when life spans were shorter.

Withdrawal from intellectual engagement, such as retirement from an intellectually challenging and complex job, can be a negative risk factor. These and other associations with cognitive functioning provide positive arguments for continued intellectual activity into old age as a deterrent or delay strategy for dementia.

There is some disagreement in the literature as to whether a busier and more complex life can lead to fatigue that interferes with cognition or, if kept in balance, can provide intellectual stimulation. A lifestyle that allows for self-pacing provides more time for reflection and provides an opportunity to encode new information and retrieve old information without hurrying.

4. Preventive Measures

The research literature is clear in that there are no absolute preventive measures for senility or age-related dementia. If genetic predisposition occurs, preventive measures might only delay symptoms. However, studies have shown repeatedly that prevalence rates of dementia are lower in cases where certain associations have occurred. Some of these are discussed in this section.

4.1. Nutrition and Nutritional Supplements

Various studies have shown associations between the prevalence of Alzheimer’s disease and the content of food intake. Vitamins that fall into the antioxidant category are considered to be beneficial in preventing dementia due to their ability to repair or replace molecules that are damaged by free radicals. The National Institute on Aging currently supports several large clinical trials that look at the effects of Vitamins A and C, selenium, betacarotene, folate, and multivitamins on cognitive decline and on the prevalence of Alzheimer’s disease. The outcome of these large trials will provide additional empirical basis for evaluating the effect of vitamins and food supplements on aging cognition.

Reduced intake of saturated fat and maintenance of a low cholesterol level are believed to lower the risk of the onset of dementia and Alzheimer’s disease. Studies have shown some association of lowered prevalence of cognitive decline among elders who eat a diet that is high in fish and other unsaturated fats. Fish oils taken in large amounts are reported to have a positive effect on the retention of cognitive function. These and other food substances have not been well tested with controlled and longitudinal studies on large samples.

4.2. Pharmacological Effects

Repeated studies have also shown some positive association between cognitive functioning and long-term use of nonsteroidal anti-inflammatory drugs such as the regime that an individual with arthritis might take. People on prednisone, a steroidal drug, have not shown protection against dementia.

There have been a number of studies on estrogen showing mixed results regarding its effect on protecting cognitive functioning in women. The pattern seems to be that the larger trials, such as the Women’s Health Study, show that there is no protective effect of hormone replacement therapy in older women on the prevalence of dementia and Alzheimer’s disease.

4.3. Physical and Mental Activity

The concept of neuroplasticity applies to the ability of the adult brain to remodel pathways as occurs in the rehabilitation process in persons with stroke or brain injury. Magnetic resonance imaging has helped researchers to visualize brain mapping and to observe the reconfiguration of active pathways. Although confirming research trials have not been conducted to show the brain’s ability to remap cognitive and memory function, the concept of ‘‘use it or lose it’’ has gained strength during recent years. Studies showing associations of cognitive function with higher education levels, as well as greater intellectual and social activity, have provided incentives that encourage people to engage in cognitive activities throughout their lifetimes so as to prevent age-related dementia. Although more longitudinal studies are needed, recommendations to engage in lifelong learning, even into old age, are widespread. However, the lasting effects of such behavior are not known.

5. Early And Late Recognition

Ethicists have discussed the efficacy of screening for dementia. Who decides to screen? What is done with the information? Who decides to share the results of dementia testing? What are the implications for labeling a person with the Alzheimer’s disease diagnosis? Who has the right to refuse screening? Does screening make a person disability eligible, or do the results of screening disqualify a person for the workplace or even for health insurance? Before screening for dementia, clinicians should ask themselves these and other questions and discuss the implications of screening with their colleagues and patients.

5.1. Early Recognition and Intervention

In looking for signs of the onset of dementia, it is important to differentiate between normal changes in memory that occur with aging and changes that may be associated with dementia such as Alzheimer’s disease. In normal aging, the older person takes longer to learn new information, and the encoding process requires more time for new material to be retained, than is the case in younger persons. Therefore, an apparent inability to learn or to remember what was just heard is not necessarily a sign of early dementia; rather, it may be a sign of slowed cognition that occurs in all aged persons.

Changes with dementia, on the other hand, emerge with difficulty in learning new information. The person often gives up trying to learn. Difficulty in learning subsequently affects the ability to recall, that is, memory. This applies to verbal information as well as spatial information such as remembering directions.

5.2. Clinical Picture

The person with early age-related dementia may be unable to initiate new ideas into conversation, appears to be repetitive in speech, engages mainly in familiar routines to minimize stress, and shows behavior changes such as impatience, frustration, and withdrawal or depression. The person may encounter difficulty in concentrating as well. Complex skills, such as language planning and problem solving, may be shunned if the person with early impairment is aware of his or her own difficulty in cognitive functioning. Later stages show more memory impairment and language skill deterioration. The advanced stage of dementia will show impairment of all mental functions, including changes in personality and emotions exhibited by changes in behavior.

5.3. Screening and Diagnostic Tools

It is important that an assessment of an individual’s cognitive functioning not be based on one instrument or tool. A multifaceted assessment of cognition will require an interdisciplinary team approach because special training is necessary to administer these and other approaches to evaluation. Where teams are absent, the use of a variety of assessment tools is important. A basic assessment regime might include the following procedures:

• History and physical examination
• Neuroimaging and electroencephalography (EEG)
• Blood and spinal fluid laboratory tests
• Social history from a close family member
• Pharmacological and food supplement history
• Evaluation of activities of daily living (ADLs) and instrumental activities of daily living (IADLs)

 One or more of the following cognition data collection instruments:

1. Mini-Mental Status Examination. The Mini-Mental Status Examination (MMSE) is a common screening test that is used because of its reliability and validity in evaluating dementia, although it may show some bias for education and socioeconomic status. The 30-item instrument covers orientation, registration, attention, calculation, short-term recall, language, and construction. The test is not sensitive to early dementia.
2. Clock Drawing Test. In the Clock Drawing Test, the patient is provided an examiner-drawn circle and asked to put numbers in it and then to draw the clock hands at a given time (e.g., 11:10, 2:45). The properly administered test requires abstraction. Although it is sensitive, it should not be used alone as the sole screen or measure of cognition.
3. Depression scales. Although a number of depression scales are available, two seem to have common applicability for the elderly. The Geriatric Depression Scale (GDS) has several versions (5–15 items per version) and is a self-report of how the individual has felt during the past week. The Beck Depression Inventory (BDI) is a 21-item self-report scale that includes some somatic symptoms that may also be found in other chronic conditions. A depression assessment is important when determining dementia in older persons due to the frequency with which depression occurs in the elderly and concern that signs of depression may mimic or cloud those of dementia.
4. Activities of daily living. An important part of the dementia assessment is an evaluation of the individual’s ability to carry out routine ADLs such as bathing or showering, dressing, eating, transferring, and toileting. Each item is rated as minimal assistance, moderate assistance, maximal assistance, or total assistance. This information may be gained from direct observation, interview of the caregiver or close relative, or self-report. A measure of ADLs can be used to rate the severity of the psychomotor or behavioral accompaniments of dementia.
5. Instrumental activities of daily living. The IADL tool provides higher level functions than does the ADL tool. IADLs include food preparation, home maintenance, laundry, financial management, communication (including use of a telephone), use of transportation, and medication administration. The IADL tool has been criticized for having a gender bias due to the food preparation and household items.

6. Misdiagnoses And Comorbidities

Careful screening and diagnosis is important in determining the presence of dementia, particularly during the early stages when signs and symptoms might not be obvious. Vision or hearing problems can interfere with verbal or spatial input and can impair the individual’s ability to communicate accurately, thereby obscuring some cognitive functions such as the date and time. Sorting out such conditions is facilitated by multidisciplinary evaluation and repeated assessments over time to ensure an accurate diagnosis.

Frequently with the onset of multiple chronic conditions and diseases, it is difficult to determine whether comorbidities precede or follow the onset of dementia. This is particularly true in the case of senility or dementia. There are some frequently observed conditions that are strongly associated with dementia or are known to predispose to cognitive dysfunction. A number of common ones are mentioned in this section.

6.1. Head Injury

Depending on the location and severity of a head injury, or in repeated head injuries such as those that boxers may experience, dementia can occur.

6.2. Stroke, Atherosclerosis of Cerebral Arteries, High Cholesterol, and Hypertension

Vascular dementia is an outcome of some strokes or advanced atherosclerosis of cerebral arteries causing cerebral emboli. Persons with advanced diabetes can experience vascular dementia.

6.3. Oxygen Depletion of Cardiovascular or Respiratory Origin

Decreased cerebral oxygenation can lower brain metabolism and, over time, can lead to cognitive impairment.

6.4. Parkinsonism

During the advanced stages of Parkinsonism, this neurodegenerative disease can exhibit cognitive impairment, particularly in working memory.

6.5. Chronic Mental Illness

Some long-term mental health problems may show a slow emergence of dementia that may be due to the mental condition or to the effects of long-term therapy.

6.6. Drugs or Other Toxic Substances

Long-term exposure to certain toxic substances can affect cognition. Short-term drug toxicity can cause the person to exhibit changes in cognitive function, particularly orientation, that can be reversible in many instances.

6.7. Other Conditions Such as Dehydration, Fatigue, and Relocation

A fair amount of research points to the effects on working memory and orientation when the older person experiences unusual physical or mental stressors such as those that may occur with dehydration, extreme fatigue, and sudden relocation of the living environment. Research has demonstrated that older people have times of peak functioning during the day, usually the morning hours. Careful assessment of the entire person is essential before applying the label of senility or dementia.

7. Interventions And Caring

There is a great deal of literature on interventions for individuals with moderate and advanced dementia. This research-paper deals with some early interventions and concerns for the care of persons with cognitive impairment.

7.1. Dietary Supplements and Medications

Aricept (other trade names include Cognex and Exelon) is the most widely used drug to alleviate the symptoms of Alzheimer’s disease. It does this by prolonging the effects of acetylcholine release events, thereby raising neurotransmission and increasing neurotransmission effectiveness. Its use is thought to delay the advancement of symptoms rather than to provide a cure, although side effects may interfere with use of the drug.

7.2. Memory Aids and Other Nonpharmacological Treatments

The use of memory cues, such as written notes, is thought to help prolong independence in people who have progressive age-related dementia. Some literature indicates that people with mild or even moderate dementia retain reading skills longer than they do oral skills. There is also evidence that the use of written language becomes less complex in terms of sentence structure and vocabulary as the dementia progresses.

If familiar routines are retained in persons with mild to moderate dementia, independent living can be extended. Conversely, learning new routines can trigger undesirable or stressful behavior. Community-based group programs are often available through a day care format and use a variety of activity approaches to enable the individual to retain a desirable quality of life and to provide respite for the family caregiver.

7.3. Management Concerns

As the dementia condition progresses from mild to moderate levels of impairment, a number of concerns that need to be addressed may arise. Because dementia emerges in very different ways for each individual, not everyone with moderate or advanced dementia will experience these problems. However, an awareness of possible concerns will enable the practitioner to aid the family caregiver in planning ahead to prevent unsafe or disturbing behaviors.

Driving is an activity that is closely identified with a person’s sense of autonomy and independence. Yet as the individual’s judgment and problem solving become impaired, it is not unusual for the person with dementia to become lost or to make wrong decisions that can result in an auto accident. Determining when it is no longer safe for the individual to drive is a problem that family members face and that often requires their intervention.

Wandering is another concern for the ambulatory person with moderate or advanced dementia. Assistive devices, such as radio and identifier tags, can help to quickly locate the individual who has the potential for wandering. Failure to locate the person who has wandered may lead to dehydration, hunger, hypothermia, and even death.

When the person with moderate dementia is unable to carry out two or more ADLs, additional support for the family might need to be considered. Such support may be provided by adding additional assistance in the home. If the behavior is unmanageable, a time may come when the family decides to move the individual to a protective environment such as an assisted living facility for persons with dementia. Measures of family coping may assist in determining the amount of caregiving burden that the caring family members are experiencing and may serve as a useful tool in assisting the family with making decisions about care.

Repetitive forgetfulness can pose problems for caregiving. Forgetfulness can include leaving a stove on, leaving a cigarette lit, and not being able to locate familiar objects such as keys.

These are just a few of the concerns that can arise in providing care for the person with moderate dementia. The caregiver can gain many tips on how to deal with caring for the family member with dementia by joining a support group and sharing concerns with others who face similar experiences.

8. Future Prospects

Many call the decade of the 1990s as the ‘‘decade of the brain.’’ Although much knowledge has been gained about brain function, there is much more to learn. Further advancements in maintaining cognitive effectiveness are certain to be made, although a cure for age-related dementia is not anticipated. Whether new approaches, such as brain stimulation from electrical or pharmaceutical products, are developed and are effective in lessening the progression of dementia is another area for empirical study.

Recent brain research, summarized in the September 2003 issue of Scientific American, indicates that there is evidence that brain pathways for motor control have the capacity to change. This phenomenon is referred to as plasticity. Future research will demonstrate whether repatterning can occur in intellectual functioning as it has with physical activity.

Impending demographics in terms of increased life expectancy and population aging means that there will be increasing numbers of elders throughout developed and newly industrialized nations. Greater numbers of people living longer will mean that increases in the prevalence of degenerative diseases, including dementia, will be experienced throughout the world. If preventive approaches and proposed therapies are found to be effective, much will be saved in terms of human and economic resources, and the quality of life of large numbers of elders will benefit.

References:

1. Blackman, L., Small, B. J., Wahlin, A., & Larson, M. (1999). Cognitive functioning in very old age. In F. I. M. Craik, & T. M. Salthouse (Eds.), Handbook of aging and cognition (Vol. 2, pp. 449–558). Mahwah, NJ: Lawrence Erlbaum.
2. Chen, P., Ratcliff, G., Belle, S. H., Cauley, J. A., DeKosky, S. T., & Ganguli, M. (2001). Patterns of cognitive decline in presymptomatic Alzheimer’s disease: A prospective community study. Archives of General Psychiatry, 58, 853–858.
3. Elias, M. F., Beiser, A., Wolf, P. A., Au, R., White, R. F., & D’Agostino, R. B. (2000). The preclinical phase of Alzheimer’s disease: A 22-year prospective study of the Framingham cohort. Archives of Neurology, 57, 808–813.
4. Fratiglioni, L., & Rocca, W. (2001). Epidemiology of dementia. In F. Boller, & J. Grafman (Eds.), Handbook of neuropsychology (Vol. 6, pp. 193–215). Amsterdam: Elsevier. Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J.,
5. Tangalos, E., & Kokmen, E. (1999). Mild cognitive impairment: Clinical characterization and outcome. Archives of Neurology, 58, 2034–2039.
6. Pope, S. K., Shue, V. M., & Beck, C. (2003). Will a healthy lifestyle help prevent Alzheimer’s disease? Annual Review of Public Health, 24, 111–132.
7. Rabbitt, P. (1998). Aging of memory. In Brocklehurst’s textbook of geriatric medicine and gerontology (5th ed., pp. 123–152). New York: Churchill Livingstone.
8. Smith, A. (1996). Memory. In J. E. Birren, & K. W. Schaie (Eds.), Handbook of the psychology of aging (4th ed., pp. 236–250). San Diego: Academic Press.

See also:

• Psychology Research Paper Topics
•  Psychology Research Paper Examples

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