Age related changes in cognition

PT.Maryam Alasfour
Age Related Changes in Cognition
MSc Candidate, KSU

Outline
• Introduction
• Structural Changes with Aging in Brain
• Cognitive Abilities Affected by Aging
• Alzheimer’s Disease
• Assessment of cognitive disorder
• Evidence Based Practice

Introduction
There is ample evidence that alternation in brain structure
and function are intimately tied to alternation in cognitive
function.
There is significant heterogeneity among older adults in the
rate of declines.

Structural changes with aging in brain

loss of brain density and weight specifically in the frontal and
temporal lobe volumes (including the hippocampus located in
the medial temporal lobe region)
5-10 % reduction
ages of (50 – 90)

Neuronal death
Accumulation of
protein beta-amyloid
Decrease neuronal
Size and Synaptic
Density
Decrease Grey matter
volume
(begins after age 20)

White matter volume decreases are much
greater than grey matter volume
decreases
16–20% decrease in white matter volume
in subjects over 70 years old compared to
younger subjects
• Memory declines
• Deficits in executive
function

Widening of brain sulci & Shrinkage of the gyri
Decreased blood
flow
Increase
neurofibriallary
tangles
Formation of senile
plaques
Reduction in the
amount of
neurotransmitters
Degradation of the
myelin sheath
25 % reduction in overall
brain electrical activity

Changes in Prefrontal
Cortex
Atrophy (gray matter - white
matter)
cognitive slowing
Changes in Medial
Temporal-Lobe
Shrinking of hippocampus
difficulties in remembering the
context in which information was
learned

Cognitive abilities affected by aging
Crystallized and Fluid Intelligence
Fluid IntelligenceCrystallized Intelligence
abilities involving problem-solving and
reasoning about things that are less familiar
and are independent of what one has
learned
skills, ability, and knowledge that is
overlearned, well-practiced, and familiar
Executive function, processing speed,
memory, and psychomotor ability
Vocabulary and general knowledge
Decline over yearsremain stable or gradually improve
Includes a person’s innate ability to process
and learn new information, solve problems,
and attend to and manipulate one’s
environment
due to accumulation of information based
on one’s life experiences
Concepts used to describe patterns of cognitive change over the lifespan.

Cognitive abilities affected by aging
 Processing speed
 Attention (selective & divided)
 Memory
 Executive Control
 Speech and Language

Risk factors for cognitive decline
• High blood pressure, diabetes, poor nutrition, and social isolation
increase the probability of developing a neurodegenerative
condition.
• Cardiovascular impairment.
• Family history of dementia.
• Psychological factors (stress and depression).

Emotion Regulation
 The ability to regulate emotion start to improve after age 60.
 Older adults show lower rates of depression than young adults.
 Are more likely to remember contextual details if the event contains
emotional relevance than if it does not.

Alzheimer's DiseaseDementia
a degenerative disease of the brain of
unknown cause.
(impairment in memory and cognitive
function enough to affect daily living)
a syndrome not a disease (group of
symptoms that affects mental
cognitive tasks such as memory and
reasoning)
IrreversibleSome cases are reversible (certain
thyroid conditions or vitamin
deficiencies; metabolic dementia)
Alzheimer’s disease accounts for 60-
70 percent cases of dementia
The prevalence of dementia almost
doubles every five years in elderly
Dementia VS Alzheimer's Disease

Structural Changes Alzheimer’s Disease
 Nerve cell death and tissue loss throughout the brain.
 Over time, the brain shrinks dramatically, affecting nearly all its functions.
Normal AD Comparison

The cortex shrivels up, damaging
areas involved in thinking,
planning and remembering
Shrinkage is especially severe in
the hippocampus
Ventricles grow larger

Plaques (abnormal
clusters of protein
fragments) build up
between nerve cells
Alzheimer's
tissue has many
fewer nerve cells
and synapses
than a healthy
brain.

10 Warning signs of Alzheimer’s Disease
1. Memory loss that disrupts daily life
2. Challenges in planning or solving
problems
3. Difficulty completing familiar tasks
4. Confusion with time or place
5. Trouble understanding visual images and
spatial relationships
6. New problems with words in speaking or
writing
7. Misplacing things and losing the ability
to steps
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood and personality
(Alzheimer's Association)

What’s the Different
Typical age-related changesSigns of Alzheimer’s/dementia
Making a bad decision once in a whilePoor judgment and decision making
Missing a monthly paymentInability to manage a budget
Forgetting which day it is and remembering laterLosing track of the date or the season
Sometimes forgetting which word to useDifficulty having a conversation
Losing things from time to timeMisplacing things and being unable to retrace steps
to find them
(Alzheimer's Association)

Stages of Alzheimer’s Disease

Preclinical:
 Delayed paragraph recall
 Frequent repetitions of the same questions or stories
 No functional impairment
 Language or executive dysfunction

EARLY STAGE (BETWEEN 1 AND 3 YEARS FROM ONSET OF SYMPTOMS):
 Slow reactions
 Sluggishness in picking up new
information
 Disorientation for date
 Naming difficulties
 Recent recall problems
 Mild difficulty copying figures
 Missed appointments, Decreased
insight
 Reduced participation in social
functions
 Getting lost, Heightened anxiety and
difficulty handling finances

MIDDLE STAGE (BETWEEN 2 AND 8 YEARS FROM ONSET OF SYMPTOMS):
 Disorientation to date, place
 Trouble recognizing familiar people
 Illegible writing & Impaired
calculating skills
 Late afternoon restlessness (sundown
syndrome)
 Difficulty with perceptual motor
coordination
 Impulsive actions
 Loss of ADL skills
 Self-neglect
 Repetitive physical movements
 Overreaction to minor events
 Delusions

LATE STAGE (BETWEEN 6 AND 12 YEARS FROM ONSET OF SYMPTOMS):
 Nearly incomprehensible verbal
output
 Loss of remote memory
 Inability to recognize self or family
members
 Incontinent
 Reduced ability to walk or get around
 No longer grooming or dressing
 Motor or verbal agitation

Assessment of cognitive disorder
Medical history: (from the patient & patient’s caregiver)
• To determine the precise features of cognitive loss.
• Past medical history: falls, head trauma, hypertension, heart disease, diabetes,
vitamin deficiencies or thyroid disorder.
• Review medications.

A comprehensive physical and neurologic examination:
• Focal weakness
• Gait impairment
• Language impairment
• Extrapyramidal signs (rigidity, tremor, bradykinesia)

A gross assessment of functional status:
• Bathing
• Dressing
• Toileting
• Transferring
• Intermediate activities (e.g., managing finances, medications, cooking,
shopping) to determine the degree of loss.

Evaluation of mental status:
• Attention
• Immediate and delayed recall
• Remote memory
• Executive function
• Depression

Cognition screens tests:
• The Mini-Cog
• Number of animals named in 1 minute
• Mini Mental Screening Exam
• Geriatric Depression Scale
• Patient Health Questionnaire
Other: St. Louis University Mental Screen (SLUMS), Short Blessed Test, Clock
Drawing Test (CDT), Time and change test and Describe similarities between two
items such as an apple and an orange.

Evidence Based Practice
A 6-Month RCT: Aerobic Exercise Increases Hippocampal Volume in Older
Women with Probable Mild Cognitive Impairment Brinke et al, 2015
Aerobic training significantly increased hippocampal volume in older women
with probable MCI.

Age related changes in cognition

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