neuropsychiatric features of aging
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Clinical manifestations
- tonic underarousal & decreased sensory processing
- slowed neuronal processing & increased stimulus persistence
- decreased psychomotor speed (cognitive processing speed)
- decreased complex, divided & sustained attention
- interference from redundant or irrelevant material
- accentuation of certain personality traits
- decreased excitability & impulsivity: more cautious
- disengagement & fewer risk goal-oriented behaviors
- decreased flexibility & tolerance for change
- classical aging pattern of intelligence
- preserved crystallized intelligence (employing old information in old solutions)
- decreased fluid intelligence (novel approaches, new information, new solutions)
- relatively stable verbal IQ
- progressive decline in performance IQ
- language:
- diminished fluency, word finding & confrontation naming
- vocabulary largely unchanged & may increase[5]
- richer narrative style
- decreased active naming
- semantic memory generally increases through middle age, then levels off[5]
- decreased primary & working memory
- diminished episodic & recent memory
- decreased retrieval of stored information; relative sparing of remote recall[5]
- retrieval affected more than encoding
- decreased perception & increased spatial segmentation
- decreased visual-spatial skills & visuoperceptual function
- declines in executive function: abstractions become more concrete
- related to structure changes in the prefrontal cortex
- cognitive changes with normal aging are NOT sufficient to interfere with activities of daily living (at least until age > 90)
- compensatory strategies may recruit neural pathways in the prefrontal cortex[5]
- cognitive changes in late life likely due to brain pathology & mortality-related processes rather than normal aging[3]
Diagnostic procedures
- MoCA 25-30
- neuropsychologic testing not routinely indicated[5]
Radiology
Differential diagnosis
Management
- elderly adjust to neuropsychiatric changes associated with aging via:
- selection:
- choosing activities that are important out of enjoyment, life purpose or necessity
- optimization:
- practicing goal-related skills, investing time & resources in useful tools
- compensation
- compensating for functional losses to accomplish goals
- selection:
- socialization
- social connections benefit health & cognition
- faith & religion may provide social connections
- with the perception of limited time left on earth, meaningful relationships are prioritized[5]
- correction of sensory deficits
Notes
- older persons tend to be influenced by first impressions longer than younger persons; impressions can be altered, but it usually takes longer[5]
More general terms
Additional terms
References
- ↑ Mendez M. Comprehensive Geriatric Assessment, Osterweil et al eds, McGraw-Hill, New York, pg 86
- ↑ UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
- ↑ 3.0 3.1 Wilson RS, Wang T, Yu L, Bennett DA, Boyle PA. Normative cognitive decline in old age. Ann Neurol 2020. March 6 PMID: https://pubmed.ncbi.nlm.nih.gov/32144793 https://onlinelibrary.wiley.com/doi/abs/10.1002/ana.25711
- ↑ Salthouse TA. Trajectories of normal cognitive aging. Psychol Aging. 2019;34(1):17-24 PMID: https://pubmed.ncbi.nlm.nih.gov/30211596 PMCID: PMC6367038 Free PMC article https://doi.apa.org/doiLanding?doi=10.1037%2Fpag0000288
- ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
- ↑ Tam HM, Lam CL, Huang H, Wang B, Lee TM. Age-related difference in relationships between cognitive processing speed and general cognitive status. Appl Neuropsychol Adult. 2015;22(2):94-9. PMID: https://pubmed.ncbi.nlm.nih.gov/24927241
- ↑ 7.0 7.1 Vallesi A, Tronelli V, Lomi F, Pezzetta R. Age differences in sustained attention tasks: A meta-analysis. Psychon Bull Rev. 2021 Dec;28(6):1755-1775. PMID: https://pubmed.ncbi.nlm.nih.gov/33772477 PMCID: PMC8642381 Free PMC article. Review. https://pmc.ncbi.nlm.nih.gov/articles/PMC8642381/
- ↑ 8.0 8.1 Arrondo P, Elia-Zudaire O, Marti-Andres G et al Grey matter changes on brain MRI in subjective cognitive decline: a systematic review. Alzheimers Res Ther. 2022 Jul 22;14(1):98. PMID: https://pubmed.ncbi.nlm.nih.gov/35869559 PMCID: PMC9306106 Free PMC article. https://pmc.ncbi.nlm.nih.gov/articles/PMC9306106/