Question

Scenario

You are the nurse working triage in the emergency department (ED). This afternoon a woman brings in her father, ALI, a 72-year-old who is a retired doctor. The daughter reports that over the past several months she has noticed her father has progressively had problems with his mental capacity. These changes have developed gradually but seem to be getting worse. At times he is alert, and at other times he seems disoriented, depressed, and tearful. He is forgetting things and doing things out of the ordinary, such as placing the milk in the cupboard and sugar in the refrigerator. He had difficulty finding objects in the kitchen and at times forgets where his room is.

This morning he thought it was nighttime and wondered what his daughter was doing at his house. He could not pour his coffee, and he seems to be getting more agitated. ALI reports that he has been having memory problems for the past year and at times has difficulty remembering the names of family members and friends.

A review of his past medical history (PMH) is significant for hypercholesterolemia and coronary artery disease (CAD). He had a myocardial infarction (MI) 5 years ago. ALI’s vital signs (VS) today are all within normal limits (WNL).

Q:You know that age-related changes in the elderly may influence cognitive functioning. Name and discuss two.                                          

Answer 1

The grey matter volume decline

Grey matter volume begins to decrease after age 20. The amount of atrophy is most prominent in the prefrontal cortex.

Age-related changes in the temporal lobes are more moderate and involve decreases in the volume of the hippocampus. The entorhinal cortex, which serves as a relay center between the hippocampus and association areas, has been reported to undergo early decreases in volume in Alzheimer’s dementia (AD), but not in normal aging.

Systemic Diseases

Numerous systemic diseases have been associated with poorer cognitive functioning. Examples include cardiovascular diseases, such as hypertension and myocardial infarction; pulmonary diseases, such as chronic obstructive pulmonary disease and asthma; pancreatic diseases, such as diabetes mellitus; hepatic diseases, such as cirrhosis; renal diseases; autoimmune diseases; various cancers; sleep disorders, such as obstructive sleep apnea syndrome and the human immunodeficiency virus and AIDS.

Disparities in health status among racial and ethnic minority groups and individuals of lower socioeconomic status or educational attainment are well documented. It is, therefore, possible that comorbidities may, in part, explain prior relations of race/ethnicity, lower education, and low socioeconomic status to poorer performance on cognitive tests.

Medical and Surgical Treatments

A variety of medical and surgical treatments for the disease have been shown to impact cognitive performance. Improvements, decrements, and absence of change have been noted in association with various medications, such as antihypertensive agents and corticosteroid or theophylline treatment for asthma. Mixed findings are also apparent in association with surgical interventions, such as coronary artery bypass surgery. Some improvements in cognitive performance have been associated with oxygen-related treatments for chronic obstructive pulmonary disease and obstructive sleep apnea syndrome and chronic hemodialysis.