Magazine article American Nurse Today

Assessing and Addressing Cognitive Impairment in the Elderly: A Look at the Research into Cognitive Impairment

Magazine article American Nurse Today

Assessing and Addressing Cognitive Impairment in the Elderly: A Look at the Research into Cognitive Impairment

Article excerpt

ALL SEGMENTS of the international population are living longer, and many will experience dementia. Policymakers are focused on the cost estimates of caring for elders with cognitive impairment. The World Alzheimer Report 2016, from Alzheimer's Disease International, a global federation of 85 Alzheimer's associations, highlighted the need to make dementia an international health priority. The numbers in the report are staggering: 47 million people are estimated to be living with dementia worldwide, with the number projected to increase to more than 131 million by 2050. The report recommends that nations develop a plan to address dementia, removing the stigma around it, and protecting the human rights of these individuals.

The United States has weighed in on the issue as well. In 2011, the Centers for Disease Control and Prevention published Cognitive Impairment: A Call for Action, Now! The publication emphasized incidence, cost, and surveillance of the aging Baby Boomer generation. It focused on state-level policy, with discussion of four target areas.

1. Gather data to understand the impact, burden, and needs of people with cognitive impairment.

2. Develop a comprehensive plan to respond to these needs in different agencies and organizations.

3. Evaluate and expand comprehensive systems of support.

4. Train health professionals to detect cognitive impairment in its early stages and assist patients to manage their care.

In this article, I'll describe the recent methods of assessing and diagnosing cognitive impairment, synthesize the evidence of both psychosocial and pharmacologic treatments to prevent or ameliorate cognitive decline, and evaluate the mechanisms developed to prevent and treat cognitive impairment.

Cognitive decline

Early research in the 1980s identified 12 areas included in cognitive function:

* attention span

* concentration

* intelligence

* judgment

* learning ability

* memory

* orientation

* perception

* problem solving

* psychomotor ability

* reaction time

* social intactness.

Not all of these areas need to be assessed to determine a patient's global cognitive function; however, it's essential to evaluate memory performance and executive function. As neuroscientists have studied the brain using neuroimaging, executive function was found to be associated with the frontal lobes and higher order processes. These functions are evident in cognitive activity involving planning, initiation, maintenance, and adjustment of goal-directed behavior.

What's the difference between normal cognitive aging and cognitive decline and impairment? This question can be answered as a series of gains and losses. Cognitive decline in normal aging refers to the slower processing of complex issues and difficulty retrieving information from long-term memory. Memory may improve with age, but many individuals experience memory complaints. For example, forgetting the location of car keys in the house is not cognitive impairment, but typically a lack of organizational strategy or divided attention. Cognitive impairment refers to a dysfunction in one of the domains noted above and is quantifiable on a test of cognitive function.

In the past 30 years, thousands of research studies have expanded our knowledge of cognitive decline and impairment and its assessment. New terminology has been adopted and refined with evidence to include sub jective evaluations such as metamemory (attitudes and opinions) and memory self-efficacy (prediction and confidence). An individual may have extensive and accurate knowledge about how his or her memory functions, but also may believe that the ability to remember is poor. In a large multistate sample of community-residing older adults (N = 686), a significant finding was that memory self-efficacy was inversely related to age, with self-efficacy scores decreasing in each decade after 70 years of age. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed


An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.