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neuropsychiatric features of aging

Clinical manifestations: 1) tonic underarousal & decreased sensory processing 2) slowed neuronal processing & increased stimulus persistence - decreased psychomotor speed 3) decreased complex, divided & sustained attention - increased tendency to struggle when confronted with a decision associated with a high cognitive load [5] 4) interference from redundant or irrelevant material - decreased attention, divided & sustained - difficulty inhibiting or disregarding irrelevant information [5] 5) accentuation of certain personality traits a) decreased excitability & impulsivity: more cautious b) disengagement & fewer risk goal-oriented behaviors c) decreased flexibility & tolerance for change 6) classical aging pattern of intelligence a) preserved crystallized intelligence (employing old information in old solutions) b) decreased fluid intelligence (novel approaches, new information, new solutions) c) relatively stable verbal IQ d) progressive decline in performance IQ 7) language: a) diminished fluency, word finding & confrontation naming b) vocabulary largely unchanged & may increase [5] c) richer narrative style d) decreased active naming e) semantic memory generally increases through middle age, then levels off [5] 8) decreased primary & working memory 9) diminished episodic & recent memory 10) decreased retrieval of stored information; relative sparing of remote recall [5] - retrieval affected more than encoding 11) decreased perception & increased spatial segmentation - decreased visual-spatial skills & visuoperceptual function 12) declines in executive function: abstractions become more concrete - related to structure changes in the prefrontal cortex 13) cognitive changes with normal aging are NOT sufficient to interfere with activities of daily living (at least until age > 90) 14) compensatory strategies may recruit neural pathways in the prefrontal cortex [5] 15) cognitive changes in late life likely due to brain pathology & mortality-related processes rather than normal aging [3] 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 - 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] Notes: - older persons tend to be influenced by first impressions longer than younger persons; impressions can be altered, but it usually takes longer [5]

Related

psychosis, agitation & difficult behavior in the elderly subjective memory problems in the elderly

General

age-associated changes in the central nervous system

References

  1. Mendez M. Comprehensive Geriatric Assessment, Osterweil et al eds, McGraw-Hill, New York, pg 86
  2. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
  3. Wilson RS, Wang T, Yu L, Bennett DA, Boyle PA. Normative cognitive decline in old age. Ann Neurol 2020. March 6 PMID: 32144793 https://onlinelibrary.wiley.com/doi/abs/10.1002/ana.25711
  4. Salthouse TA. Trajectories of normal cognitive aging. Psychol Aging. 2019;34(1):17-24 PMID: 30211596 PMCID: PMC6367038 Free PMC article https://doi.apa.org/doiLanding?doi=10.1037%2Fpag0000288
  5. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022