COGNITIVE IMPAIRMENT

§ The clinical features of an aged brain are subtle or manifest alterations in cognition and behaviour.

§ The cognitive impairment of old age not amounting to dementia has been termed as “benign senescent forgetfulness” or “age-associated memory impairment”.

§ 10% of those older than 65 years have impaired cognition.

§ Age-associated memory impairment is characterized by:

- Onset after 50 years of age;

- Gradual onset of memory dysfunction, substantiated by psychometric evidence;

- Intact global intellectual function;

- Absence of dementia (mental state examination score, MMSE score>24); and

- Absence of any neurological, medical and psychiatric disease or use of drugs.

§ The major causes of cognitive impairment that need to be considered are:

- Alzheimer’s disease

- Vascular dementia

- Depression

Management of cognitive impairment
• Familiar predictable environment
• Predictable regular routines
• Repeated explanations
• Constant reminders of time, place and person
• Strategic placement of calendar and clocks
• Allow to make simple restricted choices
• Present as much new information as the patient can comfortably handle
• Safety measures such as well-lit corridors & locked doors
• Medications kept out of reach
• Well balanced and easy to eat meals
• Daily physical exercise
• Day hospital programs
• Transfer of financial and legal affairs
• Treatment of secondary causes
• Depression should be treated

Source:Handbook of Geriatrics By-Dr. A.B.Dey.