Geriatrics

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By James E Spar; Asenath La Rue

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Extra info for Clinical manual of geriatric psychiatry

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AAMI has been shown to be stable over intervals of at least 4 years; thus, it is presumed to reflect normal aging, as opposed to beginning dementia or other brain disorder. Clinicians are also likely to see older adults whose cognitive skills are somewhat worse than expected for their age but who are still coping well overall and do not appear to have dementia. Much research has been devoted to this gray area of performance, generally referred to as mild cognitive impairment. Diagnostic criteria for this condition are still evolving, and several definitions have been proposed (see Winblad et al.

For example, one recent investigation found that cognitively healthy 65- to 74-year-olds provided more relevant solutions to problem situations—such as trying to improve the acrimonious tone of a meeting, dealing with excessive demands by one’s sons to babysit their children, or having blood drawn by a physician who is having difficulty with the procedure—than did a comparison group of 20- to 29-year-olds (Artistico et al. 2003). In general, interpersonal problem solving is an area of strength for older people (Thompson and Dumke 2005).

However, the prefrontal cortex and frontal-subcortical brain circuits have been shown to play a central role in executive functions. As noted earlier, normal aging has a greater decremental effect on these brain regions than on many other areas, and predictably, age differences are relatively large on executive function tasks (see Table 5–5 in Chapter 5, “Dementia and Alzheimer’s Disease,” for examples of neuropsychological tests of executive function). Performance on executive function tests correlates more closely than scores on many other cognitive tasks with activities of daily living, and changes in executive function may play a role in determining which older people come to clinical attention for mild cognitive changes (Royall et al.

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