714 CHAPTER 15
SUMMING UP
Summary of Normal
Versus Abnormal
Aging and Cognitive
Functioning
Most aspects of cognitive functioning remain
stable during the normal course of aging.
However, fluid intelligence and the related
abilities of processing speed, recalling verbal
information on demand, maintaining attention
and multitasking do decline in older adults.
But these declines do not generally impair
daily functioning.
Although older adults are less likely
than younger adults to have a psychologi-
cal disorder, the disorders that are most
common in older adults are depression and
generalized anxiety disorder; symptoms of
these disorders and of schizophrenia may
superficially resemble symptoms of a cogni-
tive disorder.
Brain injury, most commonly from a
stroke, can produce various cognitive defi cits
that may resemble those related to psycho-
logical disorders. Among the defi cits that may
follow a stroke or a head injury are aphasia,
agnosia, and apraxia.
In addition, legally prescribed medications
or illegal substances can alter awareness,
emotional states, and cognitive functioning.
A dose that is standard for a younger person
can adversely affect an older adult.Thinking Like a Clinician
Evan is a first-year college student who lives
with his grandmother because her home is
near his school. Before he started living with
her, he had spent only a few days at a time
with her, usually on trips with his mother.
Now that he’s spending more time with his
grandmother, he has noticed that she fre-
quently tells him the same stories from her
childhood. When she asks him to do an er-
rand, she sometimes forgets the words of
the objects she wants him to bring home or the
shop she wants him to visit. And sometimes
when he enters a room that she’s in, she
seems momentarily confused about who
he is and why he’s there. Evan is concerned
that there is something “not right” with his
grandmother, and is wondering whether he
should suggest that she be evaluated by a
doctor. Based on what you’ve learned about
normal versus abnormal changes withaging, what specific advice would you give
to Evan to help him determine whether his
grandmother’s cognitive problems are likely
to be those of normal aging (and so Evan
need not urgently suggest that she see her
doctor)?Summary of Delirium
According to DSM-IV-TR, delirium is character-
ized by a disturbance in consciousness and
changes in cognitive functioning, particularly
mental processes that rely on attention. These
symptoms develop rapidly and fl uctuate over
the course of a 24-hour period. When de-
lirious, people may not know where they are,
who they are, or what day (or year) it is. They
may also misinterpret stimuli and experience
illusions or have hallucinations. Because they
believe that these perceptual alterations are
real, patients may behave accordingly and get
hurt—or hurt other people—in the process.
Delirious people may become either restless
and agitated or sluggish and lethargic, or
they may rapidly alternate between these two
states.
Symptoms of depression, anxiety, dis-
sociation, psychosis, and substance use can
appear similar to some symptoms of delirium.
Delirium can arise from substance intoxica-
tion or withdrawal, as well as from a medical
condition such as an infection, head trauma,
or following surgery.
Treatment for delirium that targets neu-
rological factors often addresses the un-
derlying physical cause, typically through
medication. Antipsychotic medication may
be given when treatment for the underlying
condition isn’t possible or will take time to
take effect. Treatments that target psycho-
logical and social factors include correcting
sensory impairments, helping patients in-
crease their awareness of the here and now,
and educating people who interact with the
delirious patient about the symptoms of the
disorder.Thinking like a clinician
Drew is on his college’s football team and had
to have surgery on his knee. For the proce-
dure, he had general anesthesia. His mom was
with him right after the surgery, and Drew
was delirious and remained so for hours. What
can you assume, and what should you not as-
sume, about Drew’s consciousness, cognitive
functions, and emotions? What might be a
likely cause of his delirium?Summary of
Amnestic Disorder
Amnestic disorder is characterized by signifi -
cant defi cits solely in memory—other cogni-
tive functions remain relatively intact. People
with amnestic disorder may confabulate to fi ll
in memory gaps, and they may not be able to
report their history accurately during a clinical
interview. Amnestic disorder can be transient
or chronic. Amnestic disorder is caused ex-
clusively by two types of neurological factors:
(1) substance use, or (2) a medical condition,
such as stroke, head trauma, or the effects of
surgery.
Rehabilitation focuses on helping am-
nestic patients learn to use organizational
strategies and memory aids. A patient’s en-
vironment can be structured in order to mini-
mize the amount of information that needs to
be remembered to function in daily life.Thinking like a clinician
Sixty-five-year-old Lucinda recently retired
from her job as corporate vice-president of
marketing. Lucinda lives alone but frequently
visits her son, his wife, and their young
daughter. She’s noticed lately that she is los-
ing things and often forgets things—such as
where her keys are, lunch dates with friends,
and other appointments. She’s chalking up
these problems to her retirement and the re-
sulting changes in her daily patterns. At what
point might losing and forgetting things indi-
cate a cognitive disorder? For Lucinda to be di-
agnosed with amnestic disorder, what should
her symptoms be, what should they not be,
and why?Summary of Dementia
Dementia is the umbrella term for a set of
cognitive disorders that involve deficits in
memory and aphasia, apraxia, agnosia, or
problems with executive functions. Dementia
can give rise to hallucinations and delusions.
Conversely, defi cits in memory and other cog-
nitive functions may resemble symptoms of
dementia but actually arise from mental retar-
dation, schizophrenia, depression, delirium,
or amnestic disorder.
All types of dementia are caused by neu-
rological factors. The most common type of
dementia—that due to Alzheimer’s disease—
is a progressive disorder characterized by neu-
rofi brillary tangles and amyloid plaques in the