Family members bring their 75-year-old father into the hospital because of what they perceive as deteriorating mental status

Question

They think he should be placed in a nursing home, even though he has no significant chronic health problems.
a. Not knowing anything more about this patient other than the above information, compare the expected or "normal" neurological and cognitive assessment data in this healthy 75-year-old to that of a healthy 35-year-old.
b. What techniques or strategies would you engage to differentiate neurological alterations due to a disease or pathological condition from expected age-related changes?

Answer 1

- Processing of sensory information (vision, hearing, taste, touch) is altered during the aging process. This may hinder older patients from gaining an accurate perception of their environment, which may contribute to their looking and feeling disoriented. Some specific age-related sensory changes include
o Slowing of brain and spinal cord processing of sensory information
o Decreased visual acuity and night vision
o Altered hearing due to damage to auditory receptors.
o Altered taste and olfactory sensations which can lead to weakness and fatigue
o Social isolation and loss of cognitive stimulation due to alterations in sensory function, especially hearing and vision
- In addition to sensory alterations, there is a gradual age-related decline in the ability to learn, store new memories, and speed of processing information and in hand-eye coordination. Rather than comparing this patient to a "typical" 35-year-old, however, a more useful clinical approach would be to compare the patient to his own level of neurological function at an earlier age. Family members, former coworkers, or friends can be helpful in identifying observed functional changes.

b.
- Health care professionals should try to establish the time period over which the observed neurological and behavioral changes occurred. If they developed suddenly (days to weeks) rather than gradually over time (months to years), the most likely causes of significant neurological or cognitive changes are disease processes rather than normal aging processes.
- Assessment and diagnostic tests should be targeted toward ruling out possible causes of the mental changes other than aging. Assessment of medication history, acute or chronic stressors, sleep patterns, fluid and electrolyte and acid-base status, complete blood count, cardiopulmonary function, and kidney function will help in discriminating age-related versus non-age-related changes. Imaging techniques such as computed tomography (CT scans) and magnetic resonance imaging (MRI) can help in identifying any changes in brain structures.