AC was the sole author of sections “Literature and Writing,” “Visual Art,” “Film,”and “The
‘Neuro’Paradigm.”
Key Readings
Kent, M. & Li, R.,The arts and aging: Building the science. (Washington, DC: National Endowment for the Arts Office of Research and Analysis, 2013). http://arts.gov/sites/default/files/Arts-and-Aging-Buil- ding-the-Science.pdf
Rose, N., & Abi-Rached, J. M.Neuro: The new brain sciences and the management of the mind. (Princeton University Press, 2013).
Basting, A., Forget memory: Creating better lives for people with dementia. (Johns Hopkins University Press, 2009).
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97 Humanistic Perspectives
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99 Humanistic Perspectives
Part III
Methods of Assessment
6
Medical Assessment of the Aging Mind and Brain
T. Scott Diesing and Matthew Rizzo
Key Points
• The comprehensive evaluation of the aging patient with complaints of altered brain function includes obtaining a detailed history, performing a thorough examination—often obtaining additional tests—and analysis of the information to make a diagnosis.
• The patient may present for a variety of reasons including their own concerns for dementia, difficulty taking care of themselves, or at the prompting of their family.
• Corroborative or additional history from the patient’s family or loved ones is important in the evaluation of the altered mind and memory.
• Additional testing such as functional and structural brain imaging, neuropsychological testing, and blood work is often utilized in the evaluation of cognitive concerns.
Introduction
This chapter reviews the basic neurological assessment of older persons with mental and behavioral changes. Healthcare providers face a mounting burden of acute and chronic impairments of mind and brain health. Primary care and cognitive and behavioral health specialists, including neurolo- gists, geriatricians, psychiatrists, psychologists and others, must be prepared to diagnose, treat, and refer these older patients for appropriate tests, consultation, and treatment.
Mind and brain aging affect attention, perception, memory, language, executive functions (decision-making, planning and self-awareness), motor function, and emotion. Patterns of dysfunction may fall under the rubric of dementia, mild cognitive impairment (MCI), delirium and encephalopathy, in a variety of neurological, medical, and psychiatric conditions.Dementia is an acquired and persistent impairment of intellect affecting multiple domains of cognition and sufficient to interfere with everyday functions. Common causes are neurodegenerative including Alzheimer’s disease, frontotemporal dementia, Lewy body disease, Parkinson’s disease, cerebrovascular disease, trauma and central nervous system (CNS) infections (see chapter 21).
MCI is often a prodrome or transitional state between normal cognition and early dementia, usually Alzheimer’s, and is often characterized by short-term or recent-memory deficits and otherwise intact cognition and behavior. Encephalopathy (Greek for “brain suffering”) is an umbrella term1that includes many neurological disorders and abnormal states of the aging brain
The Wiley Handbook on the Aging Mind and Brain, First Edition. Edited by Matthew Rizzo, Steven Anderson, and Bernd Fritzsch.
© 2018 John Wiley & Sons Ltd. Published 2018 by John Wiley & Sons Ltd.
and mind (see chapter 25).Delirium, a form of encephalopathy, is an acute, confusional state with disturbance of awareness and is characterized by deficits in attention, delusions, hallucinations, and agitation––often due to medication effects, systemic illness, sleep deprivation, infection and other factors.
The evaluation in these cases relies on history from the patient, family and other sources, and on physical and mental status examinations. The provider develops a set of hypothetical diagnoses and may test these with a set of tools including imaging, electrophysiologic, laboratory and cognitive (neuropsychological) tests. Using the history, examination and test results, the provider solidifies a diagnosis and treatment plan.