Chapter 27: Cognitive & Neurologic Function in Older Adults

Cognitive & Neurologic Function in Older Adults details the structural transformations of the central and peripheral nervous systems, such as neuron shrinkage, the accumulation of lipofuscin and neuritic plaques, and the decrease in vital neurotransmitters like acetylcholine and dopamine, which significantly impact memory and motor control. The sources explain how these physiological shifts influence essential functions, including the sleep-wake cycle regulated by the reticular formation, balance managed by the cerebellum, and sensory perception involving vision, hearing—specifically presbycusis—and the loss of taste and smell receptors. A significant portion of the material is dedicated to the "Three Ds" of geriatric mental health: depression, delirium, and dementia. Depression is examined regarding its atypical manifestations in older adults, such as pseudo-dementia, and its high correlation with suicide risk, particularly among the oldest-old male demographic. Delirium is characterized as an acute, fluctuating state of confusion often tied to reversible physiological triggers like infection or polypharmacy, requiring systematic screening via standardized tools like the Confusion Assessment Method. Dementia is presented as a syndrome of progressive cognitive decline, with detailed explorations of Alzheimer’s disease, vascular dementia resulting from ischemic events or strokes, dementia with Lewy bodies, and frontotemporal disorders. The sources also cover chronic conditions like Parkinson’s disease, focusing on the dopamine-acetylcholine imbalance that causes hallmark symptoms like tremors, rigidity, and bradykinesia, as well as the medical urgency of cerebrovascular accidents. Nursing management underscores a comprehensive approach that includes mental status examinations using instruments like the Mini Cog or SLUMS, behavioral interventions for challenges such as sundowning and wandering, and the judicial use of psychotropic medications. Furthermore, the chapter highlights the importance of supporting caregivers through community resources like respite care and adult day services to maintain the quality of life for both the patient and their family.