Cognitive Decline

Christian mogensen@cs.stanford.edu http://www-pcd.stanford.edu/mogens/377/cognitive-decline.html

Summary

Focus on the communication process
Study using a cognitive model processor
Investigate errors that occur because of cognition errors
and consequences of misunderstanding the significance of the errors.
Many errors can be prevented.

A meeting is a cognitive event.
There is communication: verbal and non-verbal, conscious and unconscious information is exchanged.
The two sides are unevenly matched. The patient is a supplicant to the authority of the doctor. Gender and age further complicate the relationship.
Of course, neither party is sufficiently aware of these discrepancies. Even if they are, misunderstands still occur because of the asymmetric relationship.
Since meetings tend to take place in (to the patient) unfamiliar surroundings, the patient is easily flustered and confused. This can be misinterpreted as dementia by the doctor.
The staff can with training be made much more sensitive to the cognitive problems of the elderly and how it affects their behaviour.
There are certain legal rights that patients have as embodied in the Patient's Bill of Rights. Rights to information, alternatives...
Misunderstands can occur in any conversation, but since the elderly are more at risk from cognitive decline, they are more likely to misunderstand or be misunderstood.

[diagram]

Input - sensory perception
Processing - integration and storage of information, memory and planning
Output - language, action, expression.
Feedback loops:
These three stage all connect together. Changes in one part affect performance in the other parts of the system.
Input - without adequate attention, input may be missed. Similarly the information must be recognized. Quality of data depends on sensors and focus of attention.
Process - Memory recognizes inputs, categorizes and solves problems.
Output - Reactions to output from outside feed back to the input and memory stages.
People may avoid as too burdensome any conversation with someone who has a speech impediment. The poor speakers notice this avoidance and interpret it as being judged mentally deficient and unworthy of the effort of communication. They may then withdraw, with the increased isolation leading further deterioration of speech.
The elderly are more easily affected by indirect influences on their cognitive abilities. As we age, the processor is less flexible and less able to handle cognitive tasks.
Cognitive Overload - overburdening the cognitive processor with too many or too complex inputs.
The elderly regularly assume that even minor lapses signify dementia or Alzheimers disease. Healthcare personell frequently share these stereotypes.
As a person grows older, memory for recent events may suffer.

Patients cannot be effectively treated for any ailment unless they are cognitively competent. If not, they need outside help.
Cognitive decline manifests many ways. This means that some symptoms could be interpreted wrong.
Dementia: characterized by impairments in memory, judgement and abstraction.
Therefore, it is important to evaluate mental state before beginning treatment of any kind. This is measured using standardised tests. Most companies use a test to screen for cases worth focusing on.
Many types of cognitive loss, some of which can be repaired.
The basic problem of measuring day-to-day changes in cognitive ability is error prone, and is nigh impossible to do objectively.

Comprehensive team treatment approach: team of specialists who share comments and advice on treatment.
e.g: a social worker discussed their needs and resources and offers specific service.
The nurse discusses howto administer treatment with the patient.
psychologist supervises testing and analysis of results with psychiatrist.
This multidisciplinary approach contributes greatly to effective tratment, misunderstanding still occur. If a patient shows signs cognitive decline, what can be done?
Rehabilitation programs offer a variety of cognitive exercises as well as counseling and training.
patients are encouraged to develop strategies for dealing with their problem. Developing meta-strategy is also important. People's willingness to learn depends on the state the person is in.
People who are losing a cognitive capability are suffering a devastating lossss of identity. They often feel helpless and metacognitive skills can go a long way to reducing these effects.
Gains in performance tend to persist even if practice is interrupted for a few months. Similarly we tend to remember strategies for dealing with problems.
The rehabilitation therapist must often act as go-between, translating between the patient and the team treating the patient.