TAILIEUCHUNG - Screening for Cognitive Impairment in the Elderly

The third domain includes features related to safety, mobility, and access. Again these factors may operate on late-life health either through a cumulative process on the underlying health trajectory or by directly facilitating/impeding activities in old age. For example, by providing safe places to participate in physical activity, the availability of parks and recreation may facilitate healthy behaviors that have a beneficial affect on health well into late life (Brownson et al, 2001; Jackson & Kochtitzky, 2001). In addition, by enhancing the current environment, such features may promote functioning outside the home in late-life (Centers for Disease Control and Prevention,. | 75 Screening for Cognitive Impairment in the Elderly By Christopher Patterson 75 Screening for Cognitive Impairment in the Elderly Prepared by Christopher Patterson MD FRCPC1 Cognitive impairment is a common finding in older people as the prevalence of dementia increases with age. The most common cause of dementia is Alzheimer s disease a slowly progressive primary dementing disorder. Intercurrent illnesses infections metabolic disturbances and drug intoxications may all cause or exacerbate mental confusion. Depression may worsen and occasionally mimic dementia. Identification of dementia in the early stages offers the potential to plan to deal with subsequent deterioration organize community supports and anticipate later incompetence by measures such as advance directives and power of attorney. A large number of drugs have been studied for their effect on improving the cognitive and behavioural aspects of Alzheimer s disease. While beneficial effects on cognitive performance have been documented these are rarely of sufficient magnitude to be of clinical importance. The potential harm of labelling an individual as demented must be weighed against possible benefits. There is insufficient evidence to recommend for or against measures to detect asymptomatic cognitive impairment. The prudent physician is advised to remain alert for clues that suggest deteriorating cognitive function and then to pursue an appropriate diagnostic course of action. Prevalence of dementia is less than 5 below 75 years of age but above 40 over age 80 years Burden of Suffering Prevalence studies in Europe the United States and Canada reveal relatively consistent findings. While methods of ascertainment vary from study to study the prevalence of severe dementia in people aged 65 and over residing in the community is between and 5 . 1-3 For mild degrees of dementia the prevalence is agedependent with rates less than 5 below 75 years to 40 or higher above the age of 80. 4 The incidence has .

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