Mental Health Concerns and The Older Adult
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tion by a neurologist or neuropsycholo- gist can be provided if desired. Dementia (vascular, lewy body, frontotemporal, Alzheimer’s disease) Dementia is a major neurocognitive disorder classified in the DSM-5 by se - vere impairment of memory, judgment, orientation, and cognition (APA, 2013). It is not part of normal aging and is com- mon in older adults. Half of older adults age 85 years or older have a diagnosis of dementia (NIA, 2022c). Not all causes of dementia are known, and differentiating them can be challenging to the health- care worker. If a specific dementia cannot be categorized but symptoms meet crite- ria, the diagnosis of general dementia will stand. Delirium and dementia are often confused, but they can be contrasted by several clinical features. The most distin- guishable characteristic of delirium is the rapid onset of presentation and attention level. Delirium has an abrupt beginning and inconsistent level of attention, while most dementias occur over the course of time and maintain a consistent level of at- tention (Sadock et al., 2015). Although vascular dementia, which is caused by a stroke, presents very simi- larly to delirium, it can be separated by clinical evaluation. Vascular dementia is one of the several subcategories of de- mentia. It is the second most common type behind Alzheimer’s disease (NIA, 2022g). Those most at risk for developing vascular dementia are men, people with hypertension (especially uncontrolled), people with high cholesterol, and those who have other cardiovascular diseases (Sadock et al., 2015). The cognitive inva- sion of this type of dementia is a result of an infarcted plaque or emboli traveling to the brain. A diagnosis can be made after
cognitive testing is performed, a medi- cal history is taken, and brain imaging is completed (NIA, 2022g). One unfortu- nate truth about vascular dementia is the irreversibility of its damage. Treatment can include preventing further strokes by thinning the blood and lowering risk factors with lifestyle changes and medica- tions (NIA, 2022g). Another subtype of dementia is Lewy body disease (LBD). It presents similarly to Alzheimer’s but it is distinguished by areas in the brain lumped with proteins known as alpha-synuclein and called Lewy bodies after the physician who dis- covered them (NIA, 2022e). The accu- mulation of Lewy bodies causes destruc- tion and death of neurons and results in gradually decreasing brain activity (NIA, 2022e). There are two types of Lewy body dementia—dementia with Lewy bodies and Parkinson’s disease dementia. The biggest difference between Lewy body and Parkinson’s dementia is the timing and disruption in thought and movement. Classification of dementia with Lewy bodies (NIA, 2022e): Problems with thinking, unpredictable change in attention and alertness, and visual hallucinations develop early in relation to movement symptoms, such as slow movement, difficulty walking, and muscle stiffness. Classification of Parkinson’s dementia (NIA, 2022e): Movement symptoms start first and are consistent with a diagnosis of Par- kinson’s disease. Later, problems with thinking and changes in mood and be- havior develop. Not everyone with Parkinson’s disease will develop dementia. The evaluation of a person with either Lewy body or Par- kinson’s dementia will entail a physical
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