Evaluation of cognitive impairment in the elderly

Abstract

DISORDERS associated wi th progressive intel lectual decline are among the most c o m m o n and fr ightening p rob lems faced by the elderly.~ Such p rob lems were once bel ieved to be a normal consequence of aging and dignified wi th the name "seni l i ty ." This concep t is obsolete. Senile dement ia , often equated wi th Alzhe imer ' s disease, is most accurately defined as dementia occurr ing in persons over 65 which may or may not be reversible depending on the nature of the underlying disease. Serious difficulties wi th thinking and remember ing (i.e., cognit ive disorders) are not an inevitable consequence of growing old. 2-4 On the contrary, cognit ive disorders are symptoms of medical illness. Problems wi th learning and m e m o r y in older people range in severi ty and impor tance f rom the rarely serious lapses in recent m e m o r y c o m m o n l y associated wi th aging to the devastating decay of brain funct ion that characterizes Alzheimer 's disease. 5 A n u m b e r of o ther diseases result in cognit ive impairment . Some, like Alzheimer 's disease, are serious, progressive, and incurable. Others are reversible or, once recognized, can be arrested with correct t rea tment to minimize further deterioration. Although reliable data are not available, it appears that most physicians in this count ry and abroad have not been interested in or especia l ly adept at diagnosing or managing the various causes of cognit ive impa i rment in the elderly. 6-9 The reasons for this are not clear. Perhaps it is because cognit ive impa i rment in the e lder ly is often caused by Alzheimer 's disease and related disorders for which t h e r e a r e no cures or because of the mistaken not ion that failing thought processes are an inevitable consequence of aging. Whatever the reason, such an approach is indefensible. 1° There is reason to bel ieve this at t i tude may be changing. The impor tance of cognit ive impa i rment in the elder ly was highl ighted in 1980 by a National Institute on Aging Task Force, and more recent ly by the AMA Counci l on Clinical Affairs. 3, 11 Given the high prevalence of cognit ive disorders in the elderly, it is imperative that pr imary care physicians be skil led in diagnosing and managing brain failure if they are to provide compe ten t and compass ionate care.