Recent research deals with disorders and deficits caused by vascular syndrome in an effort of prediction and prevention. Cardiovascular health declines with age, due to vascular risk factors, and this leads to an increasing risk of cognitive decline. Mild Cognitive Impairment (MCI) is defined as the negative cognitive changes beyond what is expected in normal aging. The purpose of the study was to compare older adults with Vascular Risk Factors (VRF), MCI patients, and healthy controls (HC) in social cognition and especially in Theory of Mind ability (ToM). The sample comprised a total of 109 adults, aged 50 to 85 years (M = 66.09, S.D. = 9.02). They were divided into three groups: (a) older adults with VRF, (b) MCI patients, and (c) healthy controls (HC). VRF and MCI did not differ significantly in age, educational level or gender as was the case with HC. Specifically, for assessing ToM, a social inference test was used, which was designed to measure sarcasm comprehension. Results showed that the performance of VRF group and MCI patients is not differentiated, while HC performed higher compared to the other two groups.  The findings may imply that the development of vascular disorder affecting vessels of the brain is associated from its “first steps” to ToM decline at least as regards specific aspects of it such as paradoxical sarcasm understanding.

Define Atypical Presentation of Illness

Main Point 1:  Symptoms of Hypoactive Delirium: The person “isn’t right” – sudden change in thinking/ mental status, tired (lethargic), staying bed

 May or may not have a fever
Change in baseline vital signs (heart rate, weight loss, change in appetite)
Constipation
Underlying Infection

Main Point 2: Symptoms of Hyperactive Delirium: Behaviors are trying to get out of bed, fighting, fluctuating mental status (CAM)

WILD: Doesn’t stand for the behavior #lol

o   Water depletion (dehydration)

o   Infection

o   Labs, abnormal (hyponatremia, WBCs)

o   Drugs (new medications, toxicity, adverse effects)

Main Point 3: Other common presentations in older adults that are different than younger adults

“Not being right” or “something’s off”

EXAMPLES OF HOW INFECTIONS PRESENT DIFFERENTLY:
o   Pneumonia:
Younger adult: Fever, cough, having trouble breathing (shortness of breath); vital signs will be different
Older adult: She’s not right, sudden incontinence, unusually tired, fall.
May not see a fever, hypoxia (low oxygen), tachycardia (high heart rate); may or may not have a cough
o   Urinary Tract Infections:
Younger adult: Pain or burning with urination, frequency, urgency, flank pain, blood in urine (on lab, not usually visible with naked eye)
Older adult: Sudden loss of bladder control, change in mental status, unusually tired, fall

HOW DEPRESSION PRESENTS DIFFERENTLY

o   Younger adults: May say they are depressed,

o   Older adults: Less social, more stigma, “are you feeling sad or blue?”, changes in appetite, flat affect, weight loss or gain, change in functional status, pain without an identifiable underlying cause (e.g., pain due to a fall, injury)
Could be caused by a medication, situational, grief process, adjustment to living arrangements.

Bladder Infections: to Treat or Not to Treat?

Define UTI and compare to asymptomatic bacteriuria (ASB)

• Discuss urinalysis
• Mention McGreer Criteria
• Role of cognition in treating ASB
• Definition of fever per IDSA of adults in long-term care
• How are antibiotics harmful?