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•Orientation
•Ability to know one’s self, time and place
•Assess time: day of week, date, year, seasons
•Place: where person lives, present location, type of building , name of city and state
•Person:  own name, age, who examiner is, type of worker 
•Many hospitalized people normally have trouble with the exact date but are fully oriented on the remaining items. 
•Orientation is usually lost first to time, then to place, and rarely to person
•Attention
•Ability to concentrate
•Note whether patient completes a thought without wandering.  Note any distractibility.
•Can give directions of a sequence to follow (take paper etc)
•Commonly impaired in people who aare anxious, fatigued or drug intoxicated.
•Memory
•Immediate recall – can assess by having repeat 3 names or digit span (5-7 digits)
•Short-term memory – (ranges over a period of minutes to days) – remember 3 objects and recall in 5 minutes
•Remote or long-term memory – historical information
•Judgment
•A person exercises judgment when he or she can compare and evaluate the alternatives in a situation and reach an appropriate course of action.
•Perception
•Sensory and perceptual patterns describe auditory, visual, olfactory, tactile sensations and perception of pain
•Language
•Language and vocabulary use, abaility to relate an idea with words or even grammatical correctness provide clues to cognitive functioning.
•The interrelationships between the individual, the developmental stage and the environment are extremely important.
•A 20 year old male who dropped out of high school aat 16 and works ina factory will probbably have dirfferent behavior patterns tha a 20 year old medical student at Columbia.  So  cognitive functioning of the individual must be evaluated within the context of the environment.
•decreased levels of cognition or perception require increased levels of environmental control.  Sheltered work environments and group living arrangements for the mentally or sensory impaired individual are examples of this.
•Developmental stages play a significant role. Vision and hearing do not reach full potential until school age and as an adult reaches maturity there is a decline in sensory functions
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The early part of adolescence, ages 11 to 15, is the period of formal operations. 
Adolescents have the ability to see new kinds of logical relationships between classes or between and among several different properties.
for instance ask someone with formal operations to iamgine all the possible sums of money one can make form a quarter, a dime, a nickel and ad a penny.  Will come up with several ways in a sy stematic way.
It is important to remember that not all individuals achieve this advanced thinking capability at the same time.
Piaget believes that cognitive development evolves as a result of the maturation of the cerebral structures.
Main feature of this period of thought is that children can enter into possibilities beyond the world of reality.  They are able to think beyond the present and to consider things that do not exist but that might be.
Piaget uses the term formal to represent the adolescent’s focus on the “form” of thought, objects,  and experiences rather than on the exact content. Solve hypothetical, mental and verbal problems
Use scientific reasoning
Deal with the past, present and future
Appreciate a wide range of meanings and complex issues
Understand causality
Only 35% of high school graduates in industrialized countries obtain formal operations
Many people do not think formally during adulthood.
Tend to be extremely idealistic
may lead to rejection of family, beliefs, religion or social causes however the same adolescent who professes concern for the poor will spend money on records and clothes.
constantly challenge the way things are
try t convince others of their viewpoints
 consider the way things could be or ought to be.
untiring support of causes they believe in
may totally discard what is.
Introspective – and self-critical – deficiencies they see in themselves they assume society will also see. This may be irritating to adults but a necessary stage for the completion of the formal operations period.
Feel they have a special destiny or are immortal
take risks, neglect contraception, experiment with drugs. Etc.
Brain cell development reaches its peak in the twenties.
Actually the final number of neurons is determine in the first postnatal year but they continue to grow and become more complex
Memory is thought to peak at the time when brain weight peaks and then slowly begin to degenerate around age 30.  Don’t worry, never use all brain cell sand many intheir 60’smake important contributions.
The physical senses are at their peak during  young adulthood.
Piaget states that the young adult remains in the formal operations stage. Stage of formal operational thought evolved from concrete operational thought in adolescence and extends through the reasoning process of young adults. Achievement of formal operational thinking allows a person to analyze all combination of possibilities and construct hypotheses that are capable of being tested.
•Gender differences may be the result of bias in research.
•Cognitive ability in men and women has been considered unequal and has been described on the basis of different function in each cerebral hemisphere, although brain structure is the same in men and women. •Left hemisphere is dominant in 97% o people for language, logical reasoning and mathematical calculation.  The right hemisphere is nonverbal and mute: it know but cannot tell what it know without processing the knowledge through the left hemisphere. •The right hemisphere processes spatial and visual abstractions, recognition of faces, body image, music , art forms and and intuitive and fantasy processes.  •The female’s brain matures earlier; thus the two hemisphere are more integrated in the female as  indicated in less impairment of intellectual function in women who have suffered wither right or left hemisphere.   Mena re more vulnerable to brain damage. •As adults women are better able to coordinate activiies of both hemishpheres; thus they can think intuitively and globally.  Men are better at activiies in which the two hemspheres do not compete, such as problem solfing and detrerming spatial relationships.
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The physical senses are at their peak during  young adulthood.
Progressive loss of taste buds, first for sweet and salt leaving detection of bitter and sour.  Use herbs and spices
Intellectually, the thirties and forties are very good years.
The brain weight begins a gradual and progressive shrinking due to loss in number a size of cells and the myelin sheathing
Reaction time or speed of performance  is individual and generally stays the same or diminishes during late middle age.
speed of response is important primarily only in test situations, because much of the problem soloving necessary requires deliberation and accuracy rather than speed
Time for new learning increases with age but ability does not change
Memory
Maintained through young and middle adulthood
Some quantitative changes- digit span drop from 8 or 10 to 6.
-Normal abstract language ability but may as the same question over and over and have difficulty remembering details. -Patients with MCI are at increased risk of developing AD at the rate of 10-12% per year.
Want to diagnose these patients early to give them medications to postpone onset of AD
-Dementia refers to an acquired persistent loss of intellectual functions due to a brain disorder. -This is not a normal part of the aging process, even though the vast majority of persons who experience a dementia are persons over 65 years of age.
-Dementia is really a broad, umbrella term.
-A medical diagnosis is required to determine the underlying cause or causes of symptoms.  •In the past, terms like “senility” and “hardening of the arteries” were commonly used to describe dementia but do not accurately explain the diseases processes at work. •There are dozens of causes for dementia, some that are reversible through proper treatment, some that can be stabilized and others that are irreversible and progressive
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Read slide
Prevalence of Alzheimer’s Disease by Age (bar graph) ·         about 3 percent of persons aged 65-74 have AD, nearly 1 in 5 persons aged 75-84years have the disease, and almost half of those over age 85 years have the disease. •The 85+ age group is currently the fastest growing segment of the U.S population. Taking into account these figures, it is now estimated that there are over four million Americans with the disease
AD is far and away the most common form of dementia.
  The economic costs of the disease are estimated to be $100 billion annually.
The prevalence of dementia ranges from about 1% in individuals 60 years of age and close to 50% in individuals over the age of 85. Prevalence varies by clinical setting but is present in about 10 % of community-residing older adults and about 50 % of those in nursing homes.   In light of increasing longevity and 76 million aging baby boomers, the number of persons with AD is likely to triple over the next 50 years.
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