NeuroRehabilitation - Volume 23, issue 5

Authors: Martin, Thomas A. | Bush, Shane S.

Article Type: Editorial

DOI: 10.3233/NRE-2008-23501

Citation: NeuroRehabilitation, vol. 23, no. 5, pp. 377-379, 2008

Authors: Jamora, Christina Weyer | Ruff, Ronald M. | Connor, Bonnie B.

Article Type: Research Article

Abstract: Consistent with the aging population, neuropsychologists are being asked with increased frequency to evaluate older adults. These assessments are often complicated by medical and psychiatric co-morbidities, polypharmacy, and complex psychosocial and legal issues that are frequently encountered in this population. The aim of this review article is to address the challenges neuropsychologists and other frontline clinicians often confront when evaluating older individuals. Specifically, we review psychiatric and medical co-morbidities, testing accommodations, diagnostic versus descriptive testing approaches, normative issues, polypharmacy, and reimbursement rates. Finally, future implications are discussed for advancing the neuropsychologist's role in evaluating and treating older individuals.

Keywords: Geriatric neuropsychology, assessment and treatment challenges

DOI: 10.3233/NRE-2008-23502

Citation: NeuroRehabilitation, vol. 23, no. 5, pp. 381-394, 2008

Authors: Caplan, Bruce | Shechter, Judith

Article Type: Research Article

Abstract: Obtaining accurate information about the neuropsychological functioning of elderly individuals with physical or sensorimotor limitations may be fostered by judicious use of nonstandard testing strategies. We review professional documents that support this position and discuss selected “flexible” testing techniques that can serve this goal. These approaches may permit assessment of skills that might otherwise go unmeasured (e.g., naming ability or executive function in persons with visual impairment). This perspective is particularly critical when clinicians are asked to assess an older adult's capacity and competence in daily life functions.

DOI: 10.3233/NRE-2008-23503

Citation: NeuroRehabilitation, vol. 23, no. 5, pp. 395-402, 2008

Authors: Moberg, Paul J. | Rick, Jacqueline H.

Article Type: Research Article

Abstract: With our ageing population, the number of older adults with cognitive impairment has also increased. There is both an acute and growing need for evidence-based assessments to identify their decision making capacity and competence. In the present article we (1) present definitions of decision-making capacity and competence, (2) review cognitive functions that are central to decision-making capacity as well as the methods and procedures commonly used to assess these domains, and (3) address the communication of assessment findings to patients and their loved ones. The importance of assessing decision-making capacity in the context of specific functions and of respecting the …values and interests of older adults are emphasized. Show more

Keywords: Decision-making capacity, competency, geriatric, neuropsychology

DOI: 10.3233/NRE-2008-23504

Citation: NeuroRehabilitation, vol. 23, no. 5, pp. 403-413, 2008

Authors: Uomoto, Jay M.

Article Type: Research Article

Abstract: The literature related to neurorehabilitation methods specific to older adults is now emerging, the timing of which is important given the epidemiology of acquired brain injury in this population. Examined are epidemiological characteristics of acquired brain injury, with a focus on traumatic brain injury and stroke. Principles of geriatric neurorehabilitation are proposed by using a Neo-Lurian framework, and employing the PASS model of brain-behavior relationship forwarded by J. P. Das. Discussed are specific issues and strategies of geriatric neurorehabilitation by removing excess disability that complicates acquired brain injury. These include addressing depression, sleep disturbance, chronic pain, and social support. Restorative …interventions may now also appear as a part of geriatric neurorehabilitation practices. A focus on team functioning as a critical contributor to functional outcomes in those older adults with acquired brain injury is presented along with future directions that capitalize upon the ideals of primary, secondary, and tertiary prevention. Show more

Keywords: Geriatric, brain injury, excess disability, rehabilitation

DOI: 10.3233/NRE-2008-23505

Citation: NeuroRehabilitation, vol. 23, no. 5, pp. 415-424, 2008

Authors: Zec, Ronald F. | Burkett, Nicole R.

Article Type: Research Article

Abstract: This paper discusses the various pharmacological and behavioral treatments for the cognitive, emotional, and behavioral symptoms of Alzheimer disease (AD). The medications that are currently FDA-approved for the treatment of the cognitive/functional deficits of AD will first be discussed. Next, neuropsychiatric behavioral disturbances, including hallucinations and delusions, agitation and aggression, activity disturbances, depression, and anxiety will be described along with treatment interventions. Sleep disturbance and its treatment in AD and the issue of fitness to drive a motor vehicle are also reviewed. Principles of behavioral management, tips for communication, and recommendations for caregivers are discussed. Lastly, risk and protective factors …and their relevance to delaying the expression of dementia are also examined. Show more

Keywords: Alzheimer disease, pharmacological and behavioral treatment, risk factors

DOI: 10.3233/NRE-2008-23506

Citation: NeuroRehabilitation, vol. 23, no. 5, pp. 425-438, 2008

Authors: Elliott, Timothy R. | Pezent, Ginger D.

Article Type: Research Article

Abstract: Family caregivers of older individuals in rehabilitation have unique needs and concerns that should be addressed in rehabilitation and in community-based programs. Their concerns have a direct bearing on their health and on the health and well-being of their care-recipients. In this paper, we review the major problems facing many caregivers of older individuals who may receive rehabilitation services, and we discuss implications from relevant research. We conclude with recommendations for interventions, services and program development.

Keywords: Caregivers, older age, rehabilitation

DOI: 10.3233/NRE-2008-23507

Citation: NeuroRehabilitation, vol. 23, no. 5, pp. 439-446, 2008

Authors: Martin, Thomas A. | Bush, Shane S.

Article Type: Research Article

Abstract: The practice of geriatric neuropsychology demands specialized training and experience that enables the practitioner to appreciate the unique challenges and opportunities that are encountered when working with older adults. In addition to maintaining advanced knowledge regarding medical and psychological conditions, assessment issues, and treatment needs specific to older persons, clinicians working with older adults must be prepared to recognize and confront ethical dilemmas that arise. For example, ethical challenges related to professional competence, informed consent, assessment, and privacy and confidentiality may be prominent when working with older persons. Maintaining an emphasis on “positive ethics” and utilizing an ethical decision-making model …will promote the practitioner's ability to avoid, identify, and resolve ethical challenges. The present article reviews (1) the concept of positive ethics, (2) a comprehensive ethical decision-making model, and (3) ethical issues that are commonly encountered by geriatric neuropsychologists. A case vignette is presented to illustrate the application of the aforementioned tools to promote ethical practice. Show more

Keywords: Ethics, geriatric neuropsychology, positive ethics, ethical decision-making model

DOI: 10.3233/NRE-2008-23508

Citation: NeuroRehabilitation, vol. 23, no. 5, pp. 447-454, 2008