1. DESIGNING FOR ELDERS: KNOW HOW EACH ONE KNOWS THE WORLD Judah L. Ronch, Ph.D. Dean and Professor The Erickson School, UMBC

2. Cognition 1.“The process of knowing the environment” 2.A product of the brain/mind, but not exclusively due to thinking 3.Wide range of individual differences in cognition through life course 4.Not all differences in aging involve “dementia”

3. The Brain is……. A system of systems that function as an integrated eco-system to allow people to “know” the world Each person knows the world uniquely We agree on certain cognitive conventions despite these differences so we “know” the same world Sensory changes, brain injuries or diseases, and/or mental health problems, create differences in how the world is known and more extremes of different “actualities”

4. Brains are not perfect The brain takes in fragments of what is experienced, so people experience a gap-filled world Expectations, based on experiences, help fill the gaps (mental set) Gaps are filled using stored information that best fits the context People with AD mis-identify objects, people, places because they fill gaps with old information that is not from the “now” context Wishes, too, can distort perception and fill the gaps

5. Creating the future in the present The brain makes predictions about what the information it is getting means as it arrives – Brain is greedy; needs to conserve energy – Does “just enough” to make experiences make sense – Can’t keep up with the rapid pace of sensory input (older brain CNS speed slows down and can’t multi-task as well) – May result in confusion or misinterpretation

6. How some things beat the system

7. Brain Diagram

8. FOUR THEATERS OF THE BRAIN: From perceptions to identity (Ratey) Perception What the senses capture Meaning Attention, consciousness, cognition. Filters Function Memory, language, emotion, movement. Options brain uses to transform meaning into function Behavior and Identity Informs behavior/identity as to “self”-congruence and effect.

9. Factors in aging: influences on what the 4 Theaters process Sensitivity of senses of smell, touch, pain, hearing, vision Status of respiration, pulmonary function, muscle strength, balance, range of motion, mobility, sleep quality, temperature regulation, neurological function, etc. Temporary (state) and long lasting (trait) individual differences among elders’ cognition –E.g. over medication (state) vs. cognitive style (trait)

10. Routine and Cognition Helps accomplish necessary but not especially interesting things efficiently and without using too many metabolic/cognitive resources (how many routines did you engage already today?) Habituation - Repetitive inputs trigger the brain’s intrinsic feedback system for shutting down attention to things that are no longer interesting. Evident in newborns Boredom, tedium, drudgery, “brain fatigue”, cabin fever, apathy, when no novelty exists

11. Novelty and Cognition Older brains make new nerve cells as well as greater numbers of dendrites and synaptic connections when stimulated Novel stimuli mobilize attention, motivate action, and promote “wiring together” of the involved nerve cells that fire together in every interaction with the environment This helps adaptation – adds to the repertoire of available response tendencies (learning)

12. Complications of dementia, delirium, depression on cognition Each problem complicates how efficiently each of the Four Theaters can do its work They share some symptoms, but have enough in common to require expert differential diagnosis None are normal at any age person, including elders, at any time Providing help involves attention to all aspects of cognition

13. Cognition and cognitive difficulties Challenges increase as Theaters 1-3 (perception, meaning, function) have difficulty informing Theater 4 (behavior/identity) accurately Includes dementias, depression, delirium Impact is on function, not just cognition (Four Theaters model), and intervention has to be targeted toward functional improvement and self-preservation thru personal continuity