A - 18 Complexities in Evaluating the “Oldest-Old”: a Case Study of a 101-Year-Old

Abstract Objective The population of the “oldest-old” (i.e., aged 80 and older) is projected to triple by 2050 (He, Goodkind, & Kowal, 2016). Major Neurocognitive Disorder (NCD), delirium, and depression are prevalent among older adults (Downing, Caprio, & Lyness, 2013). Having one of these conditions increases the likelihood of having another. These diagnoses have commonalities and can co-occur. This poses difficulty with differential diagnosis. This case elucidates the role of neuropsychologists in differential diagnosis. Method The present case involves a 101-year-old, right-handed, African American, female referred for a neuropsychological evaluation by a geriatric psychiatrist to aid in differential diagnosis. Onset of cognitive issues began after the Veteran sustained a cerebrovascular accident (CVA) documented on neuroimaging. There was a stepwise decline in functioning over the next few years. During that time, the Veteran experienced episodes of delirium and onset of psychiatric symptoms. Upon evaluation, the Veteran was medically stable in a subacute care setting. Clinical interviews were completed with the Veteran and an informant. Neuropsychological testing was completed beside. Demographically appropriate norms were utilized. Results Neuropsychological evaluation results revealed Major Vascular NCD, Delirium-Persistent, and Adjustment Disorder with Depressed Mood. Conclusions The clinical history delineating the onset after the CVA and stepwise course was essential in clarifying this diagnosis. Major NCD likely increased the Veteran’s risk of delirium. Delirium episodes and depression complicated the course and progression. Neuropsychologists’ ability to comprehensively integrate clinical history, neuroimaging, and standardized assessment results makes them well equipped to diagnose and offer treatment recommendations for the growing oldest-old population.