PSY3032 Week 4: Late Life Disorders

DSM major neurocognitive disorders are similar to a diagnosis of ________

dementia

what is the difference between dementia and delirium- progress, symptom, cause, course, treatment, prevalence

dementia involves a gradual deterioration of abilities whereas delirium is a rapid onset. dementia involves deficits in memory for recent events delirium involves trouble concentrating and staying with a train of thought dementia is caused by disease processes that are directly influencing the brain whereas delirium is secondary to another medial condition dementia is usually progressive and nonreversible but in delirium the symptoms fluctuate over the course of a day. treatment offers only minimal benefit for dementia. delirium is usually reversible by treating underlying condition but potentially fatal if cause is not treated prevalence increases with age with dementia whereas the prevalence is highest in the very young and old for delirium,

Cases of __________ in older adults are often misdiagnosed as dementia because of the severe cognitive impairment.

depression

It is well established that __________ predicts a worse outcome for people with cardiovascular disease.

depression

the course of dementia may be

progressive static or remitting

treatment of delirium

• Complete recovery from delirium is possible if the underlying cause is treated promptly and effectively. • The patient must be examined thoroughly for all possible reversible causes of the disorder, such as drug intoxication, infections, fever, and malnutrition, and then treated accordingly. • Beyond treating the underlying medical conditions, the most common treatment is atypical antipsychotic medication. It usually takes 1 to 4 weeks for the condition to clear; it takes longer in older people than in younger people. • Because of the high rates of delirium in hospitalized older adults, preventive strategies are recommended to prevent delirium from beginning. • In one study patients who received the intervention were less likely to develop delirium, and those who did develop delirium recovered more quickly compared to patients who received standard medical care.

PROBLEMS EXPERIENCED IN LATE LIFE

→ 80% of elderly people have at least one major medical condition → As people age, the quality and depth of sleep declines, so that by age 65 25% of people report insomnia → Rates of sleep apnea also increase with age → Polypharmacy also increases- prescribing of multiple drugs to a person → About 1/3rd of elderly people are prescribed at least five medications. → Most psychoactive drugs are tested on younger people therefore gauging the appropriate dose for the less efficient metabolism of the kidneys and liver of the older person represents an issue.

what is age, cohort and time of measure effects?

→ Age effects- consequences of being a certain age → Cohort effects- consequences of growing up during a particular time period with its unique challenges and opportunities → Time of measure effects- confounds that arise because events at a particular point in time can have a specific effect on a variable that is being studied.

what are the 5 Ds of ageing

→ Ageing is seen as a natural process involving the 5Ds: decline disease disablement dependence death

What is Alzhemier's disease caused by?

→ Alzheimer's disease is caused by the presence and accumulation of amyloid plaques (composed of AB protein) and neurofibrillary tangles (composed of tau protein). → Aggregates of both AB and tau may spread from brain region to brain region and from cell to cell in a prion-like fashion. → Some people produce excessive amounts of beta-amyloid whereas others seem to have deficiencies in the mechanisms for clearing beta-amyloid from the brain

how does alzhemier's disease affect the brain?

→ At early stages, there seems to be a loss of synapses for acetylcholingeric and glutamaterigc neurons. Neurons also begin to die. → As neurons die, the cerebral cortex, the entorhinal cortex and hippocampus shrink followed by the frontal, temporal and parietal lobes. → The cerebellum, spinal cord and motor and sensory areas are less affected.

where are BA plaques mostly found?

→ BA plaques are most densely present in the frontal cortex, and they may be present from 10-20 years before the cognitive symptoms become noticeable.

what is vascular dementia?

→ Is diagnosed when dementia is a consequence of cerebrovascular disease → Most commonly, the person had a series of strokes in which a clot formed, impairing circulation and causing cell death. → About 7% of people will develop dementia in the year after a first stroke, and the risk of dementia increases with recurrent strokes. → Because strokes and cardiovascular disease can strike different regions of the brian, the symptoms of vascular dementia can vary a good deal. The onset of symptoms is usually more rapid in vascular dementia than in other forms of dementia → Vascular dementia can co-occur with Alzheimer's disorder.

what are features of delirium

→ It is typically described as a clouded state of consciousness → The two most common symptoms are extreme trouble focusing attention and profound disturbances in the sleep/wake cycle. → They may have trouble answering questions because their mind wanders → Vivid dreams and nightmares are common → May be impossible to engage in conversation because of their wandering attention and fragmented thinking. → Recent memory impairment is common → In the course of a 24-hour period, people have lucid intervals in which they become alert and coherent. They are usually worse during sleepless nights→ these daily fluctuations help distinguish delirium from other syndromes. → Perceptual disturbances are common → Delusions occur in about 25 percent of adults with delirium → Swings in activity and mod accompany these disordered thoughts and perceptions. → Fever, flushed face, dilated pupils, tremors, rapid heartbeat are common. → Delirium is often misdiagnosed. Physicians are particularly unlikely to detect delirium when lethargy is present.

when does FTD begin?

→ It typically begins in the mid to late 50s and it progresses rapidly; death usually occurs within 5-10 years of the diagnosis.

what is the DSM-criteria for mild neurocognitive disorder

→ Modest cognitive decline from previous levels in one or more domains based on both of the following: o Concerns of the patient, a close other, or a clinician o Modest neurocognitive decline on formal testing or equivalent clinical evaluation (between the 3rd-16th percentile) → The cognitive deficits do not interfere with independence in everyday activities, even though greater effort, compensatory strategies or accommodation may be required to maintain independence → The cognitive deficits do not occur exclusively in the context of delirium and are not due to another psychological disorder

what is the most common cause of delirium

→ One of the most common triggers of delirium is hip surgery. However, delirium usually has more than one cause.

what are the protective factors for AD?

→ Protective factors include Mediterranean diet, exercise, education and cognitive engagement

what are the risk factors for vascular dementia?

→ Risk for vascular dementia involves the same risk factors as those for cardiovascular disease in general- for example, a high level of bad (LDL- low density lippoproteins) cholesterol, cigarette smoking and elevated blood pressure.

what is the DSM-criteria for major neurocognitive disorder

→ Significant cognitive decline from previous levels in one or more domains based on both of the following: o Concerns of the patient, a close other, or a clinician o Substantial neurocognitive impairment or equivalent clinical evaluation (below the 3rd percentile on formal testing) → The cognitive deficits interfere with independence in everyday activities. → The cognitive deficits do not occur exclusively in the context of delirium and are not due to another psychological disorder.

where are the tangles mostly found?

→ Tangles are most densely present in the hippocampus

what is the course of alzhemier's disease?

→ The illness may begin with absentmindedness and difficulties in concentration and in memory for new material → As the disease develops, problems with language skills and word finding intensify. Visual-spatial abilities decline, which can be manifested in disorientation and trouble copying figures. → People with the disorder are typically unaware of their cognitive problems initially. → Apathy is common even before the cognitive symptoms become noticeable and about a third of people develop full-blown depression as the illness worsens

where does damage in FTD mainly occur?

→ The neuronal deterioration occurs predominantly in the anterior temporal lobes and prefrontal cortex.

old old

→ The old-old 75-84

oldest old

→ The oldest-old over 85

what is the term delirium come from?

→ The term delirium comes from the Latin words meaning out of track- the term implies being off-track or deviating from the usual state

young old

→ The young-old 65-74

what are the different types of dementia?

Alzheimer's disease, frontotemporal dementia, vascular, and dementia with Lewy bodies.

What is dementia?

Dementia is a descriptive term for the deterioration of cognitive abilities to the point that functioning becomes impaired.

what is the life expectancy in australia?

In Australia, the life expectancy is 81 for men and 83-84 for women.

prevalence of delirium

10-20%

Among those with mild cognitive impairment, about __________per year will develop dementia; those without mild cognitive impairment, about _________ per year will develop dementia.

10; 1 per cent

how many years after the onset of symptoms does one die from alzhemier's disease?

12 years

Beyond treating the underlying medical conditions, the most common approach to treatment for delirium is to use __________ medications.

atypical antipsychotic

what age group is delirium most common to occur in?

children and older adults

Among early-onset cases of Alzheimer's disease, the pattern of __________ suggests the operation of a single, dominant gene.

inheritance

what are the treatments for dementia?

medication and psychological and lifestyle treatments

Unlike AD, _______ is not severely impaired in FTD.

memory

DSM mild neurocognitive disorders are similar to___________

mild cognitive imapirment

what are the medications used to treat dementia?

o No medications have been shown to address the cognitive symptoms of FTD o Much more is known about treatments for Alzheimer's disease than for the other forms of dementia. o Medications may help slow decline, but they do not restore memory function to previous levels. o The most commonly used medications for dementia are the cholinesterase inhibitors (drugs that interfere with the breakdown of acetylcholine), including donepezil (Aricept) and rivastigmine (Exelon). o Cholinesterase inhibitors have a slight effect in slowing memory decline compared to placebo for those with Alzheimer's and dementia with Lewy bodies. o Unfortunately, many people discontinue these drugs due to aversive side effects such as nausea o Memantine (Namenda), a drug that affects glutamate receptors believed to be involved in memory, has shown small effects in placebo-controlled trials for Alzheimer's disease. o Because depression produces more cognitive impairment in the elderly than it does in younger people, treating depressive symptoms can often lead to improvements in cognitive symptoms. o Although antipsychotic medications can provide modest relief for aggressive agitation, they also increase the risk of death among elderly people with dementia. o Despite the risks, antipsychotic medications are all too commonly prescribed for people with dementia when behavioral interventions could be effective without the same risks.

what are molecular processes that cause FTD?

o Pick's disease- characterized by the presence of Pick Bodies within neurons o Some people with FTD show high levels of tau o It has a strong genetic component - they may be multiple genetic pathways involved.

what are the three stages of dementia?

o Stage 1- mild • Difficulty remembering things; forget simple things; forget words for items; awareness of memory lapses; mood swings o Stage 2- moderate • More severe memory impairment; asking repetitive questions; difficulty in every day life; become messy; social withdrawal; recite the past often; personality changes; inability to recognize familiar people; socially withdrawn; sleep disturbances; loss of inhibition o Stage 3- severe • Oblivious to surrounding environment; unable to care for self; may lose ability to communicate; sleep often; often vulnerable to other illnesses

what are some psychological and lifestyle treatments for dementia?

o Supportive psychotherapy can help families and patients deal with the effects of the disease. o The therapist also provides accurate information about the illness, helps family members care for the person in the home, and encourages a realistic rather than a catastrophic attitude in dealing with the many specific challenges that this cognitive disorder presents o Exercise also appears to have modest benefits in improving cognitive function. o Behavioral approaches have been shown to help compensate for memory loss and to reduce depression and disruptive behavior among people with early stages of Alzheimer's disease. o For example, external memory aids such as shopping lists, calendars, phone lists, and labels can help when placed prominently as visual reminders o Pleasant and engaging activities can be increased as a way of diminishing depression.

more than ________of people with delirium die within a year.

one third

myths about late life

→ Common myths include the idea that we will become doddering and befuddled. We worry that we will be unhappy, cope poorly, and become focused on our poor health. We worry that we will be lonely and that our sex lives will become unsatisfying. → Elderly people actually experience less negative emotion than do young people. → When older people are asked to think about emotionally charged topics, they display less physiological reactivity than do younger people. → People in late life are no more likely to meet criteria for somatic symptom disorders than are the young. → As we age, our interests' shift away from seeking new social interactions to cultivating a few social relationships that really matter to us- this is called social selectivity. → Social selectivity could be misinterpreted as harmful social withdrawal → Most who are in good physical health remain sexually active contrary to popular belief.

what are the two subtypes of dementia with lewy bodies?

→ DLB can be divided into two subtypes- depending on whether or not it occurs in the context of Parkinson's disease → About 80% of people with Parkinson's disease will develop DLB → The symptoms associated with this type of dementia are often hard to distinguish from the symptoms of Parkinson's and Alzheimer's disease.

what are features of DLB

→ DLB is more likely than Alzheimer's disease to include prominent visual hallucinations and fluctuating cognitive → They are often extremely sensitive to the physical side effects of antipsychotic medications. → Another distinct symptom of DLC is that people often experience intense dreams accompanied by levels of movement and vocalizing that may make them seem as though they are acting out their dreams.

psychological disorders in late life

→ DSM criteria specify that a psychological disorder should not be diagnosed if the symptoms can be accounted for by a medical condition or mediation side effects. → Angina, congestive heart failure, and excessive caffeine consumptions may all cause a faster heart rate, which can be mistaken as a symptom of anxiety. → Antihypertensive medication, hormones, corticosteroids, and antiparkinson medications may contribute to depression or anxiety.

aetiology of delirium

→ Delirium is caused by medical conditions. → Several causes of delirium have been identified: drug intoxications and drug-withdrawal reactions, metabolic and nutritional imbalances (as in uncontrolled diabetes, thyroid dysfunction, kidney or liver failure, congestive heart failure, or malnutrition), infections or fevers (like pneumonia or urinary tract infections), neurological disorders (like head trauma or seizures), and the stress of major surgery → Why are older adults so vulnerable to delirium? Many explanations have been offered: the physical declines of late life, the increased susceptibility to chronic diseases, the many medications prescribed for older people, and the greater sensitivity to drugs. Brain damage and dementia also greatly increase the risk of delirium.

what is the diagnostic criteria for FTD?

→ Diagnostic criteria include deterioration in at least three of the following areas at a level that leads to functional impairment: empathy, executive function, ability to inhibit behavior, compulsive or perseverative behavior, hyperorality (tendencies to put nonfood objects in the mouth), and apathy.

What are some features of dementia?

→ Difficulty remembering things, especially short-term memory, is the most common symptom of dementia. → Hygiene may become poor because the person forgets to bathe or dress adequately. → Judgment may become faulty, and the person may have difficulty comprehending situations and making plans or decision. → They also lose control of their impulses; they may use coarse language, tell inappropriate jokes, shoplift and make sexual advances to strangers. → Delusions and hallucinations can occur → They are likely to show language disturbances as well- vague patterns of speech → They may have trouble recognizing familiar surroundings → Episodes of delirium may also occur → Many people with progressive dementia eventually become withdrawn and apathetic → Most dementias develop very slowly over a period of years; subtle cognitive and behavioral deficits can be detected well before the person shows any noticeable impairment.

DSM-5 criteria for delirium

→ Disturbance in attention and awareness → A change in cognitive, such as disturbance in orientation, language, memory, perception or visuospatial ability, not better accounted for by a dementia → Rapid onset and fluctuation during the course of day → Symptoms are caused by a medical condition, substance or toxin

what are some injuries and diseases that can cause dementia?

→ Encephalitis, meningitis can cause dementia → The organism that produces venereal disease syphilis can invade the brain and cause dementia → HIV head traumas, brain tumors, nutritional deficiencies (especially of B-complex vitamins), kidney or liver failure, and endocrine problems can result in dementia → Exposure to toxins and chronic substance use are both additional causes.

what is FTD caused by?

→ FTD is caused by a loss of neurons in frontal and temporal regions of the brain

prevalence of disorders in late life

→ Findings indicate that persons over age 65 have the lowest overall prevalence of mental disorders of all age groups. → Most people who have an episode of a psychological disorder late in life are experiencing a recurrence of a disorder that started earlier in life rather than an initial onset. → Late onset is more common for alcohol dependence among older adults with drinking problems. → Some older adults may be more uncomfortable acknowledging and discussing mental health compared to younger people- this discomfort may minimize prevalence estimates. → There may also be cohort effects. → Because people with psychological disorders may die earlier, studies on aging may suffer from the issue of selective mortality.

what are some features of FTD?

→ In early stages, loved ones may notice changes in personality and judgment → The disorder strikes emotional processes in a more profound manner than AD. → Marital satisfaction is more affected than compared to AD

what are the genetic factors of AD?

→ In some cases gene on chromosome 19 called APOE-4 allele is associated. Having one E4 allele increases the risk of AD to about 20% but having two alleles bring the risk substantially higher. → People with two of these alleles show overproduction of BA plaques, loss of neurons in the hippocampus, and low glucose metabolism in several regions of the cerebral cortex. → One other gene that seems to be involved is GAB2. → Other factors that seem to be involved with greater risk include- smoking, being single, depression, low social support

what are the two types of research designs used to assess developmental change?

→ There are two major research designs used to assess developmental change: cross-sectional and longitudinal. → Cross-section: the researcher compares different age groups at the same time on the variable of interest. o These studies do not examine the same people over time- they do not provide clear information about how people change as they age. → Longitudinal: the researcher periodically retests one group of people using the same measure over a number of years. o These studies allow researchers to trace individual patterns of consistency or change over time. o However, results can be biased by attrition - participants drop out of the study due to death, lack of interest, immobility. → When people are no longer available for follow up because death- this is called selective mortality.

what are the 3 methodological issues when it comes to estimating the prevalence of disorders in late life?

→ These three methodological issues- response biases, cohort effects and selective mortality- could help explain the low rates of psychological disorders in late life.

what is the third age?

→ WHO came up with the idea beyond three ages of life to incorporate a fourth age of life- THIRD age (3A) focused on input of independence, healthy lifestyles, activity- based on Lastlett's the theory of the third age. → Prior to the develop of the third age theory what we were seeing was that identity and the self were only seen as dynamic and changing in the first ages of life in childhood and adulthood. → Lastlett argued that these processes of identity development and self-maintenance continue throughout the third age into older adulthood. → There is now a fourth age that is categorized by decline- a period approximate to death.

prevalence of dementia?

→ World wide prevalence of dementia = 0.4 percent of the world population → The prevalence of dementia increases with age. Its found to be 1-2% in people aged 60-69 but increases to more than 20 percent in those 85+