Lesson 17 UND Ab Psych Online
-being off-track or deviating from usual state -sudden onset of difficulties; reversible -extreme trouble focusing; sleep/wake cycle disrupted - vivid dreams and nightmares -memory impairment esp. for recent events -severe mood and activity swings
delirium
A state of great mental confusion in which consciousness is clouded, attention cannot be sustained, and the stream of thought and speech is incoherent. The person is probably disoriented, emotionally erratic, restless or lethargic, and often has illusions, delusions, and hallucinations.
delirium
clouded state of consciousness which has a rapid onset
delirium
Deterioration of mental faculties—memory, judgment, abstract thought, control of impulses, intellectual ability—that impairs social and occupational functioning and eventually changes the personality. See Alzheimer's disease.
dementia
a daily routine which should be practiced to be able to ward off memory problems
exercise
-drug effects are slim; no cure; preventions don't help -attempts to help people reminisce about key memories have minuscule effects
prevention and treatment of dementia
these people keep track of all prescribed drugs taken, discontinue nonessential drugs, and prescribe only minimum dosages needed
primary care physician
-have the most physical decline, disabilities, sensory and neurological deficits, loss of loved ones, social stresses -80% of elderly have @ least 1 major medical problem -quality and depth of sleep declines: sleep apnea and insomnia
problems experienced in late life
progressive static or remitting
the course of dementia may be
a painful condition caused by temporary constriction of blood flow to the heart
Angina Pectoris
More prevalent than depression GAD most common disorder PTSD sometimes found in older war veterans Causes of anxiety often related to life circumstances --Poverty --Medical difficulties --Social isolation Treatments --CBT --Benzodiazepenes
Anxiety Disorders
More common than depression late in life -GAD and PTSD Anxiety may be associated with: -financial concerns -medical illness or anticipation of illness -medical reactions -delirium accompanying illness -cardiovascular conditions -threats of social isolation
Anxiety Disorders Late in Life
c) 70
Approximately __________ percent of practicing psychologists conduct clinical work with older adults. a) 40 b) 50 c) 70 d) 20
70
Approximately ____________ percent of practicing psychologists conduct clinical work with older adult.
80
As many as _________ percent of elderly people have at least one major medial condition.
b) social selectivity.
As people age, interests shift away from seeking new social interactions to cultivating those few social relationships that really matter. This phenomenon is known as a) pruning. b) social selectivity. c) social adjustment. d) none of the above
Using currently available knowledge to make sense out of incoming information
Assimilation
A process by which fat is deposited on the walls of arteries
Atherosclerosis
Remembering information and events from your own life
Autobiographical Memory
Processes that are fast, reliable, and insensitive to increased cognitive demands
Automatic Processing
One of the four basic forces of development that includes all internal perceptual, cognitive, emotional, and personality factors
Psychological Forces
An approach to intelligence involving defining it as performance on standardized tests
Psychometric Approach
a) Alzheimer's Disease
This research can potentially lead to painkillers being prescribed to prevent the onset of _____________ as well as being used to treat the early stages of the disease: a) Alzheimer's Disease b) aging c) diabetes d) all of the above
One of the three fundamental effects examined in developmental research, along with age and cohort effects, which result from the time at which the data are collected
Time-of-Measurement Effects
A brain disease caused by an extreme drop in the neurotransmitter dopamine
Parkinson's Disease
-cross sectional -longitudinal
2 major research designs used to assess developmental change
number of years after diagnosis of FTD that death usually occurs
5-10 years
% heritability of alzheimer's
79%
two forms of inflammation in other brain tissue or outer covering of the brian which can possibly cause dementia
encephalitis and meningitis
Because exercise has been widely promoted in the media, many older adults are now exercising and thus are healthier than predicted by earlier measures of their well-being.
An example of time-measurement effect is:
10; 1 per cent
Among those with mild cognitive impairment, about __________per year will develop dementia; those without mild cognitive impairment, about _________ per year will develop dementia.
A normative change in the brain involving amyloid protein collecting on dying or dead neurons; a large number of amyloid plaques is a defining characteristic of Alzheimer's disease
Amyloid Plaques
Changing one's thought to better approximate the world of experience
Accommodation
Barriers to treatment --More negative beliefs about mental illness and treatment --less likely to seek treatment -----Clinicians less likely to expect successful outcome --Less likely to be assessed and referred for treatment --Financial barriers may prevent access Innovative treatments --Behavioral gerontology --teaching older adults to use computers
Adjusting treatment for Older Adults
One of the three fundamental effects examined in developmental research, along with cohort and time-of-measurement effects, which reflects the influence of time-dependent processes on development
Age Effects
The consequences of being a given chronological age. Compare cohort effects
Age effects
The untrue assumption that chronological age is the main determinant of human characteristics and that one age is better than the other
Ageism
In US, many people dread aging → Elderly not revered as in other cultures When are we old? → Society arbitrarily sets old as over 65 2001 cenus → 12.4% or 35 miilion individuals were 65 or older
Aging: Issues and Methods
most common form on dementia (1/2 to 2/3) gradually progressive disease sometimes appears in middle age, most often after 65 Time between onset and death typically 8 to 12 years
Alzheimer's
Alois Alzheimer 1907 brain tissues irreversibly deterioriate usually begins with -difficulty remembering recent events -difficulty learning new material -irritability
Alzheimer's Disease
Described by Alois Alzheimer in 1906 Irreversible brain tissue deterioration → Death usually occurs within 12 years Usually begins with → Difficulty remembering recent events → Learning new material → irritability As disease progresses → Language problems intensify including word-finding → Disorientation → Time, place, and identity confusion → Agitation → Depression
Alzheimer's Disease
Genetic factors → Heritability 79% → Early onset (before age 60) → Dominant genes on chromosome 21, 1 and 14 may cause some cases → Later onset → Gene on chromosome 19 → APOE-4 allele Environmental Factors → Head trauma → depression Strong baseline linguistic ability reduces risk Frequent cognitive activity reduces risk → e.g. crossword puzzles
Alzheimer's Disease
80% of dementia cases, brain tissue irreversibly deteriorates and death normally occurs 12 years after onset of symptoms
Alzheimer's disease
A dementia involving a progressive atrophy of cortical tissue and marked by memory impairment, intellectual deterioration, and, in more extreme cases, involuntary movements of limbs, occasional convulsions, and psychotic behaviour. See also plaques and neurofibrillary tangles.
Alzheimer's disease
plaques between neurons.
Alzheimer's disease is partly characterized by:
dev of memory impairments -inability to learn new info -inability to recall previously learned info Significant decline in social/occupational functioning not exclusive to delirium or dementia evidence that cause = general medical condition
Amnestic Disorders
inheritance
Among early-onset cases of Alzheimer's disease, the pattern of __________ suggests the operation of a single, dominant gene.
d) inheritance
Among early-onset cases of Alzheimer's disease, the pattern of __________ suggests the operation of a single, dominant gene. a) progress b) development c) degeneration d) inheritance
Way of organizing the biological, psychology, and socioculture forces on human development
Biopsychosocial Framework
atypical antipsychotic
Beyond treating the underlying medical conditions, the most common approach to treatment for delirium is to use __________ medications.
d) atypical antipsychotic
Beyond treating the underlying medical conditions, the most common approach to treatment for delirium is to use __________ medications. a) antidepressant b) anxiolytic c) mood stabilizing d) atypical antipsychotic
One of four basic forces of development that includes all genetic and health-related factor
Biological Forces
*more plaques- protein deposits outside neurons (most dense in frontal cortex) *more neuro fibrilary tangles- twisted protein filaments in neuron cell bodies (most dense in neurons in hippocampus) *atrophy of cerebral cortex, hippocampus, and other brain structures due to cell death -enlargement of ventricles
Brain Changes in Alzheimer's Disease
Plaques → Beta-amyloid protein deposits → Primarily found in frontal cortex Neurofibrillary tangles → Protein filaments composed of tau in cell bodies of neurons → Primarily found in hippocampus Measured using PET scans Loss of synapses for Aceylcholinergic (Ach) and glutaminergic neurons As neurons dies, atrophy of cerebral and entorhinal cortices and hippocampus Enlargement of ventricles.
Brain Changes in Alzheimer's Disease
An intensive investigation of individual people
Case Study
depression
Cases of __________ in older adults are often misdiagnosed as dementia because of the severe cognitive impairment.
c) depression
Cases of __________ in older adults are often misdiagnosed as dementia because of the severe cognitive impairment. a) Alzheimer's b) anxiety c) depression d) Parkinson's
Opaque spots on the lens of the eye
Cataracts
medical conditions Mx side effects substance use - alcohol
Caused of Delirium
*highly heritable 79% *chromosome 21 contains a gene that influences the formation of plaques (5% of early onset) *chromosome 19 contains a gene that influences the likelihood of developing late onset *Environmental factors 20% vitamin B deficiencies, head trauma, substance abuse
Causes of Alzheimer's Disease
Brain traumas - strokes Infections diseases (syphilis, HIV) Severe head injuries Toxic/poisonous substances Parkison's, Huntington's, Alzheimer's
Causes of Dementia
An interruption of the blood flow in the brain
Cerebrovascular Accident (CVA)
A family of age-related lung diseases that block the passage of air and cause abnormalities inside the lungs
Chronic Obstruction Pulmonary Disease (COPD)
The transition during which a woman's reproductive capacity ends and ovulation stops
Climacteric
(leaving without keys, forgetting names) common and expected feature of aging and stress -mem difficulties and lapses of attention increase -may occur with regularity by 60 or 70
Cognitive "mishaps"
Most elderly do not have cognitive disorders → Prevalence has decreased over last 15 years Dementia → a Deteroration of cognitive function Delirium → A state of mental confusion
Cognitive Disorders in late life
Factors that provide flexibility in responding and adapting to changes in the environment
Cognitive Reserve
An approach to intelligence that emphasizes the ways in which people conceptualize problems and focuses on modes or styles of thinking
Cognitive-Structural Approach
A group of people born at the same point or specific time span in historical time
Cohort
One of the three basic influences examined in developmental research, along with age and time-of-measurement effects, which reflects differences caused by experiences and circumstances unique to the historical time in which one lives
Cohort Effects
dementia
Compared with care giving for other disorders, care giving for people with __________ requires much more time.
c) dementia
Compared with care giving for other disorders, care giving for people with __________ requires much more time: a) schizophrenia b) delirium c) dementia d) bipolar disorder
d) experience less negative emotion.
Compared with young people, people over the age of 60 tend to: a) report more somatic symptoms. b) experience more physiological reactivity in response to emotionally charged topics. c) experience more negative emotion. d) experience less negative emotion. e) all of the above.
Any situation in which one cannot determine which of two or more effects is responsible for the behaviors being observed
Confounding
A condition occurring when cardiac output and the ability of the heart to contract severely decline, making the heart enlarge, increasing pressure to the veins, and making the body swell
Congestive Heart Failure
The debate over whether a particular development phenomenon represents smooth progression over time (continuity) or a series of abrupt shifts (discontinuity
Continuity-Discontinuity Controversy
An investigation in which the strength of association between variables is examined
Correlational Study
Random interaction between proteins that produce molecules that make the body stiffer
Cross-Linking
A developmental research design in which people of different ages and cohorts are observed at one time of measurement to obtain information about age differences
Cross-Sectional Study
Knowledge acquired through life experience and education in particular culture
Crystallized Intelligence
The notion that intelligence consists of many dimensions
Multidimensional
important to not diagnose if symptoms can be accounted for by a medical condition or medication side effects.
DSM criteria
dementia
DSM major neurocognitive disorders are similar to a diagnosis of ________
mild cognitive imapirment
DSM mild neurocognitive disorders are similar to___________
→ 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
DSM-5 criteria for delirium
Clouded state of consciousness --Extreme trouble focusing attention --Disturbances in the sleep/wake cycle --Fragmented thinking --Speech is rambling and incoherent --Disorientation --Memory Impariments Secondary to inderlying medical condition Detection of delirium important but often missed --Untreated, further cognitive decline and mortality may occur Beyond treating the underlying medical conditions, the most common treatment is atypical antipsychotic medication
Delirium
clouded state of consciousness involving: -concentration & attention problems -disruption of the sleep-wake cycle -disturbances in speech & short-term mem -hallucinations & delusions -rapid shifts in mood and activity
Delirium
often misdiagnosed as dementia onset is VERY RAPID and symptoms often vary over the course of a typical day 25% of elderly clients die within 6 months
Delirium
rapid onset trouble concentrating fluctuations in symptoms during the day treatable by addressing underlying medical causes or antipsychotics, prevention, family education present in all age groups
Delirium features NOT PRESENT in dementia
reassure, calm, comfort, empower treat underlying medical problem antipsychotics
Delirium treatment
Paranoid symptoms in many elderly psychiatric patients --Most common cause is brain disease -----Delirium or dementia --Paranoid ideation also linked to hearing loss and social isolation Treatment --Supportive and cognitive therapies --Antipsychotic medications
Delusional (paranoid) Disorders
Deterioration of cognitive function → Interferes with social and occupational functioning → Progresses over time → Begins with difficulty remembering recent events Deficits can be detected before impairment becomes obvious Mild Cognitive impairment increases risk of developing dementia Prevalence world wide → 4% of world population → Prevalence increases with advancing age
Dementia
deterioration of cognitive abilities to a point that functioning becomes impaired (formerly known as major neurocognitive disorder)
Dementia
gradual deterioration of cognitive ability that interferes with social and occupational functioning -decline is progressive and irreversible -symptoms are related to physical effects of a medical condition
Dementia
Two subtypes → With Parkinson's → No Parkinson's Symptoms similar to Parkinson's and Alzheimer's diseases → shuffling gait → Loss of memory Symptoms differ in that DLB patients have: → Fluctuating cognitive symptoms → Prominent visual hallucinations → Intense dreams involving movement and vocalizing Disorder involves unusual patterns of dopamine activity in the basal ganglia
Dementia with Lewy Bodies (DLB)
occurring with Parkinson's and occurring without Parkinson's.
Dementia with Lewy bodies can be divided into the following subtypes:
Behaviors or outcomes measured in an experiment
Dependent Variable
prevalence of mood disorders is lower <3% compared to 20% bipolar disorder is rare late in life symptoms of depression are similar except -feelings of guilt are less common -somatic/memory complaints are more common -difficult to differentiate between depression and dementia (each is a risk factor for the other)
Depression in the Elderly
b) behavioral
Despite the increased risk of death among elderly people with dementia when they are given antipsychotic medications, these medications are all too commonly prescribed when __________ interventions could be effective without the same risk. a) cognitive b) behavioral c) psychodynamic d) client-centered
The ability to pay attention and successfully perform more than one task at a time
Divided Attention
-the young-old = over 65 -the old-old = 75-84 -the oldest old = over 85
Division of 'old'
alleles within a person that can determine the onset of Alzheimers. Shows overproduction of beta-amyloid plaques, loss of neurons in hippocampus, low glucose metabolism
E4 allele
It requires all of the available attentional capacity when processing information
Effortful Processing
Severe lung disease that greatly reduces the ability to exchange carbon dioxide for oxygen
Emphysema
The idea that processes of thinking become connected to the products of thinking
Encapsulation
The process of getting information into the memory system
Encoding
The general class of memory having to do with the conscious recollection of information from a specific event or point in time
Episodic Memory
Strokes and other vascular disease --over 20% develop depression after myocardial infarction --White matter hyperintensities (WMH) ofter present in brain and associated with late-onset depression Poor physical health --especially disabilities, such as inability to walk Life events expected to trigger depression in late life --Death of spouse -----Most people recover from loss --Social isolation -----Not as much of a problem in late life as it is in mid life --Retirement -----Presents the greatest problem for those in ill health and with low income
Etiology of depression in late life
poor physical health cardiovascular problems, vascular disease recent life stressors
Etiology of depression late in life
A study in which participants are randomly assigned to experimental and control groups and in which an independent variable is manipulated to observe its effects on a dependent variable so that cause-and-effect relations can be established
Experiment
The conscious and intentional recollection of information
Explicit Memory
Memory aids that rely on environmental resources
External Aids
The interrelations among performances on similar tests of psychometric intelligence
Factor
When one remembers items or events that did not occur
False Memory
Abilities that make one a flexible and adaptive thinker, that allow one to draw inferences, and that allow one to understand the relations among concepts independent of acquired knowledge and experience
Fluid Intelligence
Deleterious and short-lived chemicals that cause changes in cells that are thought to result in aging
Free Radicals
Begins in mid to late 50s Memory not severely disrupted Impariments of executive functions → Planning → Problem solving → Goal directed behavior Difficulty recognizing and regulating emotion Neuronal deterioration in several areas involving serotonergic neurons → Amygdala, anterior temporal lobes, prefrontal cortex, and other regions.
Frontal-Temporal Dementia
problems with executive function such as planning and problem solving.
Frontal-temporal dementias (FTD) are characterized by:
gene associated with Alzheimer's disease
GAB2
The distinct patterns of change in abilities over the life span, with these patterns being different for different abilities
Multidirectionality
A heart attack
Myocardial Infarction (MI)
d) all of the above
Gerontologists usually divide people over 65 into those a) 65 to 74, the young-old. b) 75 to 84, the old-old. c) over 85, the oldest-old. d) all of the above
The study of aging from maturity to old age
Gerontology
A condition in the eye caused by abnormal drainage of fluid
Glaucoma
A disease in which one's blood pressure is too high
Hypertension
to someone who is drunk.
If you are talking to a person with delirium, it may feel like you are talking:
The effortless and unconscious recollection of information
Implicit Memory
c) Alzheimer's disease
In __________, brain tissue irreversibly deteriorates, and death usually occurs within 12 years after the onset of symptoms. a) vascular dementia b) delirium c) Alzheimer's disease d) dementia with Lewy bodies
True
In general, dementia associated with aging is more frequently diagnosed in women than in men: True False
Psychological disorders in late life, are usually recurrences of earlier disorders --Most episodes of depression and anxiety and recurrences --Schizophrenia rarely appears for the first time in late life Rates for psychological disorders lower than in younger populations --May be due to: ------Cohort effects -----Reporting bias -----Selective mortality Aging also appears to be genuinely related to better mental health
Incidence Rates of Psychological Disorders in Late Life
The variable manipulated in an experiment
Independent Variable
The study of how people take in stimuli from their environment and transform them into memories; the approach is based on a computer metaphor
Information-Processing Approach
An acknowledgment that adults differ in the direction of their intellectual development
Interindividual Variability
Memory aids that rely on mental processes
Internal Aids
depression
It is well established that __________ predicts a worse outcome for people with cardiovascular disease.
d) depression
It is well established that __________ predicts a worse outcome for people with cardiovascular disease. a) social support b) Alzheimer's disease c) anxiety d) depression
Ageism → Discrimination against a person, young or old, based on chronological age Sleep disturbancese increase with age → Insomnia → sleep apnea Medical treatment → Chronic problems instead of curable disorders → polypharmacy → Practice of prescribing multiple drugs to patients → Side effects and toxicity of medications --Psychoactive drugs usually tested on younger participants
Late Life problems
One of the four basic forces of development that reflects differences in how the same event or combination of biological, psychological, sociocultural forces affects people at different points int heir lives
Life-Cycle Forces
A view of the human life span the divides it into two phases: childhood/adolescence and young/middle/late adulthood
Life-Span Perspective
The aspects of memory involved in remembering rather extensive amounts of information over relatively long periods of time
Long-Term Memory
A developmental research design that measures one cohort over two or more times of measurement to examine age changes
Longitudinal Study
testing one cohort over time.
Longitudinal studies involve:
Low prevalence but 1/2 of psychiatric admissions are for depression Comorbid with alcohol abuse Cognitive deficits more likely when depression first appears in late life
Major Depressive Disorders
No diagnosis if symptoms are accounted for by medical condition or medication side effects → Thyroid dysfunction → Addison's disease → Cushing's disease → Parkinson's Disease → Alzheimer's Disease → Hypoglycemia → Anemia and vitamin deficiencies
Medical Issues in Diagnosing Psychological Disorders
chronic problems persist instead of curable disorders polypharmacy- practice of prescribing multiple drugs to clients -increases risk of drug interactions, side effects, toxicity -differential medication effects due to changes in metabolism
Medical Problems late in life
The awareness of what we are doing in memory right now
Memory Monitoring
The belief in one's ability to perform a specific memory task
Memory Self-Efficacy
The cessation of the release of eggs by the ovaries
Menopause
A technique that allows researchers to synthesize the results of many studies to estimate relations between variables
Meta-Analysis
Memory about how memory works and what one believes to be true about it
Metamemory
A special type of longitudinal design in which participants are tested repeatedly over a span of days or weeks, typically with the aim of observing change directly as it occurs
Microgenetic Study
Aging involves inexorable cognitive decline → severe cognition problems do not occur for most → Mild declines are common Late life is a sad time and most elderly are depressed → Older individuals report less negative emotion than younger people → More brain activation in key areas when viewing positive images Late in life is a lonely time → Some less likely to develop new friendships → social selectivity → as we age, we focus on the interpersonal relationships that matter most to us Older people lose interest in sex → Sexual activity does not decrease from mid to late life for most people
Myths about late life
-inevitable cognitive decline (mild decline common) -late life is sad and most elderly are depressed -late life is lonely -older people lose interest in sex
Myths about later life
insomnia
Name a medical issue that is a particular problem for adults:
A debate over the relative influence of genetics and the environment on development
Nature-Nurture Controversy
A normative age-related change in the brain involving the production of new fibers in the neuron; a large number of nuerofibrillary tangles is a defining characteristic of Alzheimer's disease
Neurofibrillary Tangles
The basic cells in the brain
Neurons
Random events that are important to an individual but do not happen to most people
Nonnomative Influences
Experiences caused by biological, psychological, and sociocultural forces that are closely related to a person's age
Normative-Age-Graded Influences
Events experienced by most people in a culture at the same time
Normative-History-Graded Influences
a) dementia
Older people with __________ appear to be the most susceptible to delirium. a) dementia b) anxiety c) depression d) phobia
In the reflective judgment framework, the highest level of information-processing capacity that a person is capable of
Optimal Level of Development
The ability a normal, healthy adult would demonstrate under the best conditions of training or practice
Optimally Exercised Ability
A form of arthritis marked by gradual onset and progression of pain and swelling, caused primarily by overuse of a joint
Osteoarthritis
A degenerative bone disease more common in women in which bone tissue deteriorates severely to produce honeycomb-like bone tissue
Osteoporosis
measures presence of both plaques and neurofibrillary tangles (can be seen 10-20 years before cognitive impairment)
PET scan
→ 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.
PROBLEMS EXPERIENCED IN LATE LIFE
b) impulses
People with dementia lose control of their __________ causing them to use coarse language, tell inappropriate jokes, shoplift, etc. a) behaviors b) impulses c) movements d) cognitions e) all of the above
c) steady cognitive symptoms.
People with dementia with Lewy bodies symptoms include all of the following EXCEPT: a) prominent visual hallucinations. b) sensitivity to physical side effects of antipsychotic medications. c) steady cognitive symptoms. d) intense dreams accompanied by movement and vocalizing.
The belief that capacity is not fixed, but can be learned or improved with practice
Plasticity
The capability of the brain to adapt its functional and structural organization to current requirements
Plasticity (2)
The range of functioning within an individual and the conditions under which a person's abilities can be modified within a specific age range
Plasticity (3)
Thinking characterized by a recognition that truth varies across situation, that solution s must be realistic to be reasonable, that ambiguity and contradiction are the rule rather thaan the exception, and that emotion and subjective factors play a role in thinking
Post-Format Thought
cohort effects - increasing pathology (baby boomers) response bias - underreporting selective morality - those w/mental illness tend to die younger improved coping ** - skills developed across lifetime are protective
Potential reasons for less psychopathology in elderly
A normative age-related loss of the ability to hear high-pitched tones
Presbycusis
The normative age-related loss of the ability to focus on nearby objects, usually resulting in the need for glasses
Presbyopia
1-5% 60-69 20-40% over 85
Prevalence of Dementia
exercise and healthy blood pressure
Prevention of Dementia
The normal, disease-free development during adulthood
Primary Aging
Independent abilities within psychometric intelligence based on different combination of standardized intelligence tests
Primary Mental Abilities
memory poor hygiene language disorder faulty judgement
Problems in Dementia
The amount of attention one has to apply to a particular situation
Processing Resources
language problems intensify including word-finding disorientation -time, place, person confusion Agitation Depression - 30% of ppl with Alzheimers
Progression of Alzheimer's
Process involving remembering to remember something in the future
Prospective Memory
strong cognitive ability = later onset maintaining high levels of cognitive activity like reading the newspaper
Protective factors of Alzheimer's
Process of remembering information without the help of hints or cues
Recall
Process of remembering information by selecting previously learned information from aong several items
Recognition
Thinking that involves how people reason through dilemmas involving current affairs, religion, science, and the like
Reflective Judgment
Process by which information is held in working memory, either by repeating items over and over or by making meaningful connection between the information in working memory and information already known
Rehearsal
The ability of a measure to produce the same value when used repeatedly to measure the identical phenomenon over time
Reliability
Cross-sectional studies → researcher tests different age groups at one point in time → fails to provide information about how people change over time. Longitudinal Studies → researchers retests the same group of people with the same measures at different points in time → may extend over several years or decades → Attrition a potential problem → Selective mortality can lead to biased sample
Research Designs
The process of getting information back out of memory
Retrieval
A destructive form of arthritis involving more swelling and more joints than osteoarthritis
Rheumatoid Arthritis
Development changes that are related to disease, lifestyle, and other environmental changes that are not inevitable
Secondary Aging
Broad-ranging skills composed of several primary mental abilities
Secondary Mental Abilities
Peoples answers to questions about a topic of interest
Self-Reports
Learning and remembering the meaning of words and concepts that are not tied to specific occurrences of events in time
Semantic Memory
The earliest step in information processing where new, incoming information is first registered
Sensory Memory
Types of developmental research designs involving combinations of cross-sectional and longitudinal designs
Sequential Designs
When individuals use their world knowledge to construct a more global understanding of what a text is about
Situation Model
In the reflective judgment framework, the gradual, and somewhat haphazard, process by which people learn now abilities
Skill Acquisition
One of the four basic forces of development that includes interpersonal, societal, cultural, and ethnic factors
Sociocultural Forces
The ability to remember the source of a familiar event as well as the ability to determine if an event was imagined or actually experiences
Source Memory
How quickly and efficiently the early steps in information processing are completed
Speed of Processing
A debate over the degree in which people remain the same over time as opposed to being different
Stability-Change Controversy
drugs to increase acetylcholine levels.
Standard treatment for Alzheimer's includes:
The manner in which information is represented and kept in memory
Storage
Various techniques that make learning or remembering easier and that increase the efficiency of storage
Strategies
Physiological consequences of alcohol more intense in late life --Tolerance for alcohol diminishes with age -----higher blood alcohol concentration --older people metabolize alcohol more slowly --cognitive deficits caused by alcohol more pronounced in elderly. Problems may go unnoticed because of isolation Misuse of prescription and OTC drugs a greater problem in the elderly --Consumes 1/3 of all prescribed medications
Substance Abuse and dependence
Older adults 3x as likely to take their own lives than younger adults --Men -----Suicide rates increase with age from adolescents -----Older white men most likely to commit suicide ----------Peak age from 80 to 84 --Women -----Suicide rate peaks in 50s, then declines gradually Major risk factor is depression Medical screening allows for detection and treatment even when the individual does not present with psychological problems
Suicide
-older people are less likely to communicate suicidal intent and are more likely to complete suicide - white men over 80 most likely
Suicide and the Elderly cont.
older ppl more likely to experience suicide risk factors such as: -severe illness -social isolation -loss of loved ones -financial pressures Rates increase for men & decrease slightly for women after their 50s
Suicide and the elderly
Tips of the chromosomes that shorten with each replication
Telomeres
Rapid losses occurring shortly after death
Tertiary Aging
d) symptoms caused by Alzheimer's disease.
The DSM-5 criteria for Delirium include of the following criteria EXCEPT: a) a change in cognition, not better accounted for by a dementia. b) evidence that symptoms are caused by a medical condition. c) disturbance in attention and awareness. d) symptoms caused by Alzheimer's disease.
social policy.
The age at which one is considered "old," which is now 65, is based upon:
a) social policy.
The age at which one is considered 'old,' which is now 65, is based upon a) social policy. b) the age at which individuals begin to refer to themselves as old. c) a scientific standard. d) clear biological changes that begin at about that age.
cohort effects.
The consequences of growing up during a particular time period with its unique challenges and opportunities are called:
d) all of the above
The course of dementia may be a) progressive. b) static. c) remitting. d) all of the above e) none of the above
cognitive reserve.
The idea that some people may be able to compensate for neurocognitive diseases by using alternative brain networks or cognitive strategies such that cognitive symptoms are less pronounced is called:
b) polypharmacy.
The prescribing of multiple drugs to a person is called a) drugging. b) polypharmacy. c) over dosage. d) all of the above.
a) declined
The prevalence of cognitive impairment has __________ among people over the age of 70 in the United States in the last 15 years. a) declined b) increased c) stayed the same d) soared
symptoms caused by Alzheimer's disease.
The proposed DSM-5 criteria for Delirium does not include:
a) Frontotemporal
This form of dementia is caused by a loss of neurons in frontal and temporal regions of the brain. a) Frontotemporal b) Lewy bodies c) Vascular d) Alzheimer's
*one type of drugs seeks to boost remaining Acetylcholine function in brain by blocking its breakdown *other drugs attempt to prevent onset by blocking the creation of Beta-amyloid (involved in plaques) *drugs can treat some related symptoms of Alzheimer's disease (depression, anxiety, sleep) buy may shorten life span -antipsychotics address agitation
Treatment for Alzheimer's
b) acetylcholine.
Treatment for Alzheimer's disease include drugs that interfere with the breakdown of a) dopamine. b) acetylcholine. c) serotonin. d) adrenaline.
similar to treatment to younger adults -CBT -Benzos (increase memory loss), BusPar (fewer side effects; not much tested in elderly)
Treatment for anxiety late in life
-supportive psychotherapy for family and client -psychoeducation -cognitive interventions when disease is in early stages -behavioral interventions to improve functioning
Treatment of Dementia
Medications --No drug reverses Alzheimer's disease --Some drugs produce slightly less decline -----Acetylcholinesterase inhibitrs ---------Drugs that prevent breakdown of acetylcholine -------------Doneepezil (Aricept) -------------Galantamine (Reminyl) Vitamin E, strains and nonsteroidal anti-inflammatory drugs have failed to find support Preventive work focuses on processes involved in the creation of amyloid from its precursor, protein Antidepressants for depression Antipsychotic medication for agitation
Treatment of Dementia
Psychological treatments --Supportive psychotherapy for family and patient --Education about disease and care --Cognitive interventions when disease is in early stages -----Labeling drawers, appliances -----Calendars, clocks, and strategically placed notes --Exercise has been associated with cognitive benefits --Music appears to reduce agitation and disruptive behavior
Treatment of Dementia
Depression under diagnosed in late life Successful treatments include: --SSRIs --CBT --IPT no more successful than placebo in preventing relapse Older adults more sensitive to side effects of medications --Postural hypotension upon rising which may lead to fall Drugs increase risk of heart attack and toxic reaction Electroconvulsive therapy (ECT) --May carry more cardiovascular and cognitive risks Psychotherapy in the home for patients with mobility problems Treatments helps but difficult to restore all aspects of quality life
Treatment of depression
CBT, short-term psychodynamic therapy, reminiscence therapy SSRI's - side effects may be problematic, dangerous
Treatment of depression late in life
d) cross-sectional and longitudinal.
Two major research designs that are used to assess developmental change include a) experimental and case studies. b) experimental and cross-sectional. c) longitudinal and case studies. d) cross-sectional and longitudinal.
Dementia of the Alzheimer's Type Vascular Dementia Dementia due to other general medical conditions Substance-induced persisting dementia Dementia due to multiple etiologies Dementia NOS
Types of Dementia
The ability a normal, healthy adult would exhibit without practice or training
Unexercised Ability
A debate over whether there is a single pathway if development or several
Universal vs. Context-Specific Development Controversy
memory
Unlike AD, _______ is not severely impaired in FTD.
a) memory
Unlike Alzheimer's disease, __________ is not severely impaired in frontotemporal dementia. a) memory b) planning c) executive functions d) problem solving
The degree to which an instrument measures what it is supposed to measure
Validity
→ 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.
What are some features of dementia?
Alzheimer's, Parkinson's, and Huntington's, cause degeneration or loss of nerve cells in the brain, and can cause dementia.
What diseases can produce dementia:
St. John's Wort
What herbal supplement is not an established intervention for depression in older adults:
→ 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
What is Alzhemier's disease caused by?
Difficulty in remembering new material.
What is an early sign of Alzheimer's disease?
Dementia is a descriptive term for the deterioration of cognitive abilities to the point that functioning becomes impaired.
What is dementia?
When the caregiver has high levels of social support.
What predicts resiliency among caregivers:
d) St. John's Wort
Which of the following is not an established intervention for depression in older adults? a) antidepressant medication b) electroconvulsive therapy c) psychotherapy d) St. John's Wort
c) strong baseline mental abilities and continued engagement in cognitive activities
Which of the following may serve as a protective factor against Alzheimer's disease? a) high spatial relations skills b) low fat diet c) strong baseline mental abilities and continued engagement in cognitive activities d) an active lifestyle involving daily exercise and social interaction
d) insomnia
Which of the following medical problems is a particular problem for older adults? a) high blood pressure b) lung cancer c) kidney disease d) insomnia e) all of the above
Refers to the processes and structures involve din holding information in mind and simultaneously using that information, sometimes in conjunction with incoming information, to solve a problem, make a decision, or learn new information
Working Memory
d) Pick's
__________ disease is one cause of frontotemporal dementia. a) Lyme's b) Parkinson's c) Rett's d) Pick's
a) Ageism
___________ refers to discrimination against someone because of his or her age. a) Ageism b) Gerontology c) Elderism d) Olderism
c) Polypharmacy
____________ is the prescribing of multiple drugs to a person that can increase the risk of adverse drug reactions that may cause numerous side effects. a) Drug overdose b) Polyprescribing c) Polypharmacy d) Polyoverdose
→ 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.
aetiology of delirium
-consequences of being a certain chronological age
age effects
method of research where in results are consequences of being a certain chronological age
age effects
-brain tissue irreversibly deteriorates -may begin w/ absentmindedness and difficulties in concentration and memory of new material -then may interfere w/ daily living, language skills -visual spatial abilities decline - disorientation -typically unaware of problems -symptoms increase drastically over time
alzheimer's
commonly seen even before cognitive symptoms of Alzheimers becomes noticeable
apathy
most common treatment for people with delirium (delirium can be completely recovered from)
atypical antipsychotic medication
-medical conditions: drugs, nutritional imbalances, infections or fevers, head traumas -most common = hip surgery
cause of delirium
reference of measure for the amount/presence of neurofibrillary tangles in the brain
cerebrospinal fluid
drugs which interfere with the breakdown of acetylcholine, can help slow down memory degradation but not restore memory completely
cholinesterase inhibitors
-have decreased in recent years -account for more hospital admissions and inpatient days than and other geriatric condition -2 types = dementia and delirium
cognitive disorders
Any behaviour therapy procedure that attempts to alter the manner in which a client thinks about life so that he or she changes overt behaviour and emotions.
cognitive reserve
the idea that some people may be able to compensate for Alzheimer's disease by using alternative brain networks or cognitive strategies
cognitive reserve
done in intervention studies, this aims hold exercises which improve memory, reasoning and cognitive processing speed
cognitive training
-consequences of growing up during a particular time period w/ unique challenges and opportunities
cohort effects
The consequences of having been born in a given year and having grown up during a particular time period with its own unique pressures, problems, challenges, and opportunities. Compare age effects.
cohort effects
method of research where in results are consequences of growing up in a particular time period
cohort effects
-investigator compares diff. age groups @ same moment in time on variety of interests -do not examine same people over time, so do not provide clear info about how people change as age
cross sectional
method of research where different age groups are compared at the same moment in time on the variable of interest
cross sectional
-deterioration of cognitive abilities to point that functioning becomes impaired -most common symptom: memory loss -difficulty comprehending situations and making plans and decisions -lose control of impulses = course language, inappropriate jokes, shoplift, sexual advantages -disturbances of emotions and language -delusions and hallucinations -slow developing
dementia (no longer major neurocognitive disorder)
-encephalitis -meningitis -treponema pallidum -HIV, head traumas, brain tumors, nutritional deficiencies, kidney or liver failure, hyperthyroidism -exposures to toxins
dementia caused by disease and injury
-can occur with parkinson's disease or not -symptoms are hard to distinguish from symptoms of parkinson's and alzheimer's -visual hallucinations are more common -often extremely sensitive to physical side effects of antipsychotic meds -often experience intense dreams accompanied by levels of movement and vocalizing that may seem to be 'acting out their dreams'
dementia w/ lewy bodies
Form of dementia that often co-occurs with Parkinson's disease; characterized by shuffling gait, memory loss, and hallucinations and delusions.
dementia with Lewy bodies (DLB)
this form of dementia can or may not co-occur with Parkinson's disease. Includes prominent visual hallucinations and tendencies to act out dreams
dementia with lewy bodies
-alzheimer's (most common, 80%) -frontotemporal dementia (area of brain most affected) -vascular dementia (cause by CVD) -dementia w/ lewy bodies (abnormal deposits on neurons)
different types of dementia
-confusion with respect to time, place, or identity; trouble copying figures
disorientation
A state of mental confusion with respect to time; place; and identity of self, other persons, and objects
disorientation
confusion with respect to time place or identity
disorientation
-based on whether symptoms interfere with ability to live independently
distinguishers b/w mild and major neurocognitive disorder
typical symptoms of FTD along with changes in personality and judgement
empathy, apathy, executive functioning, behavior control, hyperorality
-generic team for any inflammation of brain tissue is caused by viruses that enter the brain
encephalitis
-caused by loss of neurons in frontal and temporal -typically b/w mid-late 50s; progresses rapidly -memory is not severely impaired -deterioration in @ least 3: empathy, executive function, ability to inhibit behavior, compulsive or perseverative behavior, hyperorality, apthy -in early stages: changes in personality and judgement -emotional processes are effected more: damages relationships more and more atypical behaviors -strong genetic component -can be caused by many diff. molecular processes: 1. picks disease 2. high levels of TAU protein
frontotemporal dementia
caused by a loss of neurons in the frontal and temporal regions of the brain predominantly in the anterior lobes and the prefrontal cortex
frontotemporal dementia
Dementia that begins typically in the mid to late 50s, characterized by deficits in executive functions such as planning, problem solving, and goal-directed behavior as well as recognition and comprehension of emotions in others. Compare Alzheimer's disease.
frontotemporal dementia (FTD)
the rate of development of dementia where people eventually have difficulty remembering, poor executive functioning, poor impulse control, emotional disturbances and episodes of delirium)
gradual development
one molecular process cause seen in FTD which involves the presence of protein filaments which contribute to the neurofibrillary tangles observed in Alzheimers disease
high levels of tau
most common triggers of delirium in elder people
hip surgery
→ 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.
how does alzhemier's disease affect the brain?
12 years
how many years after the onset of symptoms does one die from alzhemier's disease?
-onset in 20s and 30s -disregard for social convention (bizarre clothes) -anger/violent outbursts; memory problems; delusions -chorea = involuntary twitching/jerking -genetically determined
huntington's disease
-tendencies to put nonfood objects in mouth
hyperorality
complaint which is normally caused by drug side effects or pain from medical problems in Alzheimer's
insomnia
exposure to these toxins can cause dementia
lead and mercury
-researcher periodically retests 1 group of people using same measure over # of years -great deal has been learned about mental health and aging -allow us to trace individual patterns of consistency or change over time -results can be biased by attrition, in which participants drop out due to death, immobility, lack of interest
longitudinal
method of research where one group of people are retested using the same measure over a number of years or decades
longitudinal
distinction between delirium and dementia (also related to rapid emotional shift)
lucid intervals of alertness
the only condition in which a psychological disorder cannot be diagnosed within a an elderly person
medical condition
the usual cause of delirium in elder people.
medical conditions
-inflammation of membranes covering the outer brain, usually caused by bacterial infection
meningitis
the reason why psychoactive drugs which are pretested are not fit for elder people
metabolism of younger people differ
-older adults may be more uncomfortable acknowledging and discussing mental health or drug use problems -people with mental illness at risk to die earlier -may be cohort effects: grew up w/ drugs, more likely to use -response biases, cohort effects, selective mortality
methodological issues w/ prevalence -why so low?
usual age FTD is diagnosed
mid to late 50s
early signs of decline in elder people which may not necessarily predict an onset of dementia (mild neurocognitive disorder)
mild cognitive impairment
one third
more than ________of people with delirium die within a year.
-aging involves inexorable cognitive decline -late life is a sad time and most elderly as depressed -late life is a lonely time -older people lose interest in sex
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.
myths about late life
-plaques: small round beta protein deposits outside the neurons -neurofibrillary tangles: twisted protein filaments composed of TAU in axons; highly present; often in hippocampus; related to host of brain changed over time -loss of synapses for Ach and glutamatergic neurons -neurons begin to die in cerebral cortex -neurons shrink in hippocampus, frontal, temporal and parietal lobes = enlarging ventricles
neurobiological causes
Abnormal protein filaments present in the cell bodies of brain cells in patients with Alzheimer's disease.
neurofibrillary tangles
twisted protein filaments composed largely of protein tau in the axons of the neurons (deposits of these found in the hippocampus causing alzheimer's disease memory loss)
neurofibrillary tangles
→ 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.
prevalence of disorders in late life
because cures for dementia are never guaranteed, people focus their efforts more on this
prevention
→ The old-old 75-84
old old
→ The oldest-old over 85
oldest old
-presence of Pick bodies (spherical inclusions) w/in neurons, but many other diseases or pathological processes can result
pick's disease
one molecular process cause seen in FTD which involves the presence of spherical inclusions known as pick bodies
picks disease
Small, round areas composed of remnants of lost neurons and beta-amyloid, a waxy protein deposit; present in the brains of patients with Alzheimer's disease.
plaques
small round beta-amyloid protein deposits outside the neurons (deposits of this found in the frontal lobe which cause alzheimer's disease poor executive functioning)
plaques
-prescribing of multiple drugs to a person
polypharmacy
prescription of multiple drugs to one person
polypharmacy
10-20%
prevalence of delirium
→ 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+
prevalence of dementia?
-persons over 65 have lowest overall prevalence of disorders -most 65 and older are free from serious psychopathology -most have already had disorder for long time -no disorder really has a late onset
prevalence of disorders in late life
-become withdrawn or apathetic -terminal phase = lose personality sparkle and integrity -social involvement narrows
progressive dementia
→ 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.
psychological disorders in late life
-age effects -cohort effects -time-of-measurement effects
research methods is study of aging
methodologically, older adults are usually more uncomfortable acknowledging and discussing mental health or drug use
response biases
probably reasons why older people have less reported psychological issues
response biases, cohort effects, selective mortality
The tendency for less healthy individuals to die more quickly, which leads to biased samples in long-term follow-up studies.
selective mortality
people are no longer able to follow up with results in study because of death
selective mortality
when people are no longer available for follow up because of death.
selective mortality
what happens to the size of the brain over the development of Alzheimer's disease along with enlarged ventricles
shrink
the quality and depth of this action slowly and inevitably declines in people as they age
sleep
a disorder in which people stop breathing for seconds or minutes in the night while sleeping (increases with age)
sleep apnea
lifestyle variables which can play a role in predicting the onset of alzheimers disease
smoking, being single, depression, low social support
-de-stigmatize brain disorders -give patient love, respect, and sense of control
social perspective on treatment
-less time to live, place higher value on emotional intimacy than exploring the world -may be viewed as social withdrawal
social selectivity
The late-life shift in interest away from seeking new social interactions and toward cultivating those few social relationships that matter most, such as with family and close friends
social selectivity
as we age our interests shift away from seeking new social interactions but focus on cultivating few important relationships
social selectivity
a bacteria from this disease called Treponema pallidum can cause dementia
syphilis
-supportive psychotherapy can help families and patients -education can help attitudes and caring -exercise; music -behavioral approaches have been shown to help compensate for memory loss and reduce depression and disruptive behavior (external memory aids) -pleasant and engaging activities diminish depression -triggers identified and changed
therapies
method of research where in results are confounds which arise because events at a particular point in time can have a specific effect on the variable being studied
time of measurement effects
-confounds that arise b/c events at a particular point in time can have a specific effect on a variable being studied
time-of-measurement effects
A possible confound in longitudinal studies whereby conditions at a particular point in time can have a specific effect on a variable that is being studied over time
time-of-measurement effects
-take in poisonous plants, gases, drugs, metals
toxic disorders
• 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.
treatment of delirium
-organism that produces venereal disease syphilis can invade the brain and cause dementia
treponema pallidum
2 main symptoms of delirium
trouble with focused attention, disturbances in sleep/wake cycle
-severe cognitive problems do not occur for most -mild declines are common -older individuals report less negative emotion than younger people -more brain activation in key areas when viewing positive images -some less likely to develop new friendships -social selectivity- as we age we focus on the interpersonal relationships that matter most to us -sexual activity does not decrease from mid to late life for most people
truths about late life
4 myths about late life
unhappy, unhealthy, lonely, bad sex
Involves neurological impairment → Weakness in limb → Abnormal reflexes Typically results from stroke → Clot forms and impairs circulation → cells die Risk factors → Smoking, high LDL cholesterol, high BP Affects African Americans more often than whites
vascular Dementia
-diagnosed when dementia is a consequence of cerebrovascular disease: a series of strokes in which a clot formed impairing circulation and cell death -more common in african americans -symptoms vary a great deal -onset is more rapid
vascular dementia
A form of dementia caused by cerebrovascular disease, most commonly occurring after strokes. Because the areas of the brain affected by disease can vary, the symptoms of vascular dementia vary as well.
vascular dementia
dementia caused by the consequence of a series of strokes where clots impair circulation of blood in the brain and cause cell death. Can co-occur with AD
vascular dementia
children and older adults
what age group is delirium most common to occur in?
→ 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.
what are features of DLB
→ 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.
what are features of delirium
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 molecular processes that cause 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 some features of FTD?
→ 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 are some injuries and diseases that can cause 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.
what are some psychological and lifestyle treatments for dementia?
→ These three methodological issues- response biases, cohort effects and selective mortality- could help explain the low rates of psychological disorders in late life.
what are the 3 methodological issues when it comes to estimating the prevalence of disorders in late life?
→ Ageing is seen as a natural process involving the 5Ds: decline disease disablement dependence death
what are the 5 Ds of ageing
Alzheimer's disease, frontotemporal dementia, vascular, and dementia with Lewy bodies.
what are the different types of dementia?
→ 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 genetic factors of AD?
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 the medications used to treat dementia?
→ Protective factors include Mediterranean diet, exercise, education and cognitive engagement
what are the protective factors for AD?
→ 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 are the risk factors for vascular 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 the three stages of dementia?
medication and psychological and lifestyle treatments
what are the treatments for dementia?
→ 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 the two subtypes of dementia with lewy bodies?
→ 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 two types of research designs used to assess developmental change?
→ FTD is caused by a loss of neurons in frontal and temporal regions of the brain
what is FTD caused by?
→ 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 is age, cohort and time of measure effects?
→ 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.
what is the DSM-criteria for major 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 DSM-criteria for mild neurocognitive disorder
→ 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
what is the course of alzhemier's disease?
→ 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 is the diagnostic criteria for FTD?
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,
what is the difference between dementia and delirium- progress, symptom, cause, course, treatment, prevalence
In Australia, the life expectancy is 81 for men and 83-84 for women.
what is the life expectancy in australia?
→ One of the most common triggers of delirium is hip surgery. However, delirium usually has more than one cause.
what is the most common cause of delirium
→ The term delirium comes from the Latin words meaning out of track- the term implies being off-track or deviating from the usual state
what is the term delirium come from?
→ 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.
what is the third age?
→ 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 is vascular dementia?
→ It typically begins in the mid to late 50s and it progresses rapidly; death usually occurs within 5-10 years of the diagnosis.
when does FTD begin?
→ 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.
where are BA plaques mostly found?
→ Tangles are most densely present in the hippocampus
where are the tangles mostly found?
→ The neuronal deterioration occurs predominantly in the anterior temporal lobes and prefrontal cortex.
where does damage in FTD mainly occur?
gender more noted to worry about aging and resort to methods of plastic surgery to avoid physical evidences of aging
women
→ The young-old 65-74
young old
