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Lecture 10

PSYB32H3 Lecture Notes - Lecture 10: Intellectual Disability, Multiple Sclerosis, Reminiscence Therapy

Course Code
Mark Schmuckler

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PSYB32 Lecture 10 Prof’s Speech - Purple
Slide 3 Old Age and Brain Disorders
- Dementia
o Gradual deterioration of intellectual and cognitive abilities that does not reverse it gets
worse over time
o Step wise vs. slowly progressive deterioration
Slowly progressive over time, the person will get worse, but there is no
dramatic change that happens overnight, takes years
Step wise may have some cognitive problems, and then function at that level
for a while, something happens, and then they will get worse, and then function
at that level for a while, and so on
o Impairment in social and occupational functioning in their activities of daily living
o Each dementia syndrome has a unique neuropsychological signature
Tend to present with a unique constellation of cognitive deficits
As the disorder evolves, they tend to look globally demented
Early intervention is very important because dementia cannot be reversed, the
process can only be slowed down
o A diagnosis of dementia is clinical
Without a marker, the diagnosis is a probable guess
o Only at autopsy can it be definitive
Only time you can distinguish what the dementia was
- Video
o Dementia is an umbrella term that describes lots of different conditions that give rise to
things like memory problems, communication problems, etc.
o There is no single positive test for dementia at this time
o Dementia is currently diagnosed by a process of eliminating everything else it could
possibly be
o Diagnosis at an earlier stage gives you the opportunity to plan i.e. Financial planning
o Everyone’s experience with dementia is different – the kind of support the patient needs,
depends on the patient
o Dementia places a great deal of burden on the caregiver
Slide 5 The Canadian Study of Health and Aging
- 1. Prevalence of Alzheimers and other forms of dementia is 8%
- 2. Confirmed risk factors for Alzheimers were a family history of Alzheimers, head trauma, and
lower education
o There is a certain genotype that if you have, you will have a greater risk of developing
Alzheimer’s Disease – but if you have the gene, it doesn’t mean you will get the disorder
o Head trauma and lower education is predictive/puts people at risk for Alzheimer’s
o Cognitive reserve hypothesis as we age, our brain is a gas tank filled with knowledge,
the more knowledge you have, the more sophisticated your brain circuitry is, and the
further you can go with the cognitive functioning that you have before the deficits result
in some disability

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o If you age and do not keep your brain active, you don’t have a far way to fall when it
comes to Alzheimer’s disease, making you disabled quicker
o Physical exercise is effective in keeping people functioning cognitively longer
o If you are involved in mental and physical exercise, this can result in a 10% reduction in
probability of delaying the onset of something like Alzheimer’s
- 3. ½ of Canadians with dementia are institutionalized
- 4. There are over 60,000 new cases of dementia per year
Slide 6 Alzheimer’s Disease
- Research suggests that 50% of people with dementia suffer from Alzheimer’s
o 1/13 Canadians over 65 have Alzheimer’s
- Characteristics
o Disease usually begins after 65-years of age
each year you get older, the higher your chance of getting it
o Slowly progressive
o Early onset that is more progressive than the late-onset that develops after 65.
if you have the risk gene, onset is typically before 65, and if the onset is before
65, the course is usually more progressive and the patient will die even quicker
o Death after 8-10 years of its diagnosis, usually as the result of physical decline or
independent diseases common in old age, such as heart disease
o Most common type (55-80% of all dementias)
o Women tend to outlive men when they get it
o In a brief confrontation, it’s almost difficult to tell that someone has Alzheimer’s
o In the earlier stages, people can look and can be very functional
o Video
Degenerative becomes worse over time
Usually in people over 65, fatal, body ceases to function
First sign is memory loss, followed by personality changes, loss of control of
bodily functions
Changes gradually happen
Increasing dependence on others
In the late stage, people require around the clock care can no longer
communicate, are unable to move around unassisted
As Alzheimer’s runs its course, the body slowly shuts down
Medications can sometimes help patients maintain cognitive functions for a
longer period of time
- Neuropathology
- Neuropsychological progression
o Memory, naming, visual-spatial disorder (executive skills are somewhat normal early)
- Neuroimaging
Slide 8 Neuropathology
- Neuropathology of Alzheimer’s disease is characterized by something called plaques and tangles,
which is something that we all have
- Neuropathological abnormalities in DAT was first described by Alois Alzheimer in 1906.
- He observed memory loss and disorientation in a 51-year old female patient.
- Following her death at age 55, an autopsy revealed that filaments within nerve cells in her brain
were twisted and tangled (called neurofibrillary tangles)
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