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PSYB32 Lec 10 Nov 27 2012.docx

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Konstantine Zakzanis

Aging and Psychological Disorders Tuesday, November 27, 2012 10:45 PM  Old Age and Brain Disorders  Dementia:  Not reversible  Gets worse over time  Cannot get dementia due to a traumatic brain injury  Can happen slowly progressive - no dramatic change over night, happens over course of years  Step wise deterioration - the person may have some cognitive problems, then some sort of event will happen and they will get worse, then they will stay at that level for a while, then something will happen and they get worse, etc.  To be diagnosed with dementia - has to impact social and occupational functioning or activities of daily living  Most are retired or not working  Can't leave them to cook, can't let them manage their finances  Each dementia syndrome - unique constellations of cognitive deficits particularly in the early stages  As disorder evolves - tend to appear globally demented  While treatment options may be quite limited, it allows us to conduct some research into treatment options for specific dementias - important to be able to recognize them early on - possibly can slow the progression  Early intervention is important  A diagnosis of dementia is always clinical - can never be 100% certain that the person has Alzheimer's  Don't have a marker - diagnosis is a probable guess  Can never definitive until autopsy when we can look at the brain  8% of population have a dementia disorder  Suppose to increase greatly in near future  Risk factors:  Family history of Alzheimer's - specific genotype that increases the likelihood of getting the disorder but doesn’t mean you will definitely get it  Head trauma  Lower education  Cognitive Reserve hypothesis - as we age, the more knowledge / neural connections you have, the more sophisticated your brain, the more likely you can go further with the cognitive functioning you have before the deficits of the disorder results in disability  If you age and don't keep your brain active, you don't have a far way to fall when it comes to Alzheimer's making you disabled quicker.  Research shows that physical exercise is just as effective as cognitive exercise  Some research shows that if you are engaged in mental and physical exercise this can results in a 10% reduction in the probability of developing such disorders Alzheimer's Disease  About 50% of people with dementia suffer from Alzheimer's  About 1 in 13 Canadians over the age of 65  Death typically occurs within 10 to 12 years of symptom onset  Most don’t get in front of doctor until 2 or 3 years into the disease  Other disorders person is susceptible to may cause death rather than Alzheimer's causing death  Women tend to outlive men when they get the disorder  Usually develops after 65  Slowly progressive (no stepwise)  If you have the risk gene, onset is typically before the age of 65  If before the age of 65, course is usually more progressive.  In the early course of the disorder, its almost difficult to tell on a brief conversation that the person has this disease, often are unaware of their cognitive impairments, unawareness becomes more severe  Neuropathology:  Brain - enlarged ventricles, shrinking brain, atrophy (wasting away of brain cells) in the temporal lobes/posterior frontal lobes  Characterized by plaques and tangles (read in text)  Plaques and tangles - we all have them. Difference is the number of plaques and tangles. Diagnosis at autopsy depends on number and location of these plaques and tangles. Typically accumulate in areas of brain most oxygen demanding such as the hippocampus (memory, consolidation of information)  As disease progresses, plaques and tangles hit temporal lobes then frontal lobes  Cognitive impairments - visuo spatial problems (they get lost easily), language (difficulties finding words and understanding others)  What happens over time is the brain begins to shrink  The more it shrinks, the more profound the cognitive impairment.  Neuroimaging:  SPECT image - left is normal brain. Right is Alzheimer's patient - less blood flow and oxygen levels - less activity  Hippocampal atrophy (bottom is Alzheimer brain)  Problem with neuroimaging - not markers - not every patient with Alzheimer's will look dramatically different from controls  Neuropsychological evaluations have been shown to be most sensitive to the disorder - most correct for making diagnosis  Working memory is in tact - can hold and store enough information in the early stages that you may think there's nothing wrong with their memory  Can't remember the words you ask them to remember - ten mins later (can repeat but not consolidate)  Recognition format - wouldn't remember either  Can’t learn, retrieve or recognize  Word finding difficulties - circumlocutions - tend to try and describe what we're trying to sa
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