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Lecture 10

PSYB32 - Lecture 10.docx

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Mark Schmuckler

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 Alzheimer’s and other forms of dementia is 8% - 2. Confirmed risk factors for Alzheimer’s were a family history of Alzheimer’s, 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 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) - Also seen were plaques. These are deposits of a class of protein called amyloid that accumulate in the spaces between cells of the cerebral cortex, hippocampus, and other areas of the brain structures critical to memory Slide 9 – Neurofibrillary Tangles and Plaques - The difference is the number of plaques and tangles - Alzheimer’s can only be diagnosed at autopsy – that autopsy is dependent on how many plaques and tangles are found in specific parts of the brain - Plaques and tangles typically accumulate in parts of the brain that are the most oxygen rich - Hippocampus – responsible for consolidation of information that we are trying to learn, if this is the site where plaques and tangles start, early signs of the illness might be memory disorder, or the inability to learn new information - As the disease progresses, these plaques and tangles start to fill the temporal lobes and then they reach the parietal and frontal lobes at the same time o In the temporal lobes – when the plaques and tangles start to fill it; patients will have difficulty understanding others because our language centres are located here Slide 10 – DAT Post Mortem - Over time, the brain begins to shrink - The more the brain shrinks, the more profound the cognitive impairment, which will start to affect every bit of cognitive functioning Slide 11 – Neuroimaging DAT - DAT cannot be definitively diagnosed until the patient had died and a brain autopsy is performed. - Advances in neuroimaging techniques (PET, MRI, CT, SPECT) promise the potential of diagnosing DAT in live patients Slide 11 – Alzheimer’s disease in-vivo - SPECT imaging o in left image – less yellow indicates less activity in the brain - Temporal-parietal hypometabolism - Hippocampal atrophy o We can’t use neuroimaging as a marker yet o Which is why diagnosis is only clinical, and can only be diagnosed at autopsy Slide 14 – Neuropsychology of DAT - Because it is cognitive impairment that disables the person and not the size of their hippocampus per se, neuropsychological evaluations have been shown to be the most sensitive to the disorder - Neuropsychological signature of DAT - Characteristic signature includes: Memory, Naming, Visual-spatial impairments - Explicit memory impaired because of inability to consolidate - Working memory relatively intact in Alzheimer’s patients early on o Can hold and store memory o But can’t remember after 10 minutes or so because their hippocampus was not able to consolidate the information because its function is impaired o Circumlocution – when we can’t find the word we want to say so we try to describe it  Alzheimer’s patients do this a lot o Paraphasic errors – 2 types – semantic – will give you a semantically related word, but not the word they are trying to find  These errors are typically predictive of temporal lobe impairment - Procedural memory relatively intact - Retrieval impaired - Recognition impaired - E.g., CVLT Slide 16 – Naming - Paraphasic errors o Semantic o Phonemic – not as common until later stages, will change the first few phonemes of the word they are trying to find  Specific to frontal lobe impairment  This is not a memory problem because they are able to remember what the object is called, but they just have difficulty finding the word - Semantic paraphasias are common, phonemic are not… - Naming impairments early, circumlocutions common as we
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