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Lecture 10

Abnormal Psychology Lecture 10.docx

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Konstantine Zakzanis

Abnormal Psychology: Lecture 10 Old Age and Brain Disorders  Dementia o Gradual deterioration of intellectual and cognitive abilities that is not irreversible  If someone had a brain injury it is not dementia because things stay table or they go back to normal but with dementia is gets worse o Deterioration can happen: Step wise vs. slowly progressive  Slowly progressive occurs over years with no dramatic change  Step wise deterioration will have some functioning problem and then after an event they will get worse, etc, etc. o Impairment in social and occupational (activities in daily living such as cooking if they have forgetfulness since most patients are older and don’t hold jobs) functioning o Each dementia syndrome has a unique neuropsychological signature (that is cognitive deficits) in early stages but once it develops it is difficult to differentiate between the various dementias.  Differentiating is good because it allows for more accurate treatment  Earlier treatment has a better chance of slowing the progression down; never reversible o A diagnosis of dementia is clinical- never 100% sure that the person has the disorder due to the lack of markers thus the diagnosis is a guess (90%+ accurate). o Only at autopsy can it be definitive  Canadian Study of Health and Aging o There was a prevalent study in Canada that demonstrate 8% or 26.6 million people have dementia disorder but by 2050 there will be 106 million people with the disorder o Risk factor of Alzheimer’s  Family history- specific genotype that exists and increases your chance of getting the disorder  Head trauma  Lower education  Cognitive reserve hypothesis- Those who exercise cognitive abilities and gain more knowledge (neuro connections) and have a more sophisticated brain have a higher cognitive reserve (you can go further cognitively) before deficits give you a disability  Recent research shows the physical exercise keeps people cognitive stronger for longer as well o ½ of Canadians with dementia are institutionalized  Alzheimer’s o 50% of person with dementia suffer from Alzheimer’s o 1/13 people o Disease usually begins after 65 years of age o Slowly progressive o Early onset (before 65) that is more progressive thus more deficits and earlier death than the late onset that develops after 65 is less severe o Death after 8-10 years of its diagnosis usually as the result of the physical decline or independent diseases common in old age such as heart disease o Women outlive men in this disorder o Can last 3-20 years but usually 7-8 o Stages  First stage- forgetting names, places and people  Second stage- confusion, disoriented with time and place and poor judgment o Neuropathology  Shrinking Brain also known as deterioration-especially in temporal front lobe  Diagnosis at autopsy depends on how many plaques and tangles are found in brain. Typically accumulate in parts of brain that are most oxygen rich and demanding such as the hippocampus, which creates memories.  Thus the first stage is memory disorder or the inability to learn new information, but they do remember their old memories  As disease progress, the plaques reach the temporal lobes and then the parietal and frontal lobes. Leading to visual/spatial problems so they get lost and are disoriented o Neuroimaging DAT  DAT cannot be definitely diagnosed until the patient has died and a brain autopsy is performed  Advanced in neuroimaging techniques promise the potential of diagnosing DAT in live patients  Neuropsycholigical examination is more accurate than just imaging o Neuropsychology of DAT  Signature of DAT-Memory, Naming. Visualpatial impairments  Explicit memory impaired because of inability to consolidate- in early stages they do have a working memory  Working memory relatively intact  Procedural memory relatively intact  Retrieval impaired  Recognition impaired  Eg. CVLT  Naming with paraphasic errors  Semantic paraphasis are common- trying to name something, they will give you something semantically related. That is for harmonica, they may say trumpet or trombone. Shows temporal lobe impairment  Phonemic paraphasias are not as common until later stages so they will change their letters thus a harmonica
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