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Lecture 10

PSYB32-Lecture 10.docx

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Konstantine Zakzanis

PSYB32- Lecture 10 Aging and Psychological Disorders  Dementia- progressive; gradual deterioration of intellectual and cognitive functions, as well as behavioural functions; does not get better, gets worse over time; have to demonstrate that there is an impairment over time and not just one examination o Slowly progressive- when the cognitive, intellectual, and behavioural impairments slowly get worse over time; continuous deterioration; 8-10 years from first diagnosis to ultimately death o Step wise deterioration- when the person will be functioning at a certain level, and dramatically drop literally within an hour or days because something might have happened; then they will function at that level until something happens, and they will drop, and this continues (step wise) o In order to meet diagnostic criteria, the impairment must result in some sort of social or occupational disability; as the dementia goes on, this will become incredibly obvious and will have an impairment even when it comes to self-care; mild cognitive impairment (MCI)- when an elderly individual will not only exhibit the cognitive compromise that comes with aging but a single cognitive impairment that is mild in nature, typically memory but it does not impair them in terms of their social and occupational functioning o Each dementia syndrome has a unique neuropsychological signature; a dementia syndrome cannot be diagnosed definitively while the person is alive, so we never know for sure what the person has; neuropsychological testing is the most sensitive to differentiating between dementia syndromes; in other words, the type of pattern of deficits they display and in what order they deteriorate in are unique to the different dementias we will discuss; in frontal lobe dementia one of the first signs are executive deficits or behavioural problems o A diagnosis of dementia is clinical; not until autopsy that we can definitively diagnose someone with one of the dementia syndromes o Dementia is a diagnosis made by ruling out things  Alzheimer’s Disease o Accounts for about half the patients that are diagnosed with dementia o At the present time there are 26.6 million persons worldwide diagnosed with dementia which is probably a gross underestimate; by 2050, this number is expected to go to 106 million people (tsunami of persons that are going to require care in their elder years) o Some other early signs are people who will ask the same question over and over again, naming problems (stutter a bit), usually begins at the age of 65; the older you get the more likely it is that you will get Alzheimer’s Disease; women tend to live longer with the disease, women are also more likely to die from Alzheimer’s Disease; men are more likely to have comorbid conditions that can kill them, often a vascular component to their disease (stroke, heart attack); disease is slowly progressive, and not step wise o When a person is diagnosed with Alzheimer’s Disease, they are labelled as possible Alzheimer’s Disease when their signs and symptoms look like it is AD; then their diagnosis is changed to probable AD when the doctor has seen the patient a couple times over time; confirmed AD does not happen until autopsy o Alzheimer’s Disease also has an early onset form, and when typically diagnosed it is far more progressive (go from early stages to late stages in about half of the time); error in the textbook is about the genetic risk factors of AD and a specific gene called the E4 allele and that being a risk factor for late onset AD which is untrue, it is actually a risk factor for early onset of AD; if you carry one of those genes, your chances of getting AD is increased by 40%, and if you have two of those genes it is almost certain at 90% prevalence; not a biomarker because not everybody who has an E4 gene will get AD, and not every patient with AD does not have E4 gene in their genetic makeup o Not the disease itself that kills a person but usually a complication of being bed ridden, unable to care for oneself, and all of the illnesses that can strike an individual when they are stuck and tied to a bed (pneumonia, heart disease) o The fact that Alzheimer’s Disease is the most common form of dementia could change over time; hallucinations are typically not part of the illness, but medicinal side effect if they are on something; if hallucinations are present, then they will typically be diagnosed with Lewy body Dementia that has only been known for the past decade or so o Neuropathology  Atrophy is when the brain basically wastes away  In Alzheimer’s Disease, the sulci become enlarged particularly in the temporal lobes causing problems with memory (hippocampus); atrophy moves to the medial temporal lobes, parietal lobes (disorientation), and then the posterior part of the frontal lobes (speaking); described by Aloid Alzheimer in 1906; at autopsy  You count the number of tangles and plaques in a particular part of the brain because it is not a matter of whether or not they present but how many are present  Risk factors associated with the development of AD are head injuries and depression, and the third is cognitive reserve which is the notion that high education levels delay the clinical expression of dementia because the brain develops backup or reserve neural structures as a form of neuroplasticity  Also means that there is more interconnectivity with respect to your neural communication/ you have more gas in your tank/ use it or lose it; based on the facts that someone who is cognitively active it helps preserve their cognitive functioning, and cognitive activity aids with our crystalized intelligence (vocabulary, semantic knowledge) but not so much with our fluid intelligence (novel problem solving)  Persons with head injury and depression may lack the motivation to learn; physical activity works in the same way as cognitive activity to preserve the reserve o Neuroimaging DAT  Temporal-parietal hypometabolism meaning lowered blood flow; the fact that we can see this helps us a little bit in terms of where the pathology is but does not help us a lot because by the time a patient’s brain looks like this in a neuroimaging scan, they are pretty impaired; by the time these neurobiological things show up on neuroimaging, it is already pretty late in the course of the disorder; this is important to diagnose these disorders as early as possible because there are some pharmalogical mechanisms that can be used to slow the progression of the disorder down; o Neuropsychology of DAT  Sensitive to the early stages of dementia; neuropsychological signature of somebody with an early stages of AD are memory, naming, visualspatial impairments  Explicit memory impaired because of inability to consolidate (hippocampus)  Working memory relatively intact  Procedural memory relatively intact- when we don’t have to consciously retrieve something, things we have done throughout our lives  Retrieval impaired- can’t consolidate, so they are unable to retrieve something  Recognition impaired- cannot recognize familiar people including themselves o Naming is one of the early signs of AD; patient is asked to look at a common object and name it- circumlocution is when the patient describes the object because they are unable to name the object; it is not a memory problem but a word finding problem; a little bit later on in the disease they will have a phonemic paraphasia not as commo
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