PS271 Lecture Notes - Immunosuppression, Fluid And Crystallized Intelligence, Heritability

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1 Feb 2013
signs of aging in women are not valued in society
ageism discrimination against any person based on chronological age
the Canadian CLSA has provided a wealth of basic info about healthy aging, health care use,
& risk factors for diseases and disabilities. It’s goal includes preventive intervention & cost-
efficient treatments
the “Big Boom” impact that baby boomers of Canada will have on country’s health
system as they move into their senior years in less than a decade
family physicians of Ontario feel less prepared to identify older patients with psychological
problems than younger patients
physicians are much less likely to refer older patient for treatment, & psychotherapy is less
effective for older patients
three groups of ppl older than 65 yrs of age:
1. young-old group 65-74
2. old-old group 75-84
3. oldest-old group 85+
ppl tend to become less alike as they grow older
three kinds of effects are important to define in any age related discussion:
1. age effect consequences of being a given chronological age
2. cohort effect consequence of being born in a given year & having grown up
during particular time period with its own unique pressures; a cohort effect exists if these
ppl have some factors that distinguishes them from those who turned 65 or older at an
earlier age
3. time-of-management confounds that arise coz events at an exact point in time
can have specific effect on variable being studied over time; ex: assessing post-traumatic
stress disorder in Holocaust survivors
cross-sectional studies compares different age groups at same moment in time on variable
of interest; allow us to make statements only about age effect
longitudinal studies periodically retest a selected cohort using the same measure over
number of years; allow us to make statements only about cohort effect
conclusions drawn from longitudinal studies are restricted to cohort chosen
another problem with longitudinal studies is that participants often drop out as studies
proceed creating a bias known as selective mortality the least-able people are most likely to
drop out leaving a nonrepresentative group thus overly optimistic stats
the DSM-IV criteria for older adults are basically same as those for younger adults
accurate assessment of elderly people for purposes of establishing diagnoses & conducting
research requires assessment measures tailored to elderly people
the Modified Mini-Mental State Exam (MMSE) is a brief measure of an ind cognitive state
assessing orientation, memory, attention, ability to name, follow verbal & written commands,
write sentence spontaneously, & copy a complex polygon
a Clock Test is a simple measure to detect Alzheimer and dementia it is reliable & valid
though results vary depending on scoring system used
the Geriatric Depression Scale (GDS) is true-false self-report designed to assess depression
& suicide possibilities in elderly
the elderly people with mental disorder suffer “double jeopardy” since they suffer the
stigmas associated with being old and being mentally ill
older adults who belong to groups that provide strong and meaningful roles for them seem to
have an easier time adjusting to growing old
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maladaptive personality trait & inadequate coping skills that person brings into old age plays
a role in any psychological disorder
persons over age 65 have lowest overall rates of mental disorder of all age groups
cognitive impairment is the primary problem which underlies many others (i.e. depression)
majority of 65 yrs and older are actually free from serious pychopathology 10-20% are
it is gradual deterioration of intellectual abilities to the point that social & occupational
functions are impaired
difficulty remembering things, especially recent events, is most prominent symptom
patients may leave tasks unfinished, not remember their children’s names, stay unhygienic,
may wander off and get lost even in familiar settings, poor judgment, impulsive, coarse
language, inappropriate jokes, shoplift, depressed, flat affect, & sporadic emotional outbursts
have language disturbances, vague pattern of speech, although the motor system is intact they
may have difficulty carrying out motor activities (brushing teeth, or dressing)
episodes delirium (a state of great mental confusion) may also occur
is progressive, static or remitting, depending on the cause
prevalence increases with advancing age (same goes for Alzheimer’s disease)
dementias are classified into 3 types Alzheimer’s disease, frontal-temporal, & frontal-
subcortical dementias
Alzheimer’s Disease
it accounts for 50% of dementias in older people
we are facing “looming global epidemic”
promoting mental & physical exercise would result in 10% reduction in
brain tissue deteriorates irreversibly
women with Alzheimer live longer than men but more women than men
die due to it
patients blame others for personal failings & may have delusions of being
patients are wholly unaware of the extent of their memory decline
main physiological change in brain is an atrophy of cerebral cortex,
entorhinal cortex, hippocampus, frontal & temporal & parietal lobes
have enlarged ventricles
plaques (small round remnants of lost neuron & b-amyloid) &
neurofibrillary tangles
hippocampus & medial temporal lobes has reduced volume
cerebellum, spinal cord, & motor & sensory areas of cortex are less
about 25% of patients also have brain deterioration similar to that of
Parkinson’ disease
anticholinergic drugs (those that reduce Ach) can produce memory
have fewer Ach terminals in the brain & levels of acetycholine is also low
has genetic basis
among early-onset (before age 60) cases, which account for 5% of cases,
the inheritance pattern suggests the operation of single dominant gene
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