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Lecture 1

PSCH 270 Lecture 1: Neurocog Disorders/Late Life ~ In Class Notes

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PSCH 270
Donald Tyler

Neurocognitive Disorders in Late Life ● Most elderly do not have cognitive disorders ○ Prevalence has decreased over last 15 years ■ Possibly bcuz of improvement in diet, medical care, and education ● Dementia ○ The deterioration of cognitive abilities to the point of impaired functioning. ● Delirium ○ A state of mental confusion involving disturbance in attention and awareness. ○ Usually caused by some type of medical condition. Dementia ● Deterioration of cognitive abilities ○ Resulting in impaired social and occupational functioning ○ Progresses over time ■ Often begins with difficulty remembering recent events ○ Deficits can be detected before impairment becomes obvious ● Two DSM-5 Categories: ○ Differentiated by severity of decline/impairment & ability to live independently ■ Mild Neurocognitive Disorder (Mild Cognitive Impairment) ■ Major Neurocognitive Disorder (Dementia) ● When referring to MND, must specify what disorder is due to. ○ Ex: Neurocognitive Disorder associated with Alz Dis Alzheimer’s Disease ● Irreversible brain tissue deterioration ○ Death usually occurs within 12 years ● Common symptoms ○ Memory loss [MOST COMMON SYMPTOM] ■ Usually begins with difficulty remembering recent events and learning new material ○ Apathy is common even before other symptoms are noticeable ● As the disease progresses, ○ Language problems intensify, including word-finding ○ Decline in visual-spatial abilities ■ Leads to disorientation: confusion regarding time, place, and identity. ○ Agitation ○ Depression ■ Full blown in one-third of the people with the disease Brain Changes in Alzheimer’s Disease ● Plaques ○ Beta-amyloid protein deposits outside of neurons ○ Most dense in the frontal cortex ● NEurofibrillary Tangles ○ Protein filaments composed primarily of tau in axons of … ● Loss of synapses for acetylcholinergic (Ach) and glutaminergic neurons ○ As neurons die, the entorhinal cortex, hippocampus, and other areas of cerebral cortex shrink ○ Later the frontal, temporal, & parietal lobes shrink and vesicles enlarge Genetic Factors ● 79% Heritiablity ○ Means 79% of cause is due to genes and other 21% due to env ● ApoE-4 Allele: Polymorphism of a gene on chromosome 19 ○ Having one ApoE-4 allele increases risk by 20% ○ Having two increases risk SUBSTANTIALLY higher ■ Allele responsible for: ● Overproduction of plaques ● Loss of neurons in hippocampus ● Low glucose metabolism in cerebral cortex Lifestyle Factors that INCREASE Risk ● Smoking ● Being single ● Low social support ● Obesity ● Depression ○ Bidirectional effects (which comes first??????) Lifestyle Factors that DECREASE Risk ● Mediterranean Diet ● Exercise ● Education ● Engagement in cognitive activities ○ E.g. solving crossword puzzles, reading the newspaper daily ○ Cognitive reverse!! ■ Use of alternative brain networks to compensate for disease Frontotemporal Dementia ● Loss of neurons in frontal and temporal lobes ○ Memory is NOT severely disrupted ■ In contrast with Alz ● Impairment in executive functions ○ Planning, problem solving, goal-directed behavior ○ Ability to inhibit behavior ■ Suddenly may overeat, chain smoke, and/or drink alcohol excessively. ● Difficulty recognizing and regulating emotion ○ Impairment in empathy and social awareness ■ Leading to violation of social nor
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