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Chapter 16

PSYB32H3 Chapter Notes - Chapter 16: Geriatric Depression Scale, Neurofibrillary Tangle, Suicidal Ideation

Course Code
Konstantine Zakzanis

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Chapter 16 Aging and Psychological Disorders
- researchers often assess cognitive functioning with the Mini-Mental State Examination (MMSE) in its original or
modified form (i.e., the Modified Mini-Mental State Exam)
- the MMSE is a brief measure of an individuals cognitive state, assessingorientation, memory, and attention,..
ability to name, follow verbal and written commands, write a sentence spontaneously, and copy a complex polygon
- one well-known measure crafted for the elderly is the Geriatric Depression Scale (GDS), a true-false self-report
- the GDS has acceptable psychometric characteristics and is regarded as the standard measure for assessing
depression in the elderly
- the Geriatric Suicide Ideation Scale (GSIS) is a new 31 item measure that is the 1st measure of suicide ideation
created specifically for the elderly; the GSIS has a 10-item suicide ideation scale, as well as 3 other subscales
tapping death ideation, loss of personal and social work, and the perceived meaning in life
Old Age and Brain Disorders
dementia deterioration of mental faculties memory, judgments, abstract thought, control of impulses,
intellectual ability that impairs social and occupational functioning and eventually changes the personality
- dementia what laypeople called senility
Causes of Dementia
- dementias are typically classified into 3 types
- Alzheimers disease is the most common; then there are the frontal-temporal and frontal-subcortical dementias,
which are defined by the areas of the brain that are most affected
plaques small, round areas composed of remnants of lost neurons and beta-amyloid, a waxy
protein deposit; present in the brains of patients with Alzheimers disease
neurofibrillary tangles tangled abnormal protein filaments present in the cell bodies of brain
cells in patients with Alzheimers disease
- these plaques and tangles are present throughout the cerebral cortex and the hippocampus
- although neural pathways using other transmitters deteriorate in Alzheimers, those using ACh
are of particular importance; evidence suggests that anticholinergic drugs (those that reduce
ACh) can produce memory impairments in normal people similar to those found in Alzheimers
- a gene controlling the protein responsible for the formation of b-amyloid was found on the long
arm of chromosome 21, and studies have demonstrated that this gene causes the development
of about 5% of cases of early onset Alzheimers; dominant genes causing the disease have also
been found on chromosomes 1 and 13
- the majority of late-onset cases of Alzheimers disease exhibit a particular form of a gene (called
the apolipoprotein E 4 allele) on chromosome 19
- the E 4 allele appears to be related to the development of both plaques and tangles, and it
seems to increase the likelihood that the brain will incur damage from free radicals (unstable
molecules derives from oxygen that attack proteins and DNA)
- finally, the environment is likely to play a role in most cases of Alzheimers, as demonstrated by
reports of long-lived MZ twins whoa re discordant for the disorder
- non-steroidal anti-imflammatory drugs such as aspirin appear to reduce the risk of Alzheimers
disease, as does nicotine
- the cognitive reserve hypothesis 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
- research indicates that being bilingual protects against the negative affects of aging on cognitive
Frontal-Temporal Dementias
- this type accounts for 10-15% of cases
- typically begins in a persons late 50s
- these dementias are marked by extreme behavioral and personality changes
- serotonin neurons are most affected, and there is widespread loss of neurons in the frontal and

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temporal lobes
- Picks disease is one cause of frontal-temporal dementia; like Alzheimers disease, Picks
disease is a degenerative disorder in which neurons are lost; it is also characterized by the
presence of Pick bodies, spherical inclusions within neurons
- frontal-temporal dementias have a strong genetic component
Frontal-Subcortical Dementia
- because these dementias affect subcortical brain areas, which are involved in the control of
motor movements, both cognition and motor activity are affected
- types of frontal-subcortical dementias include:
Huntingtons chorea (jerky movements) is caused by a single dominant gene located
on chromosome 4 and is diagnosed principally by neurologists on the basis of genetic
testing; its major behavioral feature is the presence of writhing (twisting movements)
(choreiform) movements
Parkinsons disease is marked by muscle tremors, muscular rigidity, and akinesia
(an inability to initiate movement) and can lead to dementia
Vascular dementia is the 2nd most common type, next to Alzheimers disease; its
diagnosed when a patient with dementia has neurological signs, such as weakness in an
arm or abnormal reflexes, or when brain scans show evidence of cerebrovascular
disease; genetic factors appear to be of no importance
Other Causes of Dementia
- encephalitis, a genetic term for any inflammation of brain tissue, is caused by viruses that enter
the brain either from other parts of the body (such as the sinuses or ears) or from the bites of
mosquitoes or ticks
- meningitis, an inflammation of the membranes covering the outer brain, is usually caused by a
bacterial infection
- the organism that produces the venereal disease sylphilis (Treponema pallidum) can invade the
brain and cause dementia
- finally, head traumas, brain tumors, nutritional deficiencies (especially of B-complex vitamins),
kidney or liver failure, and endocrine gland problems such as hyperthyroidism can result in
- exposure to toxins, such as lead or mercury, as well as chronic use of drugs including alcohol,
are additional causes
Canadian Perspective 16.1 The Canadian Study of Health and Aging
- the Canadian Study of Health and Aging have a huge project with elderly people and they have 4 main goals:
1. to use a common research protocol to estimate the prevalence of dementia in Canadians aged
65 or older
2. to identify risk factors associated with Alzheimers disease
3. to examine patterns of caring for Canadians with dementia
4. to develop a uniform database for subsequent longitudinal investigations
Focus on Discovery 16.1 The Nun Study: Unlocking the Secrets of Alzheimers?
- low linguistic ability was found in 90% of those who developed Alzheimers disease and in only 13% of those who
- supplementary analyses continue to show that high levels of linguistic ability predict less cognitive impairment
and fewer neuropathological indicators of Alzheimers disease
- nuns who expressed more positive emotions lived longer, and nuns who eventually succumbed to Alzheimers
disease gradually expressed fewer positive emotions prior to the diseases onset
Treatment of Dementia
- no clinically significant treatment has been found that can halt or reverse Alzheimers disease, although some
drugs show promise in effecting modest improvement in certain cognitive functions for a short period of time

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Biological Treatments of Alzheimers disease
- because Alzheimers disease involves the death of brain cells that secrete ACh, various studies
have attempted to increase the levels of ACh
- Donepezil (Aricept), which inhibits the enzyme that breaks down ACh, is similar to tacrine in its
method of action and results but produces fewer side effects
- findings also indicate that antioxidants, such as vitamin E, may be useful in slowing the
progression of the disease
Psychological Treatments for Patients and their Families
- the general psychological approach is supportive
- the overall goal is to minimize the disruption caused by the patients behavioral changes
- in contrast to approaches taken with other psychological problems, it may be desirable not to
make an effort to get patients to admit to their problems, for denial may be the best coping
mechanism available
- caring for a person with Alzheimers disease has been shown to be extremely stressful and
distressing; analyses indicate that depression is twice as evident among caregivers as among
non-caregivers; depression n feelings of being burdened are highly correlated among caregivers
- caregivers are also more likely than non-caregivers to experience chronic health problems
- caregivers of patients with dementia can also benefit from participating in psychoeducation
- a study found that there was substantial effectiveness for skill training programswith 3
elements: behavior management, depression management, and anger management
- another study showed that levels of functioning were much higher in caregivers of relatives with
dementia if the caregivers were relatively high in optimism
- perhaps the most wrenching decision for caregivers is whether to institutionalize the person with
dementia; a qualitative study of caregivers suggested that feelings of guilt among caregivers are
intense when a person much be institutionalized, but their most prominent emotion is worry
- a review concluded that the 3 best predictors of institutionalization are the elderly persons level
of aggression, incontinence, and the presence of psychiatric disturbances
delirium a state of great mental confusion in which consciousness is clouded, attention cannot be sustained, and
the stream of thought and speech is incoherent; the person is probably disoriented, emotionally erratic, restless, or
lethargic, and often has illusions, delusions, and hallucinations
- the term delirium is derived from the Latin wordsde meaningfrom orout of” and lira meaning “furrow or
track; the term implies being off track or deviating from the usual state
- delirium is typically described as a clouded state of consciousness; the patient, sometimes rather suddenly, has
great trouble concentrating and focusing attention and cannot maintain a coherent and directed stream of thought
- in the early stages, the person with delirium is frequently restless, particularly at night; the sleep-waking cycle
becomes disturbed, so that the person is drowsy during the day and awake, restless, and agitate during the night
- delirious patients may be impossible to engage in conversation because of their wandering attention and
fragmented thinking; also, perceptual disturbances are frequent
- memory impairment, especially for recent events, is common; in the course of 24h hours, however, delirious people
have lucid intervals and become alert and coherent; these daily fluctuations help distinguish delirium from other
syndromes, especially Alzheimers disease
- swings in activity and mood accompany disordered thoughts and perceptions; they are in great emotional turmoil
and may shift rapidly from one emotion to another
- although delirium is one of the most frequent biological mental disorders in older adults, it has been neglected in
research, and like dementia, is often misdiagnosed
- data suggests that delirium is very uncommon among people living in their usual place of residence with
prevalence of less than 0.5%
- people of any age are subject to delirium, but it is more common in children and older adults, especially
hospitalized older adults, with perhaps up to one quarter of older adults inpatients experiencing delirium at some
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