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Chapter 16

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 16: Aging and psychological disorders - Subjective age bias: people feeling younger than they actually are (the presence of negative aging stereotypes account for this, younger subjective age is linked with greater life satisfaction and other positive outcomes - Ageism: discrimination against any person, young or old, based on chronological age The Canadian Coalition for seniors’ Mental Health focus on the following issues among older adults: Delirium Depression Suicide prevention Mental health issues ISSUES, CONCEPTS, AND METHODS IN THE STUDY OF OLDER ADULTS - People tend to become less alike as they grow older - 3 kinds of aging effects: Age effects- consequences of being a given chronological age (Jewish boys are bar mitzvahed at age 13) Cohort effects- consequences of having been born in a given year and having grown up during a particular time period with its own unique pressures, challenges, and opportunities (in the 1900’s stock markets were seen as safe, in the 1960’s people lost a lot of money) Time-management effects- consequences of the effects that particular factor can have at a particular time period (people responding in the 1900’s surveys about their sexual behaviour were more likely to be frank than people responding to the same questions in the 1950’s since public 2 major research designs used to assess developmental change:  Cross-sectional studies- investigator compares different age groups at the same moment in time on the variable of interest (don’t examine the same people over time)  since they do not examine the same people over time, they allow us to make statements only about age effects in a particular study, and not about age changes over time  Longitudinal studies- researcher selects 1 cohort (graduating class of 2002), and periodically retests it using the same measure over a number of years since each cohort is unique, conclusions from longitudinal studies are restricted to the cohort chosen Selective mortality: a bias created when participants drop out as the studies proceed  generally, least able people are most likely to drop out, leaving a non-representative people who are healthier than the general population – may be highly optimistic Diagnosing and Assessing Psychopathology in later life: - DSM-IV criteria for older adults are the same as younger adults - accurate assessment of elderly people for purposes of diagnosis and research should be tailored to elderly people - must determine whether the elderly respondent has experienced declines in cognitive functioning – can perform the mini-mental state examination A relatively simple measure used to detect dementia and Alzheimer’s disease is the clock drawing subtest of the Clock Test -since elderly people have diminished attention spans, one goal is to develop short but reliable measures for screening, that are tailored directly to concerns and symptoms of elderly One well-known measure crafted for the elderly is the Geriatric Depression Scale, a true-false self- report measure OLD AGE AND BRAIN DISORDERS 2 principle types of brain disorders: Dementia- gradual deterioration of intellectual abilities to the point that social and occupational functions are impaired  Difficulty remembering things, especially recent events (most prominent symptom)  May leave tasks unfinished because they forgot to return to it after an interruption  Unable to remember the name of a son or daughter  Hygiene may be poor and appearance is sloppy because the person forgets to bathe or how to dress  Get lost in familiar settings  Trouble naming common objects  Judgments may become faulty, have difficulty comprehending situations and making plans or decisions  Lose control of their impulses (use coarse language, tell inappropriate jokes, or shoplift)  Likely to show language disturbances (vague patterns of speech)  Difficulty carrying out motor activities (brushing teeth or getting dressed)  Paraphrenia: schizophrenia with its onset during old age  Course of dementia may be progressive, static or remitting  Many with progressive dementia eventually become withdrawn and aphethic – in terminal phase, personality loses its integrity  Prevalence of dementia increases with advancing age  Dementias are typically classified into 3 types:  Alzheimer’s Disease: - Brain tissue deteriorates irreversibly, and death usually occurs 10 or 12 years after the onset of symptoms - Accounts for 50% of dementia in older people - About 1 in 13 Canadians over the age of 65 has Alzheimer’s - current worldwide prevalence is 26.6 million – estimated will quadruple to 106 million in 2050 (1/85) - modifying the environmental factors by promoting mental and physical exercise would result in 10% reduction -current 500,000 canadians with alzheimers will raise to 1.1 million cases within a generation - median survival time is 3.1 years for Canadians with alzheimers and 3.3 years for those with vascular dementia -women with alzheimers tend to live longer than men, but more women die as a resultth th - is 10 leading cause of death for women and 15 leading cause in men - person at first has difficulty in concentrating and memory for newly learned material, and appear absent minded and irritable - see an atrophy in cerebral cortex, first in hippocampus and then frontal, temporal, and parietal lobes - get enlarged ventricles - Plaques: small round areas making up the remnants of the lost neurons & b- amyloid (waxy protein deposit) are scattered throughout the cortex - Neurofibrillary tangles: tangled abnormal protein filaments, accumulate within the cell bodies of neurons - plaques and tangles are present throughout the cerebral cortex and hippocampus - hippocampal volume loss is key feature in early Alzheimers, while volume loss in medial temporal lobe is key feature in individuals with disease for +4 years - about 25% of patients with AD also have brain deterioration similar to Parkinsons disease – nigrostriatal dopamine pathway - Heritability is very high (79%) - may be involved in mutation on gene on chromosome 19 (E4 allele) - risk of dementia increased with age for those with low educational level, and the presence of the E 4 allele increased the risk by 400% - history of head injury and depression are risk factors for developing it - aspirin and nicotine appears to reduce the risk - remaining active at cognitive level may protect an individual in terms of cognitive decline - Cognitive reserve hypothesis: 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 - being bilingual may also help protect  Frontal-temporal:  Accounts for 10-15% of cases  Typically begins in a person’s late 50’s  Marked by extreme behavioural and personality changes  Sometimes very apathetic and unresponsive to their environment  Has strong genetic component  Unlike AD, not closely linked to loss of cholinergic neurons  Serotonin neurons are most affected  Widespread loss of neurons in frontal and temporal lobes  Pick’s disease is frontal-temporal dementia – characterized by presence of Pick bodies  Frontal-subcortical  Affect subcortical areas involved in motor movements, thus both motor control and cognition is affected  Types of frontal-subcortical dementias include the following: o Huntington’s chorea- caused by a single dominant gene located on chromosome 4 and is diagnosed principally by neurologists on the basis of genetic testing. Major behavioural feature is the presence of squirming (choreiform) movements o Parkinson’s disease- marked by muscle tremors, muscular rigidity, and akinesia (inability to initiate movement), and can lead to dementia o Vascular dementia- 2 most common type next to Alzheimer’s. 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. Most commonly, patient had a series of strokes where a clot formed  genetic factors do not appear to be involved - number of infectious diseases produce irreversible dementia Encephalitis: inflammation of brain tissue, caused by viruses that enter the brain from other parts of the body (sinuses or ear) or from certain bug bites parasite that causes syphilis can invade brain and cause dementia  Some other causes: head traumas, brain tumours, nutritional deficiencies (B-complex vitamins), liver failure, endocrine-gland problems (hyperthyroidism), exposure to toxins (lead or mercury), and chronic use of drugs and alcohol Treatment of dementia: - no clinically significant treatment has been found to half or reverse AD - no success in increasing acetylcholine - certain drugs may stop the progression of symptoms, but haven’t been very effective in general - Can be treated by correcting hormonal imbalance - ¼ of patients also had diabetes, ¼ had heart disease, and 36% had unacceptably high blood pressure - Burdens experienced by caregivers of these patients:  Emotional burden  Physical burden  Financial burden  Employment burden Delirium- being off track or deviating from the usual state  Typically described as “a clouded state of consciousness”  Has trouble concentrating and focusing attention and can’t maintain a coherent and directed stream of though  In early stages, frequently restless (particularly at night), sleep-walking cycle becomes disturbed, person is drowsy during the day, vivid dreams and nightmares are common  May be impossible to engage in conversation because of their wandering attention and fragmented thinking  In severe delirium, speech is rambling and incoherent  In a 24 hr period, individuals can have periods of alertness and coherentness; daily fluctuations help distinguish delirium from other syndromes  Confused, some lose their sense of time and place  Are in great emotional turmoil and may shift rapidly from 1 emotion to another  May mistake unfamiliar with the familiar  Illusions and hallucinations, especially visual and auditory-visual ones are common  Fever, flushed face, dilated pupils, tremors, rapid heartbeat, elevated blood pressure, and incontinence are common  If delirium ensues, they will completely lose touch with reality & may become stuporous  Prevalence in elderly patients could be as high as 9.6%  Causes:  Drug intoxications and drug withdrawal reactions, metabolic and nutritional imbalance (uncontrolled diabetes and thyroid dysfunction), infections or fevers, neurological disorders and the stress of change in a person’s surroundings  Major surgery (most commonly hip surgery), during withdrawal from psychoactive substances, and following head trauma or seizures  Congestive heart failure, malnutrition, cancer, urinary tract infection, and cerebrovascular accidents or strokes  Most frequent cause
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