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Chapter 16

Chapter 16 - Aging and Psychological Disorders

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 16 Aging and Psychological Disorders - researchers often assesscognitive 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, assessing orientation, 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 measure - 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 1 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 Causesof 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 patients - 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 casesof early onset Alzheimers; dominant genes causing the disease have also been found on chromosomes 1 and 13 - the majority of late-onset casesof 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 casesof 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 control 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 www.notesolution.com 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 2 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 dementia - 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 didnt - 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 www.notesolution.comBiological 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 groups - a study found that there was substantial effectiveness for skill training programs with 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
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