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Chapter 16

Chapter #16 - Aging.docx

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 16 – Aging and Psychological Disorders:  Subjective age bias – people feel younger than they actually are o Younger subjective age = positive outcomes o Negative views increase cardiovascular events and health problems  Well into 80’s can have pleasure from sex  Social problems may be more severe in women o Signs of aging in a woman not valued in society  Ageism – discrimination against any person young or old based on chronological age  Four guides: delirium, depression, suicide prevention and mental health issues for those in long- term care homes  Old are defined as those over the age of 65  People over 65 divided into 3 groups: o 65-74 young-old o 75-84 old-old o 85+ oldest-old  10 million 65/older by 22041  2015 for the first time in Canada # of old greater than children  2050 2 million worldwide will be 60 or older Issues, Concepts and Methods in the Study of Older Adults: Age Cohort, and Time of Measurement Effects:  3 kinds of effects: o Age effects – consequences of being a given chronological age o Cohort effects – consequences of being born in a given year and having grown up during a particular time period with its own unique pressures o Time of measurement effects – confounds that arise because events at an exact point in time can have a specific effect on a variable being studied over time  2 major research designs used to assess developmental change: o Cross-sectional studies – investigator compares different age groups at the same moment in time on the variable of interest o Longitudinal studies – researcher selects one cohort and periodically retests over a number of years using the same measure, allows us to look at cohort effects  Longitudinal issues: cohorts are different o Selective mortality – people can drop out of study, least able people most likely to drop out o Non-representative people left in study that are healthier than normal population o May be overly optimistic Canadian Study of Health and Aging:  4 main goals of massive project: o Prevelance of dementia in Canada in those 65+ o Identify risk factors associated with Alzheimer’s disease o Examine patterns of caring for Canadians with dementia o To develop a uniform database for subsequent longitudinal investigations  Prevelance of Alzheimer’s disease and dementia = 8%  Onset of dementia is gradual, only 11.5% had an acute, sudden onset  Approx. one half of Canadians with dementia are institutionalized o Most primary caregivers are female and married  60 000 cases of dementia per year in Canada  Alzheimer’s disease 5 and 10 years later  Physical frailty = more psychiatric illness (frailty – having multiple illnesses, smoking)  Among elderly people with some cognitive impairment but no dementia, hypertension is associated with increased likelihood of progressing to dementia Diagnosing and Assessing Psychopathology Later in Life:  Somatic symptoms more prevalent in later life  Usually look at cognitive ability decline  Use Mini-Mental State Examination (MMSE) or modified form – brief measure of cognitive state  DSM-5: dementia be dropped and captured by 2 new categories: major and minor neurocognitive disorder  Tuokko: clock-drawing test, given circle asked to draw #’s of clock and hand placement at 11:10  Geriatric Depression Scale – a true-false self-report measure, standard measure for assessing depression in elderly  Geriatric Suicide Ideation Scale – 31-item first measure for suicide in elderly o Protective factors = supportive relationships Range of Problems:  WHO: elderly people with mental disorder may suffer from “double jeopardy” – suffer from stigmas of being older and mentally ill Old Age and Brain Disorders:  2 principal types of brain disorder: dementia and delirium Dementia:  Laypeople call senility – general descriptive term for gradual deterioration of intellectual abilities to the point that social and occupational functions are impaired o Diff remembering things, esp with recent event is the most prominent symptom o May leave tasks unfinished because they forget after an interruption o Poor hygiene – forget to dress or bathe o Also get lost even in familiar settings o Faulty judgement o Lose control of their impulses – coarse language, tell inappropriate joke, shoplift o Vague patterns of speech o Diff carrying out motor activities  Distinguished from paraphrenia – term used to describe schizophrenia onset at old age  Course of dementia may be progressive, static or remitting Causes of Dementia:  Classified into 3 types: Alzheimer’s disease is the most common, frontal-temporal and frontal- subcortical dementias Alzheimer’s disease:  Account for about 50% of dementia in older people  1 in 13 Canadians over 65 have it  106 million people with it in 2050 (Alzheimer’s) 1 in 85 people  Brain tissue deteriorates irreversibly and death occurs 10-12 years after onset  Median survival time 3.1 years with Alzheimer’s and 3.3 years with vascular dementia  Women with Alzheimer’s live longer than men  But more women die as a result of the disease 10 leading cause for death women, 15 for men  Often blames other for failings and may have delusions of being persecuted  Autopsy: wasting away of cerebral cortex, first entorhinal cortex and HC and later the frontal, temporal and parietal lobes  Neurons and synapses lost, fissures widen and ridge become narrower and flatter  Ventricles become enlarged  Plaques – small round areas making up the remnants of lose neurons and b-amyloid (a waxy protein deposit) scattered throughout cortex  Neurofibrillary tangles – tangled abnormal filaments accumulate within cell bodies of neurons  25% also have brain deterioration sim to Parkinson’s, neurons lost in nigrostriatal pathway  Very strong genetic basis, increased in first degree relative  MIRAGE – role of genetic factors  Late onset cases from particular form of gene on chromosome 19 (E 4 allele) o Having one allele = 50% increase risk, two = 90%  Having different form E 2 allele reduces risk  Life events may play a role – head injury, depression  Aspirin appears to reduce risk of disease as does nicotine  3 conclusions: cognitive activity helps preserve functioning, helps crystallized intelligence more than fluid intelligence, support the cognitive reserve hypothesis  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  Related protective factor = bilingual  High levels linguistic ability = low cognitive impairment Frontal-Temporal Dementias:  Accounts for 10-15% of cases  Typically begins in person’s late 50’s  Marked by extreme behavioural and personality changes  Very apathetic and other time euphoric and impulsive  Not closely linked with loss of cholingergic neurons (like Alzheimer’s)  Serotonin neurons are most affected  Pick’s disease is one cause of frontal-lobe dementia – degenerative disorder in which neurons are lost, spherical inclusions within neurons  Strong genetic component Frontal-Subcortical Dementias:  Both cognition and motor activity affected  Types: o Huntington’s chorea – caused by single dominant gene on chromosome 4  Presence of writhing (choreiform) movements o Parkinson’s disease – muscle tremors, muscular rigidity and akinesia (inability to initiate movement) and can lead to dementia o Vascular dementia – second most common type, diagnosed when patient has neurological signs  Weakness in an arm, abnormal reflexes  Most commonly strokes in which a clot formed  No genetic factors Other Causes of Dementia:  Encephalitis – generic term for inflammation of brain tissue is caused by viruses that enter the body  Meningitis an inflammation of membranes covering the outer brain (usually bacterial infection)  Syphilis (Treponema pallidum) – can invade brain and cause dementia  Head traumas, B complex deficiencies, kidney/liver failure, endocrine gland problems, exposure to toxins Treatment of Dementia:  No drugs to cure Biological Treatments of Alzheimer’s disease:  Involves death of brain cells that secrete acetylcholine  Cognex (tacrine) – inhibits enzyme that breaks down acetylcholine (drug) o Cannot be used in high doses  Aricept  Tacrine, donepezil, rivastigmine, galantamine, memantine Psychosocial Treatments for the Individual and the Family:  Supportive approach  Overall goal to min disruption caused by person’s behavioural changes  Denial is the best coping mechanism  Family members caring for person is very stressful  Caregivers more likely to exp chronic health problems, more physical illness and decreased immunity Delirium:  Being off track or deviating from the usual state, clouded consciousness  Great trouble concentrating and focusing attention  Frequently restless at night in early stages  Sleep-walking cycle disturbed  Vivid dreams and nightmares common  May be impossible to engage in conversation  Memory impaired for recent events  Have lucid intervals and become alert and coherent  Perceptual disturbances are frequent  Paranoid delusions 40-70% of time  Swings in mood  Emotional turmoil  One of most frequent biological disorders in adults often misdiagnosed though  Very low survival rate Causes of Delirium:  Several classifications: drug intoxications and drug withdrawal reactions, metabolic and nutritional imbalances, infections and fevers, neurological disorders, stress of a change in person’s surroundings  May also occur following hip surgery and following head trauma or seizures  Most frequent cause is intoxication with prescription drugs  Usually has more than one cause  Medication, medical illness, age and male gender  D
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