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Chapter 16


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Konstantine Zakzanis

Chapter 16: Aging and Psychological Disorders • Subjective age bias: A tendency to feel younger than one’s chronological age in a way that may reflect an age bias. • The physical realities of aging are complicated by ageism, which can be defined as discrimination against any person young or old, based on chronological age. Issues, Concepts, and Methods in the Study of Older Adults Diversity in Older Adults • The word “diversity” is well suited to the older population. Not only are older people different from one another, but they are more different from one another than are individuals in any other age group. Age, Cohort, and Time-Of-Measurement Effect ­ Age effects are the consequences of being given chronological age ­ Cohort effects are the consequences of having been born in a given year and having grown up during a particular time period. A cohort effect exists if these people have some factor that distinguishes them from people who turned 65 or older at an earlier date. ­ Tim-of-measurement effects are confounds that arise because events at an exact point in time can have a specific effect on variable being studied over time. For example, time of measurement could affect the results of studies assessing post-traumatic stress disorder is Holocaust survivors if one of the assessments occurs shortly after 9/11. • In cross-sectional studies, the investigator compares different age groups at the same moment in time on the variable of interest. They allow us to make statements only about age effects in a particular study or experiment, not about age changes over time. • In longitudinal studies, the researcher selects one cohort – say, the graduating class of 2002 – and periodically retests it using the some measure over a number of years. • Conclusions drawn from longitudinal studies are restricted to the cohort chosen. • An additional problem with longitudinal studies is that participants often drop out as the studies proceed, creating a bias commonly called selective mortality. The least-able people are the most likely to drop out, leaving a non-representative group of people who are usually healthier than the general population. Diagnosing and Assessing Psychopathology in Later Life • Researchers often assess cognitive functioning with the Mini-Mental State Examination. The MMSE is brief measure of an individual’s cognitive state, assessing “orientation, memory, and attention . . . ability to name, follow verbal and written commands, write a sentence spontaneously and copy a complex polygon. • A relatively simple measure used to detect dementia and Alzheimer’s disease is the clock drawing subset of the Clock Test. • Respondents are presented with a previously drawn circle ( 7 cm in diameter) and are asked to imagine that the circle is the face of a clock and to put the numbers on the clock and then draw the hand placement for the time 11:10. Up to 25 different types of errors can occur, including omissions, perseverations (i.e., repetition), rotations, misplacements, distortions, substitutions, and additions. This simple test has been found to be reliable and valid, though results vary depending on the scoring system used. • 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 to assessing depression in the elderly. The Geriatric Suicide Ideation Scale (GSIS) is a 31-item measure that is the first measure of suicide ideation created specifically for the elderly. Range of Problems • “Double jeopardy”; that is, they suffer the stigmas associated with being older and being mentally ill. Old Age and Brain Disorders Dementia • Dementia – what laypeople call senility – is a general descriptive term for gradual deterioration of intellectual abilities to the point that social and occupational functions are impaired. Difficulty remembering things, especially recent events, is the most prominent symptom. • They may also have trouble recognizing familiar surroundings or naming common objects. These should be distinguished from paraphrenia, the term used to describe schizophrenia that has its onset during old age. Causes of Dementia • Dementias are typically classified into three types. Alzheimer’s disease is the most common. Then, there are the frontal-temporal and frontal- subcortical dementias, which are defined by the areas of the brain the are most affected. Alzheimer’s Disease • The main physiological change in the brain, evident at autopsy, is an atrophy (wasting away) of the cerebral cortex, first the entorhinal cortex and the hippocampus and later the frontal, temporal, and parietal lobes. As neurons and synapses are lost, the fissures widen and the ridges become narrower and flatter. The ventricles also become enlarged. Plaques – small, round areas making up the remnants of the lost neurons and b-amyloid, a waxy protein deposit – are scattered throughout the cortex. Tangled, abnormal protein filaments – neurofibrillary tangles – accumulate within the cell bodies of neurons. These plaque and tangles are present throughout the vertebral cortex and the hippocampus. • In terms of structural imaging, volume loss within the hippocampus (and episodic memory impairment) best discriminated people in the early stages of Alzheimer’s disease from control participants. • The most reliable predictor of progression from mild cognitive impairment to Alzheimer’s disease was not changes in the posterior cingulate cortex and precuneus. Rather, it was atrophy in the (trans-) entorhinal area in the hippocampus and hypometabolism/ hypoperfusion in the inferior parietal lobules. • About 25% of patients with Alzheimer’s disease also have brain deterioration similar to the deterioration in Parkinson’s disease. Neurons are lost in the nigrostriatal pathway. • A substantial proportion of late-onset cases Alzheimer’s disease exhibit a particular form of gene (called the apolipoprotein E 4 allele) on chromosomes 19, which functions more like the genetic diatheses we have considered so often before. Having one E 4 allele increases the risk for Alzheimer’s disease to almost 50% and having two alleles brings the risk to above 90%. H
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