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Chapter 16

chapter 16

15 Pages

Course Code
Konstantine Zakzanis

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1 Chapter 16: Aging and Psychological Disorders Ageism: discrimination against any person, young or old, based on chronological age Old: over 65 years of age; 65-74 are young-old; 75-84 are old-old; >85 oldest-old ISSUES, CONCEPTRS AND METHODS IN THE STUDY OF OLDER ADULTS Diversity in old people: they are more different from one another than are individuals in any other age group; people tend to become less alike as they grow older Age, Cohort and Time of measurement Effects: Age effects: are the consequences of being given chronological age Cohort effect: are the consequences of having been born in a given year and having grown up during a particular time period with its own unique pressures, problems, challenges and opportunities; this effect exists if people have some factor that distinguishes them from people who turned 65 or older at an earlier date or a later date Time of measurement effects: are confounds that arise because events at an exact point in time can have specific effect on a variable being studied over time; they are the consequences of the effects that particular factor can have at a particular time period Two major research designs tat assess developmental change are Cross sectional studies: investigator compares different age groups at the same moment in time on the variable of interest; these do not examine the same people over time; therefore they allow us to make statements only about age effects in a particular study or experiment, not about age changes over time Longitudinal studies: researches select one cohort and periodically retests it using the same measure over a number of years; it allows them to trace individual patterns of consistency or change over time (cohort effect) and to analyze how behaviour in early life relates to behaviour in old ageconclusions are limited to cohort chosen; another problem is that people can drop out as study proceeds hence creating bias called selective mortality (least able people are most likely to drop out, leaving a non-representative group people who are usually healthier than the general population==hence findings can be overly optimistic about the rate of decline of a variable such as sexual activity over a lifespan Diagnosing and Assessing Psychopathology in Later Life DSM 4 criteria is same for old and young nature and manifestations of mental disorders are assumed to be the same in adulthood and old-age A major of cognitive functioning is included as standard practise in research to determine whether the elderly respondent has experienced decline in cognitive abilities Often done with Mini-Mental State Examination (MMSE) in its ordinal or modified formit 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 Reliable measure for screening purposes: clock test used for Alzheimers and dementia patients; up to 25 different errors can occur in this test such as rotations, omission, preservations, misplacements, distortions, substitutions, and additions Create measures who items content is tailored directly to the concerns and symptoms reported by elderly people, not to those of younger respondents Geriatric Depression Scale (GDS) is a true-false self report measure; has acceptable psychometric characteristics and is regarded as standard measure for assessing depression in elderly Geriatric Suicidal Ideation Scale (GSIS) is a 31 item measure; has 10 item suicide ideation scale as well as 3 other subscales tapping death ideation, loss of personal and social work and perceived meaning in life Range of Problems: double jeopardy: suffer stigma associated with being older and being mentally ill OLD AGE AND BRAIN DISORDERS: majority dont have them but they account for most admissions and hospital days 2 Dementia: called senility by laypeople: 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 and reported memory problems in people who objectively have normal cognition predicted subsequent dementia They leave tasks unfinished because they forget to return to them after an interruption Hygiene may be poor and appearance slovenly because the person forgets to bathe or how to dress They get lost even in familiar settings Judgement becomes faulty and person may have difficulty comprehending situations and making plans or decisions They relinquish their standards and lose control of their impulses; may use coarse language, tell inappropriate jokes or shoplift Ability to deal with abstract ideas deteriorates and disturbances in emotions are common (depression, flatness of affect and sporadic emotional outbursts) Language disturbances and vague patterns of speech Motor systems are intact but they have difficulty carrying out motor activities, such as brushing teeth or dressing Trouble recognizing familiar surroundings or naming common objects The course may be progressive, static or remitting depending on cause Those with progressive dementia become withdrawn and apathetic In terminal phase of illness personality loses its spark and integrity; social involvement narrows and person is oblivious to their surroundings Prevalence of it increases with advancing age Causes: Alzheimers disease is most common; frontal-temporal and frontal-sub-cortical dementias Alzheimers Disease: it has been observed that modifying the environmental factors by promoting mental and physical exercise could result in 10% reduction in its prevalence if disease onset could be delayed by a year Brain tissue deteriorates irreversibly and death occurs 10 or 12 years after onset of symptoms Women with AD live longer but more women than men die as a result of this disease Person has difficulties first in concentration and in memory for newly learned material and may appear absent minded and irritable, shortcomings that can be overlooked for several years but eventually interfere with daily living As disease develops, person often blames others for personal failings and may have delusions of being persecuted Memory continues to deteriorate and person becomes increasingly disoriented and agitated patients are wholly unaware of the extent of their memory decline Main physiological change in brain at autopsy is atrophy of cerebral cortex and hippocampus and later the frontal, temporal and parietal lobes; as neurons and synapses are lose, the fissures widen and ridges become narrower and flatter; the ventricles also become enlarged Plaques: small, round areas comprising remnants of lost neurons and b-amyloid, a waxy protein deposit- are scattered throughout the cortex Tangled, abnormal problem filaments- neurofibrillary tangles accumulate within the cell bodies of neurons Plaques and tangles present throughout cerebral cortex and hippocampus Volume loss within hippocampus (episodic memory impairment) best discriminated people in early stages of AD Volume loss within medial-temporal lobes (associated naming deficits) was most sensitive measure when identifying patients with AD for 4 or more years Cerebellum, spinal cord and motor and sensory areas of cortex are less affected until late into the disease process 25% also have deterioration like Parkinsons neurons are lost in nigrostriatal pathway Neural pathways using transmitters (5-HT and NE) deteriorate in Alzheimers, those using ACh are important fewer ACh terminals in AD patients and level of major metabolite of ACh are also low and are associated with greater mental deterioration 3 Genetic basis of AD: increased risk in first degree relatives of afflicted individual and concordance of MZ twins greater than DZ twins People with down syndrome often develop AD if they survive until middle age, so interest is on chromosome 21 Gene controlling the protein responsible for formation of b-amyloid was found on the long arm of chromosome 21 gene causes 5% cases of early onset of AD Chromosome 1 and 14 are also dominant genes causing the disease Presence of these AD genes does not require activation by stressor to result in disease Majority of late onset cases of AD exhibit particular form of a gene called apolipoprotien E 4 Allele on chromosome 19 Having different form of this gene (E 2 allele) lowers the risk of developing AD Risk of dementia increased with age for those with low educational level and presence of E4 allele increased risk The gene appears to be related to development of both plaques and tangles and it seems to increase likelihood that brain will incur damage from free radicals (unstable molecules derived from oxygen that attack proteins and DNA) Environment likely to play a role in most cases of AD; life events play a role- history of head injury is a risk factor for developing AD; depression also increases the risk of AD Some environmental factors appear to offer protection against developing it; non-steroidal anti- inflammatory drugs such as aspirin appear to reduce risk and nicotine does too Remaining active at the cognitive level may buffer or protect individual in terms of degree of cognitive decline experienced -> use it or lost it Milgram et al. Made 3 conclusions (1) Cognitive activity helps preserve cognitive functioning (2) cognitive activity helps crystallized intelligence more than fluid intelligence (3) there is support for cognitive reserve hypothesis act of cognitive compensation creates a co
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