Audrey - Cerebral Disorders and Mental Health Issues in Later Life Flashcards
Life events associated with older life
⭐️Overall, adjustments in cognitive, emotional and social functioning need to be made during this time. They depend heavily on the health and fitness of the individual, the social circumstance they’re in and what meaning they place on having a working role.
-Retirement = critical transition time; Can be hard to enter into retirement if you want to remain independent and want to earn your own income- thus depends heavily on how the individual perceives it.
-Grandparenting- full time can have positive and negative outcomes 😥⬆️rates of depression 😥diabetes 😥hypertension 😥insomnia 😥social isolation 😥stress 😥financial pressure
- Bereavement: generally older individuals cope better than younger particularly if the loss is expected (better social networks, expected course)- regardless still difficult transition; most common in older adulthood
- Grief: associated with sadness, changes in appetite, sleep
Memory and normal ageing
❗️Must be able to recall what causes memory difficulties in normal ageing (ie structural changes in hippocampus)
‘Worried well’: worrying about slips in memory and not being as sharp as when they were younger.
-⬇️in amount of new information remembered
-lapses in memory
-⬆️difficulty with complex attentional tasks
-decrements in time based tasks
✖️criticised however for being too pessimistic as it has been shown that they don’t demonstrate the same performance drop when task is untimed
DSM-5:
Neurocognitive Disorders
⭐️Classified according to severity of symptoms:
-mild
-moderate
-severe
✔Broader; this has changed how we conceptualise old age; it now looks at disorders across the age range, not just those of old age (degenerative disorders) but those which can occur earlier in the lifespan and affect younger people.
Include:
- Alzheimer’s Disease
- Fronto Temporal Dementia
- Traumatic Brain Injury
- Parkinson’s Disease
- Huntington’s Disease
Preclinical Dementia
❗️Must be able to recall what it is
- Precedes mild cognitive impairment (MCI)
- Includes both people:
i. for whom changes have started in the brain but who are clinically indistinguishable from profile of normal or “typical” ageing, and
ii. those who have demonstrated subtle decline (almost indistinguishable from normal ageing) from their baseline that exceeds that expected in typical ageing, but who would not yet meet criteria for MCI.
✔️Can be used to treat and prevent full blown dementia
⭐️MCI is the more obvious stage.
😥Those with MCI are more likely to develop Alzheimer’s or other dementia diseases.
DSM-5:
Neurocognitive Disorders:
Alzheimer’s Disease 😥
⭐️Most common dementia
Symptoms/Effects include:
😥Memory loss that disrupts daily life (most common)
😥Difficulties planning or solving problems
😥Difficulty completing familiar tasks at home, at work or at leisure
😥Confusion with time or place (eg no longer know how long an hour is)
😥Trouble understanding visual images and spatial relationship
😥New problems with words in speaking or writing (eg marked confusion with speech; word salad)
😥Misplacing things and losing the ability to retrace steps
😥Decreased/poor judgement
😥Withdrawal from work or social activities
😥Changes in mood and personality (may not be recognised as being the same person by loved ones, may get angry and irritable much easier)
DSM-5:
Neurocognitive Disorders:
Alzheimer’s Disease:
3 Stages of Decline
- Early dementia
✖️Hard to tell whether it is really dementia or just normal decline; or attributable to other medications - Moderate dementia
- Advanced dementia
⭐️It is the progressive spread of the tangles and plaques which determine which stage one is at.
⭐️It’s a slow and progressive decline that occurs over 8-14 years
DSM-5: Neurocognitive Disorders: Alzheimer's Disease: 3 Stages of Decline: Early Dementia
-Very gradual
✖️Often impossible to identify the exact time it began
Person may:
- appear more apathetic, with less sparkle; low mood
- lose interred in hobbies and activities
- be unwilling to try new things
- be unable to adapt to change
- show poor judgement and make poor decisions
- blame others for “stealing” lost items
- become more forgetful of details of recent events
- be more likely to repeat themselves
- be more irritable or upset
- have difficultly handling money
DSM-5: Neurocognitive Disorders: Alzheimer's Disease: 3 Stages of Decline: Moderate Dementia
The problems are more APPARENT and DISABLING
Person may:
-be more forgetful of recent events; memory for the distant past generally seems better, but some details may be forgotten
-be confused regarding time and place
-become lost if away from familiar surroundings
-forget names of family or friend
-forget saucepans and kettles on the stove; may leave gas unlit
-wander around streets, perhaps at night, sometimes becoming lost
-behave inappropriately (eg going outdoors in sleepwear)
-see or hear things that are not there
-become very repetitive
-be neglectful of hygiene or eating
-need more assistance by others in day to day activities so as to avoid hazardous scenarios (eg forgetting to turn stove off)
-may struggle to appraise whether an interaction with others was friendly or not
-struggles with money (eg may be taken advantage of)
⭐️Decision needs to be made as to whether they should stay at home and receive care or be put into a care facility; remember, can spur further memory decline when removed from unfamiliar environment into one with no cues.
DSM-5: Neurocognitive Disorders: Alzheimer's Disease: 3 Stages of Decline: Advanced Dementia
❗️Must be able to recall at least 3 features
😥Person is severely disabled and needs total care.
Person may:
-be unable to remember occurrences for even a few minutes (eg forgetting they have just had a meal)
-lose their ability to understand or use speech
-be incontinent
-show no recognition of friends or family
-need help eating, washing, bathing, toileting and dressing
-fail to recognise everyday objects
-be disturbed at night
-be restless, perhaps looking for a long-dead relative
-be aggressive, especially when feeling threatened or closed in
-have difficulty walking
-have uncontrolled movements/immobility will become permanent, and in the final weeks or months the person will be bedridden 😥
⭐️Person either needs full time care in the home/to be put into a care facility.
DSM-5: Neurocognitive Disorders: Alzheimer's Disease: 3 Stages of Decline: The progression of the neurofibrillary tangles and plaques in the brain
- Hippocampus: where memories are first formed
- Language brain region
- Front of brain- logical thought, problem-solving, planning, grasping concepts
- Emotional region of brain
- Where brain makes sense of things they see, hear, and smell; hallucinations may occur at this stage of deterioration
- Back brain
- Compromises individual’s balance and co-ordination
- Destroys part or brain responsible for breathing and the heart 😥
Vascular Dementia
❗️Must be able to identify what causes if
⭐️Caused by reduced blood supply to the brain due to diseased blood vessels.
Brain cells need a constant supply of blood to bring oxygen and nutrients.
Blood is deliver to the brain through a network of vessels called the vascular system.
⚠️If the vascular system within the brain becomes damaged- so the the blood vessels leak or become blocked- then blood cannot reach the brain cells and they will eventually die.
➡️problems with memory, thinking/reasoning.
Differs from Alzheimer’s in that is has a STEP-WISE progression➡️sharp decline vs slow, relentless decline as seen in Alzheimer’s (eg one may undergo events every now and again where there is a blockage of blood to the brain resulting in a sharp decline and so on so forth amongst periods of being okay.
DSM-5:
Neurocognitive Disorders:
Parkinson’s Disease
⭐️A progressive disease marked by TREMOR, MUSCULAR RIGIDITY, and SLOW MOVEMENT.
⭐️Associated with degeneration of the basal ganglia of the brain and a deficiency of the neurotransmitter dopamine.
50-80% will develop dementia😥
DSM-5:
Neurocognitive Disorders:
Parkinson’s Disease:
Characteristic motor symptoms
- rigidity and trembling of head
- rigidity and trembling of extremities
- forward tilt of upper body from shoulders up
- reduced arm swinging
- shuffling gait with short steps
DSM-5:
Neurocognitive Disorders:
Parkinson’s disease with dementia
Characterised by deficits in: 😥executive function (🔑 feature) 😥visuospatial deficits 😥irritability- changes in mood 😥memory problems (not the initial feature for many)
✔️Medications are effective in controlling motor symptoms, but cognitive symptoms are however now an area of concern.
Stroke
⭐️A sudden disturbance of the normal functioning of the nervous system, caused by a disruption of the blood supply to the brain.
2 main possible underlying causes for this disrupted blood supply:
- Ischaemic stroke: a BLOCKAGE in 1/+ of the arteries carrying blood to the brain.
- Haemorrhagic stroke: a BLEED in the brain, caused by a burst artery.
⚠️Blood kills brain cells.
⭐️Deficit caused by stroke depends on where it occurred (which artery); may/may not recover
