Ch 14 (lesson 17): Late life and Neurocognitive Disorders

Question 1

aging- what is old?

Answer 1

• in US, aging is dreaded
  
  • elderly not revered as in other cultures
• 65 + considered “Old”
  
  • 12.4% (35 mill) 65 +
  • young-old: 65-74, old: 74-84, oldest: 85+

Question 2

myths about late life

Answer 2

• aging inolves inevitible cognitive decline
  
  • sever cog probs don’t occur for most
  • mild declines common
• late life is a sad time/ most elderly depressed
  
  • older ppl report less neg emotion
  • more brain activation in key areas when viewing pos images
• late life is lonely
  
  • some less likely to ddevelop new friendships
  • social selectivity- focus more on relationships that matter most to us
• older people lose interest in sex
  
  • sexual activity don’t decrease from mid to late life for most

Question 3

Late life problems- probs multiply w age

Answer 3

• physical decline and disabilities
• sensory and neurological deficits
• loss of loved ones
• social stresses such as stigmatizing attitudes towards elderly
• 80% have 1+ major medical condition

Question 4

late life problems- sleep disturbances increase w age

Answer 4

sleep deteriorates w age

• insomnia
• sleep apnea

Question 5

late life problems- medical treatment

Answer 5

• chronic probs instead of curable disorders
• polypharmacy: practice of prescribing multiple drugs to patients
• psychoactive drugs usually tested on younger participants

Question 6

three kinds of effects in research of aging people

Answer 6

• age effects
• cohort effects
• time-of-measurement effects

Question 7

age effects

Answer 7

the effects of being a certain age (eg getting social security)

Question 8

cohort effects

Answer 8

effects of having grown up during particular time (eg: frugality increased among those who lived during great depression)

not to be confused w age effects

Question 9

time-of-measurements effects

Answer 9

effects of testing people at particular time in history (eg: in 1990s ppl became more frank about sexuality in surveys as media discussion of sexuality increased)

Question 10

types of research designs

Answer 10

• Cross-sectional studies
• Longitudinal studies

Question 11

Cross-sectional studies

Answer 11

• researcher tests different age groups at one point in time
• fails to give info about how ppl change over time/ as they age

Question 12

Longitudinal studies

Answer 12

• researcher retests same group of ppl w same measures at diff points in time
  
  • may extend over several years or decades
• attrition is a potential prob-
  
  • attrition = ppl dropping out
  • selective mortality (attrition due to death) can lead to biased sample– sample left represent healthy people, can’t draw conclusions about unhealthy people
• time of measurement can also be confused w aging effects

Question 13

Neurocognitive Disorder in Late Life

Answer 13

• most elderly do not have cog disorders
  
  • prevalence has decreased over last 15

most common:

• Dementia
  
  • deterioration of cog function
• Delirium
  
  • state of mental confusion

Question 14

psychological disorders in older adults

Answer 14

every single disorder is less common in elderly people than younger adults

• most people with disorder later in life are experiencing a continuation of a disorder they’ve previously had
• older adults may be uncomfortable acknowledging/ disclosing mental health problems
• people with psych disorders at risk of dying earlier for variety of reasons

Question 15

treating psych disorders in elderly

Answer 15

• psychotherapy
• be careful of side effects of meds, but they can be effective
• caregiver, if cog decline

Question 16

Dementia

Answer 16

• Deterioration of cog func
  
  • impairs social/occupational func
  • progresses over time
    
    • begins w forgetting recent events
• deficits can be detected before impairment is obvious
• Mild cog impairment develops slowly, major happens quickly

Question 17

DSM-5 2 categories of Dementia

Answer 17

differentiated by ability to live independently:

• mild neurocognitive disorder (mild cog impairment)
• Major neurocognitive disorder (dementia)

Question 18

DSM- 5 Neurocognitive disorders

Answer 18

• Delirium
• Neurocognitive disorder: specify mild or major
  
  • Neurocog disorder assoc. w Alzheimer’s disease
  • ” “ fronto-temporal lobar degeneration
  • ” “ vascular disease
  • ” “ traumatic brain injury
  • ” “ Lewy body disease
  • ” “ Parkinson’s disease
  • ” “ HIV infection
  • ” “ substance use
  • ” “ Huntington’s diseease
  • ” “ prion disease
  • other specified neurocog disorder

Question 19

DSM-5 Criteria for Mild Neurocog Disorder

Answer 19

• Minor cog decline from previous levels in 1+ domains based on both of the following:
  
  • concerns of patient, close other, clinician
  • neurocog performance below appropriate norms (btwn 3-16%) on formal testing/clinical eval
• The cog deficits don’t interfere w independence, even though greater effort, compensatory strategies, or accommodation may be required
• cog deficits don’t occur exclusively in context of a delirium and not due to another psych disorder

Question 20

DSM-5 criteria for Major Neurocog disorder

Answer 20

• evidence of sig cog decline from prev levels in 1+ domain based on both:
  
  • concernts of patient/other/clinician
  • neurocog permorance below 3rd percentile on formal testing/ clinical eval
• Cog deficits interfere w independence
• cog deficits don’t occur exclusively in context of a delirium and not due to psych disorder

Question 21

Alzheimer’s Disease

Answer 21

• Alois Alzheimer 1906
• more than half dementia is alzheimers
• Irreversible brain tissue deterioration
  
  • death w/in 12 years
• Usually begins w
  
  • difficulty remembering recent events
  • learning new material
  • irritability
• as disease progresses
  
  • language probs intensify, word-finding
  • disorientation- time, place, identity confusion
  • agitation
  • depression

Question 22

Brain changes in Alzheimers

Answer 22

• plaques
  
  • beta-amyloid protein deposits outside neurons
  • primarily found in frontal cortex
• Neurofibrillary tangles
  
  • protein filaments composed of protein tau in axons of neurons
  • primarily found in hippocampus
• measured using PET scans
• Plaques most dense in frontal cortex; tangles most dense in hippocampus
• loss of synapses for acetylcholinergic (Ach) and glutaminergic neurons
  
  • as neurons die, atrophy of cerebral and entorhinal cortices and hippocampus
  • enlargement of ventricles

Question 23

Genetic factors- alzheimers

Answer 23

• heritability 79%
• ApoE4 allele: gene on chromosome 19
  
  • one E4 increases risk 20%
  • 2 E4 increases risk substantially more
    
    • related to over-production of beta-amyloid plaques, loss of neurons in hippocampus and low glucose metabolism in cerebral cortex
• many genes related to alzheimers also related to immune func and cholestoral metabolism
  
  • conditions that involve immune and inflammatory processes at greater risk for alzheimers

Question 24

Environmental Factors- Alzheimers

Answer 24

• brain traumas from accidents/ injuries can increase risk
• smoking, being single, low social support, depression related to greater risk
• mediterranean diet, exercise, education, cog engagement predict lower risk
• Cognitive reserve
  • using alt brain networks to compensate for disease

Question 25

frontotemporal Dementia

Answer 25

• loss of neurons in frontal and temporal lobes
  
  • memory not severely disrupted
• impairment of exec functions
  
  • planning
  • prob solving
  • goal-directed behavior
• Difficulty recognizing and regulating emotion
  
  • much more profound impact than alzheimers
• caused by multiple genetic pathways
  
  • pick’s disease
  • high levels of tau proteins
• rare, less than 1%
• begins in late 50’s progresses rapidly
  
  • death occurs w/in 5 yrs

Question 26

Vascular Demetia

Answer 26

• Typically from stroke (cardiovascular)
  
  • clot forms and impairs circulation
  • cells die
• risk factors
  
  • smoking, high LDL cholesterol high BP
• Symptoms and severity can vaery greatly depending on type and location of stroke
• 7% develop dementia after first stroke, risk increases w recurrent strokes

Question 27

Dementia w Lewy Bodies (DLB)

Answer 27

• lewy bodies: protein deposits that form in the brain (olfactory bulb and brain stem) and cause cog decline
• 2 subtypes
  
  • w parkinsons
  • no parkinsons
• Symptoms similar to parkinsons and Alzheimers
  
  • shuffling gait
  • loss of memory
• Symptoms
  
  • fluctuating cog symptoms
  • prominent visual hallucination
  • intense dreams involving movement and vocalizing

less than 10% of dementia is DLB

Question 28

Dementias caused by Disease/ injury

Answer 28

• Encephalitis (inflammation of brain tissue by viruses
• meningitis (inflammation of covering membranes by bacteria)
• HIV
• Head traumas
• Brain tumors
• Nutritional deficits (B-complex)

Question 29

treatments for dementia- medications

Answer 29

• no drug reverses
• some drugs produce slightly less decline
  
  • cholinesterase inhibitors (prevent breakdown of acetylcholine)
  • donepezil (Aricept)
  • Galantamine (Reminyl)
• Vitamin E, statins, nonsteroidal anti-inflammatory drugs have failed to find support
• preventive work focuses on processes involved in creation of amyloid from precursor protein
• antidepressents for depression

-antipsychotic meds for agitation

Question 30

Psych treatments for dementia

Answer 30

• supportive psychotherapy for family and patient
• education about disease and care
• cog interventions when disease in early stages
  
  • labeling drawers, appliances
  • calendars, clocks, strategically placed notes
• exercise assoc w cog benefits
• music reduces agitation and disruptive behavior

Question 31

Delirium

Answer 31

• Clouded state of consciousness
  
  • extreme trouble focusing attention
  • disturbances in sleep/wake cycle
  • fragmented thinking
  • speech rambling, incoherent
  • disorientation
  • perceptual disturbances
  • memory impairments
  • mood swings
• secondary to underlying medical condition
• detection of delirium important but often missed
  
  • untreated, further cog decline and mortality may occur

Question 32

dementia vs delirium

Answer 32

• dementia gradual deterioration — delirium rapid onset
• dementia decifits in short term memory – delirium trouble concentrating/ staying on train of thought
• dementia caused by disease processes that directly influence brain, delirium secondary to anther med condition
• dementia usually progressive and nonreversible– delirium fluctuations over course of day
• dementia treatment offers min benefit – delirium usually reversible by treating underlying condition, fatal if not treated
• dementia prevalence increases w age – prevalence highest in young very young and old

Question 33

etiology of delirium

Answer 33

• drug intoxications and withdrawal reactions
• metabolic and nutritional imbalances (diabetes, thyroid dysfunction, kidney/liver failure, heart failure, malnutrition
• neurological disorders (dementia, head trauma, seizures
• stress of major surgery,
• physical immobility/ restraints are key risk factors
• usually has more than one cause

older adults vulnerable bc

• physical decline, susceptibility to chronic disease, medications, sensitivity to drugs

Question 34

treatment of delirium

Answer 34

• beyond treating underlying medical conditions, most common treatment is atypical antipsychotic medication
• prevention- reduce risk factors in hospital settings such as sleep deprivation, immobility, dehydration, visual/hearing impairment