Chapter 11: Late Onset Disorder Flashcards
Some general stats on the aging population: Physical Changes
- 15% of people age 65 to 75 require some kind of assisted living
- 45% for those 85+
- Reduced functioning and size of the brain of at least 10% by the age of 80
- Change in hormone levels
Aging Population: Psychological Changes
1) Inability to store new information and in the speed of the individual’s reactions to visual and auditory stimuli
2) Loss of social support
3) Life experience
- Less impulsive
- Better at avoiding stress
- Less stressed since they no longer work or have to child-rear
- Have a schedule and routine and are less likely to take risks, making them less prone to psychological vulnerability with age.
Symptoms of Dementia
1) Aphasia
-Deterioration in the ability to communicate with language
2) Apraxia
-Manifest a decline in motor skills
3) Agnosia
-The failure to identify familiar objects and people
Failure to recognize family members
4) Loss of executive function
5) Comorbidity
-Depressive and psychotic symptoms
Alzheimer’s: Prevalence
- 2-4 million people in the U.S.
- 8% of American adults over the age of 65 diagnosed with it
- 1/3 of those are severely handicapped
- Women are at high risk of developing it
Symptoms of Alzheimer’s
1) Loss of initiative, forgetfulness, naming disability and apraxia (inability to execute explicit movement)
2) Loss of hygiene, incontinence, unmanageable behaviors such as screaming, aggression and refusal to eat or drink, problems in walking and balance that leads to falls and injuries
3) Becomes bed-ridden
- At this time, complications such as pneumonia, malnutrition, dehydration and/or infection occur, leading to death.
4) Psychosis is very common, including delusions and hallucinations, paranoid in nature, often involving concerns about personal health and safety.
5) Feelings of sadness, depression (10-20% meeting DSM criteria)
- Sometimes because they are aware of symptoms
6) Comes full circle, and once they are no longer aware of their deficits, they regain happiness.
Causes of Alzheimer’s
1) Grouping of proteins inside the neurons, accumulation of protein between neurons, and loss of cells in a number of areas of the nervous system
20 Neurofibrillary plaques tangles constitute neuropathological features that confirm a diagnosis of Alzheimer’s disease at biopsy or autopsy.
3) Neural malformations in Alzheimer’s patients are particularly common in the hippocampus, but they are also observed in the cerebral cortex.
4) Shrinkage in the temporal lobe and enlargement of the ventricles due to cell death in the cortex.
5) Beta amyloid can be detected in the cerebral spinal fluid of most patients with Alzheimer’s.
6) Low levels of Acetylcholine, a brain neurotransmitter that is known to be important in memory.
-Loss associated with aging.
7) Increase in aluminum in the body, causing neural malformations.
8) Neurofibrillary tangles and plaque
9) Defect in chromosome 14 and 1
Primary drugs to treat Alzheimer’s
1) Tacrine and donepezil
- Side effects: nausea, insomnia.
- Modest but noticeable improvement, but it does not stop or slow the progression of the disease.
2) Nicotine
- cholinergic agonist: it enhances the activity of acetylcholine in the brain
- Smoking decreases risk of Alzheimer’s and Parkinson’s
- Slows the progression of the disease in humans
- Improvement in cognitive function when wearing a nicotine patch
3) Estrogen, NSAIDs and Nerve Growth Factors
4) Antioxidant Vitamins
5) Vitamin E
- Slow or even prevent the condition
Causes of Vascular Dementia
1) Often caused by a stroke, resulting in…
- Reduction in capillaries and arteries that supply blood and oxygen to the brain
- Dead or dying brain tissue in a particular area
2) If capillaries are partially blocked, the effects are less pervasive, often referred to as “silent stroke.”
- Result is a milder form of vascular dementia
Symptoms of Vascular Dementia
1) Parallel that of Alzheimer’s
Except
2) Patients show unusual reflexes and movement abnormalities.
3) Strange gait
Risk Factors and Prevalence of Vascular Dementia
1) Cardiovascular disease risk factors, lesions in the white matter surrounding the ventricles
2) Occurs more often in males than females
3) African Americans at a higher risk of Alzheimer’s VD
4) More devastating affect on mental health than does Alzheimer’s disease.
Major depression 7x higher in people with VD (21%) than Alzheimer’s (3.2%)
Frontal Lobe Dementia
- Show variable, often mild memory deficits and little or no visuo-spatial impairment
- Marked changes in personality, disinhibition, unconcern, language problems and socially inappropriate behavior.
- More cognitive problems arise, including memory problems and apraxia, as the problem progresses.
- Between 50-60 years of age
Parkinson’s Dementia Prevalence
- 1 out of 100,000 people, onset after 60 years of age.
- 20-60% also show dementia
Symptoms of Parkinson’s Dementia
-Memory loss, particularly long-term memories, storing new information, procedural skills, deficits in executive functions, such as planning and organization
Who is at risk of Parkinson’s Dementia?
Patients with Parkinson’s disease who develop dementia from families with higher rate of other forms of dementia, including Alzheimer’s.
What is Parkinson’s Dementia Comorbid with?
- Most common symptom of those with Parkinson’s is depression
- 50% of them, with 26% on anti-depressants.
- Could be a direct consequence of the dopamine deficiency.
