Chapter 15 - Disorders of Aging and Cognition Flashcards
age range when memory or attention issues seems to increase
60-70 years old
age-related cognitive decline
the normal instances of memory difficulties and lapses of attention that the DSM-5-TR considers normal
memory issues that do not have biological causes fall under this category
dissociative disorders
the typical cause of cognitive problems late in life
biological causes
delirium
a major disturbance in attention and orientation to the environment
what can the confusion caused by delirium sometimes lead to?
misinterpretations, illusions, and sometimes hallucinations
how long does it take delirium to develop?
hours or days
percent of non-elderly population that experiences delirium
0.5%
percent of people over 50 years old that experience delirum
1%, 14% over 85 years old
percent of elderly people that enter the hospital with symptoms of delirium
10%
percent range of people who develop delirium during their hospital stay
10-20%
percent of elderly who are admitted to surgery that develop delirium
17%
percent of elderly that are admitted suddenly for acute surgery
23%
percent range of nursing home residents with some delirium
18-50%
what can cause delirium?
fever, certain diseases and infections, poor nutrition, head injuries, strokes, stress (including the trauma of surgery), and intoxication by certain substances
why can delirium often be difficult to treat?
it is hard to detect
the cognitive functions that are affected in a person with a neurocognitive disorder
planning, memory, attention, visual perception, decision-making, language ability, or social awareness
when is a diagnosis of major neurocognitive disorder needed?
when a person’s cognitive decline is substantial and significantly interferes in their ability to live independently
when is a diagnosis of minor neurocognitive disorder needed?
when a person’s cognitive decline is modest and does not interfere with independent functioning
number of people in the world with a neurocognitive disorder
50 million
number of new cases of neurocognitive disorders
10 million
expected number of people with neurocognitive disorders by 2050
150 million
percent of people 65 years old with a neurocognitive disorder
1-2%
percent of people 85 years old with a neurocognitive disorder
50%
most common type of neurocognitive disorder
Alzheimer’s disease
number of people in the United States with Alzheimer’s disease
5.8 million people
expected number of people in the United States with Alzheimer’s disease by 2050
14 million people
percent of people 65-74 years old with Alzheimer’s disease
3%
percent of people 75-84 years old with Alzheimer’s disease
17%
percent of people 85 and older with Alzheimer’s disease
32%
ratio of women and men with Alzheimer’s disease
women twice as likely as men to get Alzheimer’s disease
racial differences among people with Alzheimer’s disease
African Americans and Hispanic Americans twice as likely as White Americans to develop Alzheimer’s disease
most prominent cognitive dysfunction in Alzheimer’s disease
memory impairment
Alzheimer’s diagnosis in early stages of Alzheimer’s
mild neurocognitive disorder due to Alzheimer’s disease
Alzheimer’s diagnosis in late stages of Alzheimer’s
major neurocognitive disorder due to Alzheimer’s disease
who was Alzheimer’s disease named after?
Alois Alzheimer, a German physician who discovered Alzheimer’s in 1907
average time between Alzheimer’s disease onset and death
4 to 8 years
beginning symptoms of Alzheimer’s disease
mild memory problems, lapses of attention, and difficulties in language and communication
late symptoms of Alzheimer’s disease
difficulty with simple tasks, forgetting distant memories, and very noticeable changes in personality
percent of people with Alzheimer’s disease who also develop a depressive disorder
40%
when does the physical health of people with Alzheimer’s usually decline?
when their mental functioning worsens to the point where they are essentially dependent on other people
number of deaths every year in the United States that can be tied to Alzheimer’s disease
122,000 deaths
6th leading cause of death in the United States
Alzheimer’s disease
structural features in the brain that indicate Alzheimer’s disease
senile plaques and neurofibrillary tangles
senile plaques
deposits of the beta-amyloid protein that form in the spaces between neurons in the hippocampus and cerebral cortex
neurofibrillary tangles
twisted protein fibers found within the neurons of the hippocampus and certain other brain structures
how do plaques lead to Alzheimer’s disease?
interfering with neuron-to-neuron communcations
how do tangles lead to Alzheimer’s disease?
blocking the transportation of essential molecules within neurons
what are proteins?
fundamental components of all living cells made up of chains of carbon, hydrogen, oxygen, nitrogen, and sulfer
two important proteins that contribute to plaques and tangles
beta-amyloid protein (plaques) and tau protein (tangles)
leading theory about the connection between beta-amyloid protein and tangles
plaques produced by beta-amyloid protein also cause tau proteins within neurons to start breaking down, resulting in tangles and the death of many neurons
percent of Alzheimer’s disease sufferers under 65 years old
less than 10%
type of Alzheimer’s disease onset that typically runs in families
early onset Alzheimer’s disease
proteins produced by genetic abnormalities in early onset Alzheimer’s disease
the beta-amyloid precursor protein and the presenilin protein
late-onset form Alzheimer’s disease seems to result from a combination of these three factors
genetic, environmental, and lifestyle factors
genetic factor that most leads to late-onset Alzheimer’s disease
the apolipoprotein E (ApopE) gene
chromosome that the ApopE gene is located on
chromosome 19
what is the Apop E gene generally responsible for?
for the production of a protein that helps transport cholesterol in the bloodstream
the form of the ApopE gene that 30% of the population inherits and leave people vulnerable to Alzheimer’s disease
E-4
what does the ApoE-4 gene do to contribute to Alzheimer’s?
it promotes the excessive formation of beta-amyloid proteins
important brain structure in short-term memory
the prefrontal cortex
important brain structures in the process of transforming short-term memory into long-term memory
the hippocampus, amygdala, thalamus, and hypothalamus
brain structures that may have poor interconnectivity or are generally dysfunctional in those with Alzheimer’s disease
prefrontal cortex, amygdala, hippocampus, thalamus, and hypothalamus
brain chemicals that are responsible for the production of memory-linked proteins
acetylcholine, glutamate, RNA, and calcium
natural substances in the brain that might act as toxins and contribute to Alzheimer’s disease
zinc (in high levels) and lead
the autoimmune theory of Alzheimer’s disease
changes in aging brain cells may trigger and autoimmune response that can lead to Alzheimer’s disease
autoimmune reaction
a mistaken attack by the immune system against itself
the prion theory of Alzheimer’s disease
Alzheimer’s disease resembles Creutzfeldt-Jakob disease, which is caused by prions, so Alzheimer’s disease might be caused by prions as well
the methods diagnosticians use to figure out if someone probably has Alzheimer’s disease
neuropsychological tests, brain scans, blood tests, and carefully noting family history of the patient
what are diagnosticians looking for when trying to diagnose Alzheimer’s disease?
biomarkers
biomarkers
biochemical, molecular, genetic, or structural characteristics that usually accompany Alzheimer’s disease
neuropsychological tests
tests that measure a person’s cognitive, perceptual, and motor performances on certain tasks
one important biomarker for Alzheimer’s disease
large numbers of beta-amyloid proteins and tau proteins
when do Alzheimer’s biomarkers typically appear?
years before the obvious onset of Alzheimer’s disease
two key aspects in the treatment of neurocognitive disorders
they try to prevent the problems in the first place and they are applied early
vascular neurological disorder
follows a stroke during which blood flow to specific areas of the brain was cut off, thus damaging the areas
frontotemporal neurocognitive disorder (AKA Pick’s disease)
a rare disorder that affects the temporal and frontal lobes
neurocognitive disorder due to prion disease (AKA Creutzfeldt-Jakob disease)
has symptoms that include spasms of the body
neurocognitive disorder due to Huntington’s disease
an inherited disease in which memory problems—along with personality changes, mood difficulties, and sever twitching and spasms—worsen over time
Parkinson’s disease
slowly progressive neurological disorder marked by tremors, rigidity, and unsteadiness; can result in neurocognitive disorder due to Parkinson’s disease
in the past many people were mistakenly diagnosed with neurological disorder due to Parkinson’s disease, when instead they suffered from this disorder
neurocognitive disorder due to Lewy body disease
neurocognitive disorder due to Lewy body disease
a buildup of clumps of protein deposits, called Lewy bodies, within many neurons
other causes of neurocognitive disorders that the book doesn’t say much about
HIV infection, traumatic brain injury, substance abuse, meningitis, and advanced syphilis
effectiveness of neurocognitive disorders
at most only modestly helpful
approaches to the treatment of neurocognitive disorders
drug therapy, cognitive-behavioral interventions, support for caregivers, and sociocultural approaches
what can no neurocognitive disorder intervention do?
stop the progression of the disorder
what are the drugs for treating Alzheimer’s meant to do?
to affect acetylcholine and glutamate
drugs for treating Alzheimer’s
donepezil (Aricept), rivastigmine (Exelon), galantamine (Reminyl), and memantine (Namenda)
what often improves after someone with Alzheimer’s disease begins drug treatment?
short-term memory gets better, their communication improves, and they are better able to cope when under pressure
vitamin that some people believe helps to treat Alzheimer’s disease
vitamin E
when do clinicians believe that drug treatment is most effective?
when it is given to people in the early, mild stage of Alzheimer’s disease
drug treatment that helps prevent Alzheimer’s disease in women years into menopause
estrogen treatment
drug treatments that help prevent Alzheimer’s disease
long-term use of nonsteroidal anti-inflammatory drugs such as ibuprofen and naprosyn
cognitive techniques in the treatment of Alzheimer’s disease
computer-based cognitive stimulation programs and cognitively stimulation activities (writing letters, reading, following the news, and attending plays/concerts) help lower risk of Alzheimer’s disease
behavioral techniques in the treatment of Alzheimer’s disease
physical exercise and changing the behaviors the patient’s family find stressful
the process of changing the behaviors the patient’s family find stressful
role-playing exercises, modeling, and practice to teach family members how and when to use reinforcement to shape more positive behaviors
percentage of people with Alzheimer’s disease who are taken care of by family, usually their adult children or spouses
90%
one of the most frequent reasons for the institutionalization of people with Alzheimer’s disease
their caregivers are overwhelmed and can no longer cope with the difficulties of keeping them at home
sociocultural approaches to the treatment of Alzheimer’s disease
day-care facilities and assisted-living facilities
day-care facilities
they provide treatment programs and activities for outpatients during the day and returning them to their homes and families at night
assisted-living facilities
those suffering from neurocognitive impairments live in cheerful apartments, receive needed supervision, and take part in stimulating activities
use of devices in the management of Alzheimer’s disease
tracking beacons worn on the wrists or shows that contain a GPS tracker help locate patients who may wander off
three issues affecting the mental health of older adults
racial discrimination towards the elderly who are part of minority racial groups, the inadequacies of long-term care, and the need for a health-maintenance approach to medical care
double jeopardy
to be both a member of a minority group and to be old
triple jeopardy
to be old, a member of a minority group, and to be a woman
elderly women are more likely than elderly men to be . . .
living alone, widowed, and poor
some ways in which elderly people in minority groups might be unlikely to receive proper treatment
language barrier between patient and clinician, cultural beliefs that prevent them from receiving health services, and not knowing about culturally sensitive treatments
what is a common fate for many elderly members of racial and ethnic minority groups that suffer from medical or mental illnesses?
to rely largely on family members or friends for remedies and health care
percent of older adults in the United States that live with their children because of increasing health problems
10%
long-term care
a general term that may refer variously to the services offered outside the family in some kind of care facility
percent of the elderly US population that actually lives in nursing homes
3%
percent of people 85 years and older that do eventually wind up living in long-term care facilities
15%
the average cost per year for a nursing home room in the US
$80,000 per year
can insurance companies pay for the cost of living in a long-term care facility?
they often do not adequately cover the costs of long-term care facilities
health-maintenance approach to the aging process
do things that promote physical and mental health
what will help the elderly adapt more readily to change and negative events?
having a health-maintenance approach to the aging process
