disorders of later life Flashcards
old age facts
- mild decline in cognitive functioning is common
- experience less negative emotions for shorter period of time
sleep
- the quality and depth of sleep decline
- sleep apnoea: person stops breathing for seconds to minutes during the night
medical treatment
- hard to treat them when chronic health problems never go away and no cure is available chronic health problems seldom diminish
- multiple chronic conditions and poor communication
- doctors do not check to see if the person is taking other medications or seeing other health service providers)
- Polypharmacy, the prescribing of multiple drugs to a person –> adverse drug reactions such as side effects and toxicity.
- most psychoactive drugs are tested on younger people –> side effects and toxicity are much more likely as people age
social selectivity
: When we have less time ahead of us, we tend to place a higher value on emotional intimacy than on exploring the world - spend our limited time with our closest ties rather than with casual acquaintances
sometimes mistaken for depression
Estimating the prevalence of psychological disorders in late life
- persons over age 65 have the lowest prevalence of psychological disorders of all age groups.
- Late onset is also extremely rare for schizophrenia
- late onset is more common for alcohol dependence among older adults with drinking problems
- ageing is also genuinely related to better mental health.
Dementia
progressive deterioration of cognitive abilities to the point that functioning becomes impaired.
Alzheimer’s disease, frontotemporal dementia, vascular dementia and dementia with Lewy bodies
-gradual onset, and are progressive and irreversible
DSM-5 criteria for mild neurocognitive disorder
experience modest cognitive decline from previous levels in one or more domains (complex attention, memory, language, executive function, social cognition)
based on both of the following:
– concerns of the patient, a close other or a clinician
– modest neurocognitive decline on formal testing or equivalent clinical evaluation.
– The cognitive deficits do not interfere with independence in everyday activities (e.g., paying bills or managing medications), even though greater effort, compensatory strategies or accommodation may be required to maintain independence.
– The cognitive deficits do not occur exclusively in the context of delirium and are not due to another psychological disorder.
o require a low score on only one cognitive test. This may lead to an artificially high rate of diagnosis for mild neurocognitive disorder
DSM-5 criteria for major neurocognitive disorder
experience significant cognitive decline from previous levels in one or more domains (complex attention, memory, language, executive function, social cognition) based on both of the following:
– concerns of the patient, a close other or a clinician
– substantial neurocognitive impairment preferably documented by standardised neuropsychological testing or equivalent clinical evaluation.
– The cognitive deficits interfere with independence in everyday activities.
– The cognitive deficits do not occur exclusively in the context of delirium and are not due to another psychological disorder.
-The DSM-5 distinguishes between mild and major neurocognitive disorder based on whether symptoms interfere with the ability to live independently.
Alzheimer’s disease- Alois Alzheimer
- most common type of dementia ( 60 to 80 % of cases)
- Death usually occurs within 12 years after onset
Characterized by progressive cognitive deterioration which affects: o Memory o Language o Praxis o Visuospatial abilities o Executive skills
Insidious onset: symptoms have gradual onset over months or years (usually, 2-3 years before diagnosed)
Early stages of alzheimers
Early stages
- Problems coming up with the right word or name
- Trouble remembering names
- Having greater difficulty performing tasks in social or work settings
- Forgetting material that one has just read
- Losing or misplacing objects
- Increasing trouble with planning or organising
Moderate stages of alzheimers
- Forgetfulness of events or about one’s own personal history
- Confusion about location or date
- Changes in sleep patterns, such as sleeping during the day and becoming restless at night
- wandering and becoming lost
- Personality and behavioural changes, including suspiciousness and delusions or compulsive, repetitive behaviour like handwringing or tissue shredding
Late stages of alzheimers
- Require full-time, around-theclock assistance with daily personal care
- Reduced awareness of recent experiences as well as surroundings
- Experience changes in physical abilities, including the ability to walk, sit and, eventually, swallow
- Have increasing difficulty communicating Become vulnerable to infections (e.g. pneumonia)
neurological problems in alzheimers
amyloid plaques
- amyloid plaques (small, round beta-amyloid protein deposits that are outside the neurons) * frontal cortex and they may be present for 10 to 20 years before the cognitive symptoms become noticeable.
o produce excessive amounts of beta-amyloid, whereas others seem to have deficiencies in the mechanisms for clearing beta-amyloid from the brain
neurofibrillary tangles
- neurofibrillary tangles (twisted protein filaments composed largely of the protein tau in the axons of neurons) densely present in the hippocampus, an area that is important for memory.
responses to plaques lead to inflammation which then triggers a series of brain changes over time
- At early stages, there seems to be a loss of synapses for acetylcholinergic (ACh) and glutamatergic neurons
- As neurons die, the entorhinal cortex and then the hippocampus and other regions of the cerebral cortex shrink, and later the frontal, temporal and parietal lobes shrink
As this happens, the ventricles become enlarged
- The cerebellum, spinal cord and motor and sensory areas of the cortex are less affected
apolipoprotein ε4 or ApoE-4 allele
polymorphism of a gene on chromosome 19,
- ε4 interfere with clearing excess beta-amyloid peptide from the brain.
- 2 of the ε4 alleles show overproduction of beta-amyloid plaques, loss of neurons in the hippocampus and low glucose metabolism
High cholesterol and metabolism in alzheimers
- Immune processes and excessively high cholesterol can trigger inflammation and appear related to a greater risk of Alzheimer’s disease.
- type II diabetes, which has been tied to immune and inflammatory changes, is related to greater risk of developing Alzheimer’s disease
- Similarly, brain traumas from accidents or injuries can also increase the risk of Alzheimer’s disease later in life
Lifestyle contributing to alzheimers
- smoking, being single, obesity, depression and low social support are related to a greater risk of Alzheimer’s disease
- while a Mediterranean diet, exercise, education and engagement in cognitive activities are related to a lower risk
protective factors for alzheimers
exercise
- Regular exercise predicts less decline in cognitive functions
- Exercising = lower levels of plaques in the brain and particularly so for those with the ApoE-4 polymorphism
Intellectual brain games
- ‘use it or lose it’
- frequent cognitive activity (e.g., reading and puzzle solving)
- protects against cognitive decline for those with the ApoE-4 polymorphism
- cognitive reserve or the idea that some people may be able to compensate for the disease by using alternative brain networks or cognitive strategies such that cognitive ¬symptoms are less pronounced.
