Chapter 15 – Disorders of Aging and Cognition – Flashcards
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36 million people in the United States are
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"old" over 65 more than 12% of population
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Older women outnumber men
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3 to 2
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As many as ___ the elder people would benefit from mental health services yet fewer than ___ actually receive them
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half 20%
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gerosychology
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field of psychology dedicated to mental health of elderly people developed almost entirely within last 35 years only small percentage of clinicians work primarily with elderly persons
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Two Groups of Psychological problems of elderly persons
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Disorders connected to aging Disorders of cognition
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Disorders connected to aging
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depressive anxiety substance-related disorders
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Disorders of cognition
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delirium mild neurocognitive disorders majjor neurocognitive disorders result from brain abnormalities
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What is the most common mental health problems of older adults
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Depression highest in older women 20% of people experience depression in old age
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Depression jumps to __ percent who live in nursing homes
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32%
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Does depression raise chances of developing medical problems for elderly?
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Yes
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Elderly are more likely to commit suicide than young people
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True 16 per 100,000
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Anxiety Disorders men vs. women
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11% of elderly women 6% of elderly men
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Medications vs. elderly
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must be used cautiously/body breaks down drugs differently when older
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Substance Abuse vs. Elderly
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4-7% more men drinks as a result of aging death of a spouse/living alone/unwanted retirement
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misuse of prescription drugs
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leading substance problem in elderly elderly buy 30% of all prescription drugs 40% over the counter have to take so many/confusing medication or skipping doses is high
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Most elderly take at least ___ prescription drugs and ___ over the counter drugs
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5 2
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Misuse of medications in nursing homes
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anti-psychotic drugs being given to 30% of total nursing home population in US individuals do not display psychotic functioning given to quiet and manage patients
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Schizophrenia and Delusional disorder are disorders of
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Cognition within the elderly
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Schizophrenia young vs. old
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less common in older persons than younger ones symptoms of schizophrenia lessen later in life
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Schizophrenia of Elderly men vs. women
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women outnumber men by at least 2 to 1
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Delusional Disorder
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develop beliefs that are false but not bizarre 3 of every 10,000 increase in elderly population
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Leading cognitive disorders in elderly are
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delirium and neurocognitive
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Delirium
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major disturbance in attention and orientation to environment great difficulty concentrating and thinking in an organized way leads to illusions, misinterpretations, hallucinations
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Delirium develops over
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a period of time usually hours or days
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Percent of Elderly with Delirium
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1% over 55 14% over 85 1 in 10 shows symptoms of delirium entering hospital 10% develop delirium during their stay
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Delirium vs. nursing homes
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60% older than 75 have this compared to 35% living independently with assistance of home health services
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Causes of Delirium
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fever certain diseases infections poor nutrition head injuries strokes stress intoxication by certain substances
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Neurocognitive disorder
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experience significant decline in at least one (more than one) area of cognitivie functioning such as memory and learning motor skills/planning/decision making etc. also undergo personality changes
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Major neurocognitive disorder
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decline is substantial interferes significantly with ability to be independent
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Mild neurocognitive disorder
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decline is modest and does not interfere with independent functioning
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Alzheimer's disease
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most common type of neurocognitive disorder 2/3 of all cases 5 million ppl in US *to triple by 2050* vast majority occurs after 65 (late onset) can appear middle age (early onset)
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Onset of death with Alzheimer's
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8 to 10 years
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Death and Alzheimer's
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accounts for 75,000 deaths a year 7th leading cause of death in country *THIRD LEADING CAUSE AMONG THE ELDERLY*
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Alzehimer's diagnosis in brain
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excessive senile plaques and neurofibrillary tangles
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senile plaques
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sphere shaped deposits of a small molecule - beta-amyloid protein form in spaces between cells in hippocampus, cerebral cortex, nearby blood vessels occurs normally/higher for those with Alzheimer's
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Neurofibrillary tangles
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twisted protein fibers found within cells of hippocampus and certain other brain areas occur in all people as age extraordinary number produced with disease
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Genetic causes of Alzheimer's
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proteins fundamental components of all living cells abnormal activity by proteins/frenzied manner result in death of many neurons
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Tau
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another protein key to excessive formation of tangles
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Abnormalities in genes with two proteins Genetic Factors
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beta-amyloid precursor and presenilin protein families transmit mutations of one or both genes lead to abnormal functioning of proteins
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Late-Onset of Disease is result of
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genetic/environmental/lifestyle factors
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Apolipoprotein E (ApoE)
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normally responsible for production of a protein that helps carry various fats into bloodstream
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30% inherit ApoE-4 which is
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form of protein that is particularly vulnerable to development of Alzheimer's promotes excessive formation of proteins/spur formation of plaque/numerous tangles/death of neurons
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Brain and Alzheimer
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prefrontal lobes temporal lobes diencephalon involve damage to or improper functioning of one or more brain structures
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Biochemical and Alzheimer
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acetycholine glutamate RNA calcium -responsible for production of memory linked proteins abnormal activity leads to disease
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Zinc
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high levels found in those with disease observed to trigger clumping of beta-amyloid similar to disease
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Environmental toxins
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lead elderly exposed to high levels in 60s,70s damaged or destroyed neurons
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Autoimmune theory
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mistaken attack by immune system against itself helps lead to disease
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Viral Theory
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Resembles Creutzfeldt-Jakob disease (caused by slow-acting virus) propose similar virus may cause Alzheimer's *no such virus has been detected in brains of Alzheimer's victims*
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Most cases of Alzheimer's can be diagnosed with absolute certainty
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only after death when autopsy is performed
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PET Scan hippocampus
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new study developed cognitive impairments displayed lower hippocampus activity on their initial PET scans than participants who stayed healthy
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PET Scan accuracy
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mild 71% major 83%
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Vascular Neurocognitive disorder
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follows cerebrovascular accident or stroke blood flow to specific areas in brain was cut off; damaging the areas still have functioning in parts of brain where blood flow was not cut off
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Frontotemporal Neurocognitive Disorder
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Pick's Disease rare disorder affects frontal and temporal lobes similar to Alzheimer's *two can be distinguished at autopsy*
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Creutzfeldt-Jakob Disease
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spasms of the body caused by slow acting virus - live in body for years before disease develops once launched/disease is rapid
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Huntington's disease
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inherited progressive disease memory problems worsen over time personality changes mood difficulties movement problems too 50% of gaining it if parents had it
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Parkinson's disease
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slowly progressive neurological disorder tremors rigidity unsteadiness can result in neurocognitive due to Parkinson's in older people whose cases are advanced
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Neurocognitive disorders can be caused by
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HIV infections traumatic brain injury substance abuse various medical conditions/ meningitis/advanced syphilis
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Drug Treatment for Alzheimers
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tacrine (Cognex) donepezil (Aricept) rivastigmine (Exelon) galantamine (Reminyl) memantine (Namenda) improve slightly in short term memory/reasoning/language or take vitamin E helps slow down cognitive decline in mild stage of Alzheimers *administered after a person has the disease*
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Estrogen
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women who took hormone after menopause cut their risk of developing Alzheimer's in half
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Anti-Inflammatory Drugs
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ibuprofen and naprosyn may help reduce risk of disease *mixed*
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Cognitive Approach Alzheimer
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temporary success mental exercises stimulation programs help prevent or delay onset of disease
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Behavioral Approach Alzheimer
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physical exercise improve specific symptoms focus on changing everyday behaviors that are stressful /wandering/loss of bladder/ etc.
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___ percent of people with Alzheimer's are taken care of by their relatives
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90%
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Most common reason for institutionalization of Alzheimer's victims
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caregivers can no longer cope with difficulties of keeping them at home
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long term care
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services offered outside the family supervised apartment senior housing complex nursing home
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___ percent of elderly population actually live in nursing homes but as many as ___ percent eventually wind up being placed in such facilities
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5% 30%
