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CHAPTER 16 DEVELOPMENTAL PSYCHOPATHOLOGY. Learning Objectives What criteria are used to define and diagnose psychological disorders? What is the perspective.

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Presentation on theme: "CHAPTER 16 DEVELOPMENTAL PSYCHOPATHOLOGY. Learning Objectives What criteria are used to define and diagnose psychological disorders? What is the perspective."— Presentation transcript:

1 CHAPTER 16 DEVELOPMENTAL PSYCHOPATHOLOGY

2 Learning Objectives What criteria are used to define and diagnose psychological disorders? What is the perspective of the field of developmental psychopathology? What sorts of questions or issues do developmental psychopathologists study? How does the diathesis-stress model explain the causes of psychopathology?

3 What Makes Development Abnormal? Mental health professionals use three criteria to differentiate between normal and abnormal behavior –Statistical deviance Does the person’s behavior fall outside the normal range of behavior? –Maladaptiveness Does the person’s behavior interfere with adaptation or pose a danger to self or others? –Personal distress Does the behavior cause personal anguish or discomfort?

4 What Makes Development Abnormal? DSM Diagnostic Criteria Professionals who diagnose and treat psychological disorders use the criteria of the Diagnostic and Statistical Manual of Mental Disorders (1994) –DSM-IV-TR published in 2000 –DSM-V to be published in 2013

5 What Makes Development Abnormal? DSM Diagnostic Criteria According to the DSM-IV-TR diagnostic criteria for major depressive disorder, an individual must experience at least 5 of the following symptoms, including one of the first two, persistently within a 2-week period 1.Depressed mood (or irritable mood in children and adolescents) nearly every day 2.G reatly decreased interest or pleasure in all, or almost all, usual activities most of the day 3.S ignificant weight loss when not dieting or weight gain (or for children, failure to achieve expected weight gains)

6 What Makes Development Abnormal? DSM Diagnostic Criteria The DSM-IV-TR diagnostic criteria for major depressive disorder (continued) 4. Insomnia or sleeping too much 5. Psychomotor agitation or sluggishness/slowing of behavior observable by other people 6. Fatigue and loss of energy 7. Feelings of worthlessness or extreme guilt 8. Decreased ability to think or concentrate or indecisiveness 9. Recurring thoughts of death, recurring suicidal ideas, or a suicide attempt or specific plan to commit suicide

7 What Makes Development Abnormal? DSM Diagnostic Criteria The DSM-IV-TR diagnostic criteria manual calls for distinguishing major depressive disorder from other disorders and requires that the symptoms cause significant distress or impaired functioning and are not due to the direct effects of a substance (an abused drug or a medication) or a general medical condition Symptoms should not be described as reactions to bereavement –To qualify as major depressive disorder, grief reactions would need to persist for more than 2 months after a death and involve serious symptomatology

8 What Makes Development Abnormal? Developmental Psychopathology Sroufe and Rutter (1984) define developmental psychopathology as the study of the origins and course of maladaptive behavior –Evaluate abnormal development in relation to normal development and study the two in tandem

9 Caption: Developmental pathways leading to normal and abnormal outcomes

10 What Makes Development Abnormal? Developmental Psychopathology March (2009) believes that psychological disorders should be viewed as lifespan neurodevelopmental disorders –This perspective requires looking at normal and abnormal pathways of brain development and their implications for functioning and intervening early with individuals who are at risk for various disorders to put them on healthier developmental trajectories

11 What Makes Development Abnormal? Developmental Psychopathology Developmental psychopathologists regard behaviors as abnormal or normal according to their social and developmental contexts –Social norms are expectations about how to behave in a particular social context –Age norms are societal expectations about what behavior is appropriate or normal at various ages

12 What Makes Development Abnormal? Developmental Psychopathology Two major developmental issues are relevant to understanding the pathways to adaptive or maladaptive functioning –Nature and nurture –Continuity and discontinuity

13 What Makes Development Abnormal? Developmental Psychopathology Understanding the developmental pathways of psychopathology in light of the nature-nurture issue involves asking questions such as –How do biological, psychological, and social factors interact over time to give rise to psychological disorders? –What are the important risk factors for psychological disorders, and what are the protective factors that keep some individuals who are at risk from developing disorders?

14 What Makes Development Abnormal? Developmental Psychopathology Understanding the developmental pathways of psychopathology in light of the continuity- discontinuity issue involves asking questions such as –Are most childhood problems passing phases that have no bearing on adjustment in adulthood, or does poor functioning in childhood predict poor functioning later in life? –How do expressions of psychopathology change as the developmental status of the individual changes?

15 What Makes Development Abnormal? Developmental Psychopathology Developmental psychopathologists have proposed a diathesis-stress model to explain how nature and nurture contribute to psychopathology –Suggests that psychopathology results from the interaction over time of a predisposition or vulnerability to psychological disorder and the experience of stressful events The predisposition or vulnerability is called a diathesis, which can involve a particular genetic makeup, physiology, set of cognitions, personality, or a combination of these

16 Caption: The diathesis-stress model

17 Learning Objectives What are the characteristics, suspected causes, treatment, and prognosis for individuals with autism and its related syndromes? In what ways do infants exhibit depression- like conditions? How is depression in infants similar to, or different from, depression in adults?

18 The Infant – Autism Autism is a serious disorder that begins in infancy and is characterized by –Abnormal social development Difficulty forming normal social relationships, responding appropriately to social cues, and sharing social experiences with others –Impaired language and communication May be mute or may have language but be unable to communicate –May use flat, robotic tone, reverse pronouns, and engage in echolalia, parroting of another’s speech –Repetitive behavior Engage in stereotyped behaviors (rocking) or rituals Highly distressed when the physical environment is altered

19 The Infant – Autism Autism is one of the autism spectrum disorders Labeled in the DSM-IV as “pervasive developmental disorders” Asperger syndrome is another of the autism spectrum disorders – Characterized by normal or above-average intelligence and good verbal skills – The individual desires to establish social relationships but has seriously deficient social- cognitive and social-communication skills – Affected children are sometimes called “little professors” because they talk at length about topics that interest them

20 The Infant – Autism In 2006 the autism spectrum disorders affected almost 9 of 1,000 8-year-olds According to 2005 data, autism (in the narrow sense) affected about 20 of 10,000 children There are 4 or 5 affected boys for every girl Researchers believe that the increase in rates of autistic spectrum disorders is a result of increased awareness of autism, broader definitions of it to include the entire autistic spectrum (including mild cases), and better recognition and diagnosis of cases that might previously have been diagnosed as language impairments, learning disabilities, or even odd personalities

21 The Infant – Autism Autistic children display autistic characteristics before age 3 and likely were autistic from birth Early screening and diagnosis enables early treatment and improved developmental outcomes The longer autistic infants are undiagnosed and therefore are not learning about the social world, the more severe their social and communicative problems become

22 The Infant – Autism Autistic infants fail to display normal infant behaviors such as – Orientation to human voices – Babbling – First words – Preference for human over nonhuman stimuli – Eye contact – Visual focus on faces in a scene (autistic babies tend to focus on objects in the background) – Joint attention (a key precursor of theory-of- mind skills) – Reciprocity or taking turns (as in mutual smiling and peek-a-boo games)

23 The Infant – Autism Suspected causes of autism include the following - Genes related to neural communication appear to have been copied incorrectly “Copy number variations” - Environmental contributors A virus or chemical could interact with a genetic predisposition to autism Epigenetic influences that turn genes that guide brain development on or off could be involved Prenatal exposure to teratogens can contribute to ASDs Maternal bleeding or pregnancy complications could be involved

24 The Infant – Autism Suspected causes of autism include the following conditions (continued) - Early brain overgrowth Neurons in the frontal cortex and/or the amygdala proliferate wildly during the early sensitive period for brain development in infancy and do not become properly interconnected with other areas of the brain so that they can integrate brain signals from these other areas

25 The Infant – Autism Suspected causes of autism include the following conditions (continued) - Malfunctioning of the mirror neuron systems Mirror neuron systems allow us to make sense of other people’s feelings and thoughts by reacting to them as though they were feelings and thoughts we have experienced ourselves - Malfunctioning of mirror neuron systems located in a number of brain areas could account for the deficits individuals with autism show in imitation, theory-of-mind skills, empathy, and language

26 The Infant – Autism The autism spectrum disorders involve multiple cognitive impairments - Autistic individuals have difficulty with certain executive functions Higher-level control functions based in the prefrontal cortex of the brain that allow us to plan, change flexibly from one course of action to another, and inhibit actions This may explain the repetitive behaviors The tendency to focus on details is accompanied by difficulty integrating pieces of information to get “the big picture” or overall meaning

27 The Infant – Autism Previously, the long-term outcome for individuals with ASDs has been poor, especially if autism is accompanied by intellectual disability - Most individuals with autism improve in functioning, but they are usually autistic for life - Positive outcomes are most likely among those who have IQ scores above 70 and reasonably good communication skills by age 5

28 The Infant – Autism The most effective approach to treating autism is intensive and highly structured behavioral and educational programming, beginning as early as possible, continuing throughout childhood, and involving the family -The goal is to make the most of the plasticity of the young brain during its sensitive period for development

29 The Infant – Depression Infants can exhibit some of the behavioral symptoms and somatic (bodily) symptoms of depression Depressive symptoms are most likely to be observed in infants who lack a secure attachment relationship or who experience a disruption of an all-important attachment Infants who display a disorganized pattern of attachment are especially likely to show symptoms of depression

30 The Infant – Depression Infants whose mother or father are depressed are at risk for depression –They use an interaction style that resembles that of their caregivers They vocalize little, look sad, and show developmental delays Infants who are abused, neglected, separated from attachment figures, or raised in a stressful, unaffectionate manner may develop failure to thrive –A life-threatening disorder in which infants fail to grow normally, lose weight, become seriously underweight for their age, and often are developmentally delayed

31 Learning Objectives What are the symptoms, suspected causes, treatment, and long-term prognosis for children with ADHD? How is depression during childhood similar to, or different from, depression during adulthood? How do interactions of nature and nurture contribute to psychological disorders? Do childhood problems persist into adolescence and adulthood?

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33 The Child – Externalizing and Internalizing Problems Two broad categories are used to refer to whether a child’s behavior is out of control or overly controlled –Externalizing problems –Internalizing problems When children have externalizing problems, they act out in ways that disturb other people and violate social expectations When children have internalizing problems, negative emotions are internalized or bottled up rather than externalized or expressed

34 The Child – Externalizing and Internalizing Problems Externalizing behaviors decrease from age 4 to age 18 Internalizing difficulties increase during this time Externalizing problems are typically more common among boys Internalizing problems are more prevalent among girls, across cultures Children from low socioeconomic homes show more externalizing and internalizing problems than higher SES children do, partly because their environments are more stressful

35 The Child – Externalizing and Internalizing Problems It is helpful to view developmental disorders from a family systems perspective and to consider how emerging problems affect and are affected by family interactions Problems are located not in an individual family member but in a whole family – From a family systems perspective, parents both influence and are influenced by their children, and the family also functions in a larger environment that influences it

36 The Child – Externalizing and Internalizing Problems As the diathesis-stress model suggests, disorders often arise from the toxic interaction of a genetic vulnerability and stressful experiences Abnormal development, like normal development, is the product of both nature and nurture and of a history of complex transactions between person and environment in which each influences the other

37 The Child – Externalizing and Internalizing Problems The research of Caspi and colleagues (1996) suggests that there is continuity in susceptibility to problems over the years and that early problems tend to have significance for later development –Children who had externalizing problems (such as aggression) as young children and were described as irritable, impulsive, and rough were more likely than inhibited, overcontrolled children, or well- adjusted children to be diagnosed as having antisocial personality disorder and to have records of criminal behavior as young adults –Internalizers – inhibited children who were extremely shy, anxious, and upsettable at age 3 – were more likely than other children to be diagnosed as depressed as young adults

38 The Child – Externalizing and Internalizing Problems The research of Caspi and colleagues (1996) suggested that there is continuity in susceptibility to problems over the years and suggested that early problems tend to have significance for later development –Children who had externalizing problems were more likely to be diagnosed as having antisocial personality disorder and to have records of criminal behavior as young adults –Internalizers – inhibited children – were more likely than other children to be diagnosed as depressed as young adults However, the study also revealed discontinuity –The relationship between early behavioral problems and later psychology pathology was weak – most children with temperaments that put them at risk did not have diagnosable problems as adults

39 The Child – Depression Children as young as age 3 can meet the same criteria for major depressive disorder that are used to diagnose adults An estimated 2% of children have diagnosable depressive disorders Depression may coexist with other distinct diagnoses such as conduct disorder, attention deficit hyperactivity disorder, and anxiety disorder The co-occurrence of two or more psychiatric conditions in the same individual is called comorbidity –Comorbidity is very common throughout the lifespan

40 The Child – Depression Depression in children may manifest with behavioral and somatic symptoms of depression such as losing interest in activities, or eating poorly They are prone to be anxious As early as age 3, children who are depressed may express excessive shame or guilt (for example, saying that they are bad) Some depressed children act out themes of death and suicide in their play Depressed children are sad or irritable and show the same lack of interest in usually enjoyable activities that depressed adults do Children as young as age 2 or 3 are capable of attempting suicide

41 The Child – Depression The carryover of depression problems from childhood to adulthood is not as strong as carryover from adolescence to adulthood However, research has shown that 5- and 6- year-olds who report many depression symptoms are more likely than their peers as adolescents to be depressed, to think suicidal thoughts, to struggle academically, and to be perceived as in need of mental health services It is estimated that half of children and adolescents diagnosed as having major depressive disorder have recurrences in adulthood

42 The Child – Depression Most depressed children respond well to psychotherapy –Cognitive behavioral therapy attempts to identify and change distorted thinking and the maladaptive emotions and behavior that stem from it –The category of antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) may be used to correct for low levels of the neurotransmitter serotonin in the brains of depressed individuals However, SSRIs do not appear to be as effective with children as with adults Some research suggested that SSRIs may increase the risk of suicidal thoughts and behavior among child and adolescent users, causing the U.S. government to issue a warning to that effect in 2004

43 Learning Objectives Are psychological problems more prevalent during adolescence than other periods of the lifespan? What are the characteristics, suspected causes, and treatment of eating disorders such as anorexia nervosa? What is the course of depression and suicidal behavior during adolescence? What factors influence depression during adulthood?

44 The Adolescent – Storm and Stress? Adolescence is a period of risk-taking, of problem behaviors such as substance abuse and delinquency, and of heightened vulnerability to some forms of psychological disorder – Among adolescents, there is a 20% rate of diagnosable psychological disorder at a given time –Most adolescents cope with the challenges of teenage life remarkably well and maintain the level of adjustment they had when they entered adolescence –However, for a minority of adolescents, a buildup of stressors can precipitate serious psychopathology

45 The Adolescent – Eating Disorders Anorexia nervosa (“nervous loss of appetite”) has been defined as a refusal to maintain a weight that is at least 85% of the expected weight for the person’s height and age Anorexic individuals are also characterized by a strong fear of becoming overweight, a distorted body image (a tendency to view themselves as fat even when they are emaciated), and, if they are females, an absence of regular menstrual cycles

46 The Adolescent – Eating Disorders Another eating disorder is bulimia nervosa (the so-called binge-purge syndrome), which involves recurrent episodes of consuming huge quantities of food followed by purging activities such as self-induced vomiting, use of laxatives, or rigid dieting and fasting

47 The Adolescent – Eating Disorders Approximately 3 in every 1,000 adolescent girls experience anorexia There are about 11 female victims for every 1 male victim Anorexia is evident at all socioeconomic levels and in all racial and ethnic groups

48 The Adolescent – Eating Disorders Both nature and nurture contribute to eating disorders –On the nurture side, cultural factors are influential, especially the Westernized ideal of thinness as the standard of physical attractiveness –On the nature side, researchers believe that genes serve as a diathesis, predisposing certain individuals to develop eating disorders Genes may contribute to low levels of the neurotransmitter serotonin, which is involved in both appetite and mood and has been linked to both eating disorders and mood disorders

49 The Adolescent – Eating Disorders Both nature and nurture contribute to eating disorders –On the nature side (continued) The neurotransmitter dopamine has also been implicated, as it is involved in the brain’s reward system, and some evidence suggests that eating disorders, like alcohol and drug addiction, involve compulsive behavior that is reinforcing Genes also may contribute to a personality profile that puts certain individuals at risk –Females with anorexia tend to be highly anxious and obsessive perfectionists

50 The Adolescent – Eating Disorders The interaction of nature and nurture –However, anorexia may not emerge unless a genetically predisposed girl living in a weight- conscious culture experiences stressful events Genes and environment interact to produce a disorder

51 The Adolescent – Eating Disorders Treatment for individuals with anorexia begins with behavior modification programs designed to bring their eating behavior under control, help them gain weight, and deal with any medical problems they may have Then the individual may begin psychotherapy designed to help her understand and gain control of the problem –Possibly family therapy designed to change parent-child relationships The Maudsley approach to family therapy views the family as part of the treatment team and requires cooperation of all family members –Medication for depression

52 The Adolescent – Substance Abuse Disorders Substance abuse and dependence take heavy tolls on development –Substance abuse occurs when use of a substance has adverse consequences such as putting the person in physically dangerous situations, interfering with performance in school or at work, or contributing to interpersonal problems –Substance dependence refers to continued use despite significant problems, as indicated by such signs as compulsive use, increased tolerance for the drug, withdrawal symptoms if use is terminated, and inability to quit

53 Caption: Percentage of adolescents in grades 8, 10, and 12 who report ever using various substances

54 The Adolescent – Substance Abuse Disorders The University of Michigan Monitoring the Future study has tracked adolescent substance use –The reported rates of usage were highest in the 1970s and early 1980s, lower in the 1990s, and increased again in 2008 –There is an increase with age in use of most substances (except inhalants) – The use of alcohol is widespread 8 th graders, 10 th graders, 12 th graders, and college students report binge-drinking –Native-American youth have high rates of use, Hispanic white and non-Hispanic white youth have medium rates, and Asian- and African-American youth have lower rates –Traditionally, males have had higher rates of substance use and abuse than females, but the gap has been narrowing

55 The Adolescent – Substance Abuse Disorders The developmental pathway to adolescent substance use and abuse begins in childhood Dodge and others (2009) developed a cascade model of substance use to illustrate that adolescent problem behaviors and psychological disorders grow out of the accumulating effects of transactions between an individual and parents, peers, and other aspects of the social environment over many years

56 Caption: A cascade model of substance use

57 The Adolescent – Substance Abuse Disorders The cascade model of substance use illustrates the chain of influences, starting with (1)A child who is at risk due to a difficult temperament, (2)Born into an adverse family environment characterized by such problems as poverty, stress, and substance use, who is then (3) Exposed to harsh parenting and family conflict, (4) Develops behavior problems, especially aggression and conduct problems, as a result, and

58 The Adolescent – Substance Abuse Disorders The cascade model of substance use illustrates the chain of influences (continued) (5) Is therefore rejected by peers and gets into more trouble at school, causing (6) Parents, perhaps in frustration, to give up trying to monitor and supervise their now difficult-to-control adolescent child, which contributes to (7) Involvement in a deviant peer group, where the adolescent is exposed to and reinforced for drug taking and other deviant behaviors

59 The Adolescent – Substance Abuse Disorders Substance use disorders are often comorbid with other disorders such as depression and anxiety disorders –Some of the same genes seem to contribute to both substance abuse and internalizing disorders like depression –It is likely that substance abuse develops as a way to cope with emotional problems through self-medication Preventive interventions to delay drinking and drug use in adolescence can deter problematic substance use in adulthood

60 The Adolescent – Depression and Suicidal Behavior Before puberty, boys and girls have similarly low rates of depression After puberty, rates climb and the rate for girls becomes higher than that for boys Up to 35% of adolescents experience depressed moods at some time, and as many as 7% have diagnosable depressive disorders at any given time Symptoms are mostly like those displayed by depressed adults, although depressed adolescents sometimes act out and look more like delinquents than like victims of depression

61 The Adolescent – Depression and Suicidal Behavior Genetic influences on symptoms of depression seem to become stronger in adolescence than they were in childhood The changes of puberty and the timing of puberty may be factors Teens (especially females) who have experienced family disruption and loss in childhood may be especially vulnerable to interpersonal stress after they reach puberty –Stressful events, especially interpersonal ones such as family disruption, predict increases in depressive symptoms Girls are more likely than boys to use ruminative coping, or unproductively dwell on their problems

62 The Adolescent – Depression and Suicidal Behavior Suicidal thoughts, suicide attempts, and completed suicides become more common from childhood to adolescence Suicide is the third leading cause of death for the 15- to 24-year-old age group –The annual rate is 10 per 100,000 for this age group Although more adults commit suicide, adolescents attempt suicide more frequently

63 Caption: Number of suicides per 100,000 people by age and sex among European Americans, African Americans, and Hispanic Americans in the United States

64 The Adolescent – Depression and Suicidal Behavior Suicidal behavior in adolescence is the result of diathesis- stress Four key risk factors are –An existing psychological disorder Such as depression, substance-related disorder, anxiety disorder, or another diagnosable psychological condition –Family pathology and psychopathology Such as a history of troubled family relationships or a family history of psychopathology and suicide –Stressful life events Such as deteriorating relationships with family and peers, academic and social failures, problems with the law –Access to firearms Which makes it easy to act on suicidal impulses

65 Learning Objectives What factors contribute to the onset of major depressive disorders in adulthood? What factors make it challenging to diagnose of major depressive disorder among older adults? What are the characteristics and causes of dementia?

66 The Adult Stressful experiences in childhood and adolescence increase a person’s chances of psychological disorder later in life –Psychological problems then emerge when a vulnerable individual faces overwhelming stress –The greatest number of life strains occur in early adulthood and then decrease from early to middle adulthood

67 The Adult Rates of affective disorders (major depression and related mood disorders), alcohol abuse and dependence, schizophrenia, anxiety disorders, and antisocial personality all decrease from early adulthood to late life Cognitive impairment is the only category of disorder that increases with age Overall, about one-fourth of American adults experienced a psychological disorder in the past year (reported in 2005)

68 The Adult – Depression The average age of onset of major depression is in the early 20s About 28% of Americans will experience a diagnosable mood disorder by age 75 Compared to young or middle-aged adults, older adults tend to be less vulnerable to major depression and other affective disorders Unless older adults develop physical health problems that contribute to depression or experience increasing (rather than decreasing) levels of stress as they age, their mental health is likely to be good

69 The Adult – Depression Reports of depression symptoms, if not diagnosable disorders, increase when people reach their 70s and beyond –Possibly this is because depression can be difficult to diagnose in later adulthood –Symptoms of depression may be interpreted as normal aging, as chronic illness, or as signs of dementia

70 The Adult – Depression In many cultures, beginning in adolescence, females are more likely than males to be diagnosed as depressed by a margin of about 2 to 1 –This gender difference probably results from a variety of factors Hormones and biological reactions to stress Levels of stress Ways of expressing distress –Women more likely to express classic depression symptoms; men more likely to become angry or overindulge in alcohol and drugs Styles of coping with distress –Women tend to engage in more ruminative coping; men tend to distract themselves from problems In late life, the rates of depression become similar for males and females

71 The Adult – Depression Many adults who have major depression are undiagnosed and untreated –Especially elderly adults and those who are African American and other minority group members Failure to diagnose and treat may occur because –Depression and anxiety may be seen as a normal part of getting older or of becoming ill –Mental health problems are stigmatized (seen as shameful) –Mental health professionals may underdiagnose or misdiagnose the problems of elderly individuals –Mental health professionals may believe that elderly adults as less treatable than younger adults

72 The Adult – Aging and Dementia Dementia is a progressive deterioration of neural functioning associated with cognitive decline –Includes memory impairment, declines in tested intellectual ability, poor judgment, difficulty in abstract thinking, and possibly personality changes Rates of dementia increase steadily with age –Overall, dementia affects 6-8% of elderly adults age 65 and older –Rates climb steeply with age, from less than 1% in the 60-to-64 age group to around 30% for people 85 and older

73 The Adult – Aging and Dementia Alzheimer’s disease is one form of dementia –In the DSM-IV-TR, the disease is referred to as dementia of the Alzheimer’s type Alzheimer’s disease has two characteristic features in the brain –Senile plaques – masses of dying neural material with a toxic protein that damages neurons, beta-amyloid, at their core –Neurofibrillary tangles – twisted strands of neural fibers within the bodies of neural cells

74 The Adult – Aging and Dementia The first noticeable signs of Alzheimer’s disease emerge 2-3 years before diagnosis is possible –For example, difficulties in learning and remembering recently encountered verbal material such as names and phone numbers In the early stages, free recall tasks are difficult, but memory is good if cues to recall are provided With progression of the disease, people may have trouble remembering both new and old information, forget mid-way through a task, or lack orientation to time and place

75 The Adult – Aging and Dementia Eventually those with Alzheimer’s disease become incapable of self-care, no longer recognize loved ones, and lose all verbal abilities Death occurs, on average, 8 to 10 years after onset of the disease Other symptoms may include agitation and uncontrollable behavior, depression, and possibly psychotic symptoms such as a hallucinations

76 The Adult – Aging and Dementia Alzheimer’s disease has a genetic basis, but there is no single “Alzheimer’s gene” Alzheimer’s disease may be characterized as “early onset” or “late onset” –A gene on the 21 st pair of chromosomes may be associated with the early onset form of the disease –Genetic contributors to late-onset Alzheimer’s disease are more common than the early- onset variety and are not as clearcut or strong Rather than making Alzheimer’s disease inevitable, a number of genes only increase a person’s risk slightly

77 The Adult – Aging and Dementia One variant of a gene on chromosome 19 has been associated with late-onset Alzheimer’s disease –The gene is responsible for the production of ApoE, a protein involved in processing cholesterol It is believed that the ApoE4 gene may increase the buildup of beta-amyloid – the damaging substance in senile plaques – and therefore speed the progression of Alzheimer’s disease –Having two of the risk-inducing ApoE4 variants of the gene means having up to 15 times the normal risk of Alzheimer’s disease Signs of brain atrophy can be detected in people with two ApoE4 genes before they show cognitive impairment

78 The Adult – Aging and Dementia Chromosome 19, ApoE4 gene (continued) –Having another specific variant of the ApoE gene means having a good chance of maintaining good cognitive functioning into very late adulthood However, not everyone with the ApoE4 gene, or even a pair of them, develops Alzheimer’s disease, and many people with Alzheimer’s disease lack the gene –Apparently other genes and environmental factors apparently play a role

79 Caption: Alzheimer’s disease emerges gradually over the adult years; brain cells are damaged long before noticeable cognitive impairment results in old age

80 The Adult – Aging and Dementia The risk for developing Alzheimer’s disease is influenced by the following factors or conditions –Head injuries in earlier adulthood increase the risk –Obesity and a diet that increases the odds of high blood pressure, high cholesterol, and cardiovascular disease also contribute –Cognitive reserve is important. Extra brain power or cognitive capacity that some people can fall back on as aging and disease begin to take a toll on brain functioning People who have advanced education and high intelligence and have been mentally, physically, and socially active over the years have more cognitive reserve than less active people and, as a result, are less likely to be impaired as Alzheimer’s disease begins to damage their brains

81 The Adult – Aging and Dementia Prevention and treatment of Alzheimer’s disease focuses on early detection in hopes that drugs can prevent or delay the associated changes in the brain –Current medications modestly improve cognitive functioning, reduce behavioral problems, and slow the progression of the disease in some people

82 The Adult – Aging and Dementia Although deterioration leading to death is inevitable, there are options for both patients and their caregivers to help them understand and cope with dementia and function better –Memory training and memory aids –Behavioral management techniques and medications to address behavioral problems –Educational programs and psychological interventions

83 The Adult – Aging and Dementia Vascular dementia is the second most common form of dementia and often occurs in combination with Alzheimer’s disease –Multi-infarct dementia is caused by a series of minor strokes that cut off the blood supply to the brain Vascular dementia may do its greatest damage to executive functions or the functions that reside in the area of the brain that is damaged by the stroke or brain injury Vascular dementia is closely associated with environmental risk factors for cerebro- vascular diseases that affect blood flow in the brain, such as smoking or eating a fatty diet

84 The Adult – Aging and Dementia Other possible causes of dementia are Huntington’s, Parkinson’s disease, AIDS, and multiple sclerosis Reversible or curable problems such as alcoholism, toxic reactions to medication, infections, metabolic disorders, and malnutrition can cause symptoms of dementia

85 The Adult – Aging and Dementia Sometimes elderly adults who are experiencing delirium are mistakenly diagnosed as having dementia –Delirium emerges more rapidly than dementia and comes and goes over the course of the day –Delirium is a disturbance of consciousness characterized by periods of disorientation, wandering attention, confusion, and hallucinations Many hospital patients experience delirium in reaction to any number of stressors such as illness, surgery, drug overdoses, interactions of different drugs, or malnutrition

86 The Adult – Aging and Dementia It is critical to distinguish among irreversible dementias (including dementia of the Alzheimer’s type and vascular dementia), reversible dementias, delirium, depression, and other conditions To accurately distinguish and diagnose requires a thorough assessment, including a medical history, physical and neurological examinations, and assessments of cognitive functioning


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