abnormal PSYCHOLOGY Third Canadian Edition Prepared by: Tracy Vaillancourt, Ph.D. Chapter 16 Aging and Psychological Disorders

Issues, Concepts and Methods in the Study of Older Adults

Dementia Dementia— term for gradual deterioration of intellectual abilities to the point that social and occupational functions are impaired Course may be progressive, static, or remitting Prevalence  with advancing age –1% in people aged 65 to 75 –4% in people aged 75 to 84 –10% in people over age 84

Symptoms of Dementia Difficulty remembering things –especially recent events Leaving tasks unfinished Hygiene may be poor and appearance sloppy Getting lost Difficulty comprehending making plans or decisions Poor impulse control –may use coarse language, tell inappropriate jokes, or shoplift Deterioration of abstract ideas Disturbances in emotions Symptoms of depression

Classification of Dementias Alzheimer’s Disease Frontal-temporal Dementias Frontal-subcortical Dementias

Alzheimer’s Disease Described by German neurologist Alois Alzheimer (1906) Accounts for ~ 50% of dementia in older people –~ 1 in 13 Canadians 65+ Death usually occurs 10 or 12 years after onset Although women live longer, more die

Alzheimer’s Disease cont. Main neurological changes: Atrophy of cerebral cortex –1 st entorhinal cortex and hippocampus and then frontal, temporal, and parietal lobes –As neurons and synapses are lost, fissures widen and ridges become narrower and flatter –Ventricles also become enlarged Plaques—small, round areas comprising remnants of lost neurons and b-amyloid are scattered throughout cortex Neurofibrillary tangles— tangled, abnormal protein filaments accumulate within cell bodies of neurons Plaques and tangles present throughout cerebral cortex and hippocampus

Alzheimer’s Disease cont.

Causes of Alzheimer’s Disease Very strong evidence for a genetic basis Risk  first-degree relatives of afflicted individuals Concordance for MZ twins is greater than for DZ twins Genes Gene controlling protein responsible for formation of b-amyloid (located on long arm of chromosome 21) –causes development of about 5% of cases of early-onset Chromosomes 1 and 14 also implicated (dominant) –chromosome 14 accounts for 75% of early-onset cases –no person with gene on chromosome 21 has survived beyond the age of 67 without developing disease Chromosome 19 (apolipoprotein E 4 allele) –  risk almost 50% –having two alleles  risk above 90%

Frontal-Temporal Dementias Accounts for 10 to 15% of cases Begins in a person’s late 50s Marked by extreme behavioural and personality changes Not closely linked to loss of cholinergic neurons Pick’s disease is one cause

Frontal-Subcortical Dementias Types include: Huntington’s chorea —caused by single dominant gene located on chromosome 4 –Major behavioural feature presence of writhing (choreiform) movements Parkinson’s disease — marked by muscle tremors, muscularrigidity, and akinesia –an inability to initiate movement Vascular dementia — diagnosed when patient with dementia has neurological signs or when brain scans show evidence of cerebrovascular disease

Other Causes of Dementia Infectious diseases –Encephalitis –Meningitis –Syphilis (Treponema pallidum) Head traumas Brain tumours Nutritional deficiencies –especially of B-complex vitamins Kidney or liver failure Endocrine-gland problems –Hyperthyroidism Exposure to toxins –lead or mercury –chronic drug and alcohol use

Treatment of Dementias Biological Treatments of Alzheimer’s Disease –involves death of brain cells that secrete acetylcholine thus try to  levels –blocking creation of amyloid from its precursor protein –antioxidants (vitamin E) may be useful in slowing progression Psychosocial Treatments for Patients and their Families

Delirium Delirium— “a clouded state of consciousness” –trouble concentrating and focusing attention –cannot maintain coherent thought –early stages— person frequently restless especially at night –perceptual disturbances –memory impairment –paranoid delusions in 40 to 70% severe delirium –speech is rambling and incoherent –person is bewildered and confused

Causes and Treatment of Delirium Causes Drug intoxications Drug-withdrawal reactions Metabolic and nutritional imbalances –uncontrolled diabetes and thyroid dysfunction Infections or fevers Neurological disorders Stress Treatment If syndrome identified correctly and underlying cause promptly treated –1-4 weeks for condition to clear If underlying cause not treated –permanent brain damage –death Intervention addresses risk factors –Sleep deprivation, –Immobility –Dehydration –Visual and hearing impairment –Cognitive impairment

Dementia vs. Delirium

Other Psychological Issues Depression < prevalent in older adults than in younger adults –< 3% compared to 20% –Still, estimated to account for nearly 50% of admissions of older adults to acute psychiatric care Anxiety Delusional Disorder Schizophrenia –paraphrenia Substance-Related Disorders Hypochondriasis Somatization Sleep Disorders Suicide

Treatment & Care of Older Adults Nursing Homes Alternative Living Settings Community-Based Care Prevention

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