1. Maria Margarita Reyes, MD
Aging and Mental Health: What’s Normal and When to Seek Professional Assessment
Maria Margarita Reyes, MD

2. Facts vs Myths
Older patients are more likely than younger cohorts to be referred to mental health specialists (false)
Major depression in later life is closely correlated with poorer self-perceived health (true)
Men ages 65 and older have twice the rate of completed suicide than men ages years of age (true)
Memory loss and significant cognitive decline are a normal and expected part of aging (false)
The general approach to treating depression and anxiety in the older population should mirror that of treating younger adults (false)

3. Depression: Normal vs Abnormal
Feeling sad or irritable from time to time
Grief
Occasional insomnia
Feeling sad or irritable most of the time
Losing interest in people/activities
Pervasive, self deprecating thoughts
Change in cognitive function (concentration, planning, memory)
Change in appetite and/or sleep patterns
Suicidal thoughts

4. Anxiety: Normal vs Abnormal
Worrying from time to time
Fear of things that present an eminent danger
Mild nervousness when meeting new people, public speaking, etc
“Fear of fear”
-avoidance of situations/activities because you’re afraid of appearing anxious/having a panic attack
“Worrying yourself sick” (somatization)

5. Cognitive decline: Normal vs abnormal
Forgetting names of people or an appointment and remembering it later
Occasional difficulty finding the right word
Occasional fender bender
Misplacing items but being able to retrace steps
Getting lost in unfamiliar places
Forgetting recent conversations
Forgetting appointments w/o any recollection of having made them
Forgetting common words (eg watch = “hand clock”)
Inability/difficulty performing IADLs (pay bills, cooking meals, grocery shopping, using the phone)
Frequent car accidents or “near misses”
Frequently misplacing items w/o ability to retrace steps
Getting lost in familiar places

6. Types of Major Neurocognitive Impairment
Alzheimer’s
Vascular
Lewy body
Parkinson’s plus dementia
Frontotemporal lobular dementia
Huntington’s, Creuzfield-Jacob, HIV, Alcoholism
Mixed

7. Mild Cognitive Impairment vs Major Neurocognitive Disorder (aka dementia)
Minor Neurocognitive Impairment
Major Neurocognitive Impairment
Modest cognitive decline in > 1 domains
Domains = memory, executive function, language, visual/special reasoning
Cognitive deficits do not interfere with independence in daily activities
Independent Activities of Daily Living (IADLS) are preserved but may require greater effort, compensatory strategies or accommodation
No severity specifier
Significant cognitive decline in ≥ 1 domains
Cognitive deficits interfere with independence in daily activities
Requires assistance with IADL’s
Severity specifier (mild, moderate, severe)

8. Prevalence of Major Neurocognitive Impairment (aka dementia) with Advanced Age
Krasuski, 2016

9. Medical Contributions to Dementia
Infection (HIV/AIDS, even a bladder infection!)
Medication toxicity/unintended drug effects/ interactions
Over/under active thyroid
Vitamin deficiencies
Uncontrolled diabetes
Cancer
Stroke, heart attack, high blood pressure, high cholesterol

10. Is it depression or dementia?
Krasuski, 2016

11. Geriatric Psychiatry Evaluation
Review of medications
Review of health history
Basic labs
MMSE/MoCA (cognitive screening)
+/- Brain imaging
+/- Psychometric testing