Disorders of Aging and Cognition. Old Age and Stress Old age is usually defined in our society as...

Disorders of Aging and Disorders of Aging and CognitionCognition

Old Age and StressOld Age and Stress

Old age is usually defined in our society Old age is usually defined in our society as the years past age 65as the years past age 65 More than 35 million “old” people in the More than 35 million “old” people in the

U.S.U.S.

Older women outnumber older men by 3 to 2Older women outnumber older men by 3 to 2

Like childhood, old age brings special Like childhood, old age brings special pressure, unique upsets, and key pressure, unique upsets, and key biological changesbiological changes


The stresses of elderly people need not The stresses of elderly people need not result in psychological disorders; result in psychological disorders; however, studies indicate that as many however, studies indicate that as many as 50% of elderly people would benefit as 50% of elderly people would benefit from mental health servicesfrom mental health services

Fewer than 20% actually receive themFewer than 20% actually receive them Geropsychology is the field of psychology Geropsychology is the field of psychology

dedicated to the mental health of elderly peoplededicated to the mental health of elderly people


The psychological problems of elderly The psychological problems of elderly persons may be divided into two groups:persons may be divided into two groups: Disorders that are found in people of all ages Disorders that are found in people of all ages

but are connected to the process of agingbut are connected to the process of aging Depressive, anxiety, and substance-related Depressive, anxiety, and substance-related

disordersdisorders

Disorders of cognition that result from brain Disorders of cognition that result from brain abnormalitiesabnormalities

Delirium, dementiaDelirium, dementia

Depression in Later LifeDepression in Later Life

Depression is one of the most common Depression is one of the most common mental health problems of older adultsmental health problems of older adults

The features of depression are the same for The features of depression are the same for elderly people as for younger peopleelderly people as for younger people As many as 20% of people experience this As many as 20% of people experience this

disorder at some point during old agedisorder at some point during old age The rate is highest in older womenThe rate is highest in older women

Several studies suggest that depression Several studies suggest that depression among older people raises their chances of among older people raises their chances of developing significant medical problemsdeveloping significant medical problems

Depression in Later LifeDepression in Later Life

Like younger adults, older people who are Like younger adults, older people who are depressed may be helped by cognitive depressed may be helped by cognitive therapy, interpersonal therapy, therapy, interpersonal therapy, antidepressant medications, or a antidepressant medications, or a combination of these approachescombination of these approaches More than half of older patients with More than half of older patients with

depression improve with these treatmentsdepression improve with these treatments

It is sometimes difficult for elderly people to It is sometimes difficult for elderly people to use antidepressant drugs effectively and safely use antidepressant drugs effectively and safely because the body’s metabolism works because the body’s metabolism works differently in later lifedifferently in later life

Anxiety Disorders in Anxiety Disorders in Later LifeLater Life

Anxiety is also common among the elderlyAnxiety is also common among the elderly

At any given time, around 6% of elderly At any given time, around 6% of elderly men and 11% of elderly women in the men and 11% of elderly women in the U.S. experience at least one of the anxiety U.S. experience at least one of the anxiety disordersdisorders GAD is particularly common, experienced by GAD is particularly common, experienced by

up to 7% of all elderly personsup to 7% of all elderly persons

Anxiety in the elderly may be underreportedAnxiety in the elderly may be underreported

Anxiety Disorders in Anxiety Disorders in Later LifeLater Life

There are many things about aging that may There are many things about aging that may heighten anxiety levels, including declining heighten anxiety levels, including declining healthhealth Researchers have not, however, systematically tied Researchers have not, however, systematically tied

anxiety disorders among the elderly to specific anxiety disorders among the elderly to specific events or lossesevents or losses

Older adults with anxiety disorders are often Older adults with anxiety disorders are often treated with psychotherapy of various kinds, treated with psychotherapy of various kinds, particularly cognitive therapiesparticularly cognitive therapies Many also receive antianxiety medicationsMany also receive antianxiety medications

Again, all such drugs must be used cautiously with older Again, all such drugs must be used cautiously with older peoplepeople

Substance Abuse in Later Substance Abuse in Later LifeLife

Although alcohol abuse and other forms Although alcohol abuse and other forms of substance abuse are significant of substance abuse are significant problems for many older persons, the problems for many older persons, the prevalence of such patterns actually prevalence of such patterns actually appears to decline after age 60appears to decline after age 60

Accurate data about the rate of substance Accurate data about the rate of substance abuse among older adults is difficult to abuse among older adults is difficult to obtain because many elderly persons do not obtain because many elderly persons do not suspect or admit they have such a problemsuspect or admit they have such a problem

Substance Abuse in Later Substance Abuse in Later LifeLife

A leading kind of substance abuse in A leading kind of substance abuse in the elderly is the misuse of the elderly is the misuse of prescription drugsprescription drugs Most often it is unintentionalMost often it is unintentional

Psychotic Disorders in Psychotic Disorders in Later LifeLater Life

Elderly people have a higher rate of Elderly people have a higher rate of psychotic symptoms than younger psychotic symptoms than younger personspersons Among aged people, these symptoms are Among aged people, these symptoms are

usually due to underlying medical usually due to underlying medical conditions such as delirium and dementiaconditions such as delirium and dementia

However, some elderly persons suffer However, some elderly persons suffer from schizophrenia or delusional disorderfrom schizophrenia or delusional disorder


Schizophrenia is less common in Schizophrenia is less common in older persons than in younger onesolder persons than in younger ones Many people with schizophrenia find Many people with schizophrenia find

that their symptoms lessen in later lifethat their symptoms lessen in later life

It is uncommon for new cases of It is uncommon for new cases of schizophrenia to emerge in later lifeschizophrenia to emerge in later life


Another kind of psychotic disorder found Another kind of psychotic disorder found among the elderly is delusional disorder, in among the elderly is delusional disorder, in which individuals develop beliefs that are which individuals develop beliefs that are false but not bizarrefalse but not bizarre This disorder is rare in most age groups, but its This disorder is rare in most age groups, but its

prevalence appears to increase in the elderly prevalence appears to increase in the elderly populationpopulation

Some clinicians suggest that the rise is related to the Some clinicians suggest that the rise is related to the deficiencies in hearing, social isolation, greater stress, or deficiencies in hearing, social isolation, greater stress, or heightened poverty experienced by many elderly personsheightened poverty experienced by many elderly persons

Disorders of Cognition Disorders of Cognition

Cognitive “mishaps” (e.g., leaving without Cognitive “mishaps” (e.g., leaving without keys, forgetting someone’s name) are a keys, forgetting someone’s name) are a common and quite normal feature of stress common and quite normal feature of stress or of agingor of aging As people move through middle age, these As people move through middle age, these

memory difficulties and lapses of attention memory difficulties and lapses of attention increase, and they may occur with regularity by increase, and they may occur with regularity by age 60 or 70age 60 or 70

Sometimes, however, people experience memory Sometimes, however, people experience memory and other cognitive changes that are far more and other cognitive changes that are far more extensive and problematicextensive and problematic

Disorders of Cognition Disorders of Cognition

While problems in memory and related While problems in memory and related cognitive processes can occur without cognitive processes can occur without organic causes (in the form of organic causes (in the form of dissociative disorders), more often, dissociative disorders), more often, cognitive problems have organic roots, cognitive problems have organic roots, particularly when they appear in later particularly when they appear in later lifelife The leading cognitive disorders among The leading cognitive disorders among

elderly persons are delirium and dementiaelderly persons are delirium and dementia

DeliriumDelirium

Delirium is a clouding of Delirium is a clouding of consciousnessconsciousness As a person’s awareness of the As a person’s awareness of the

environment becomes less clear, he or environment becomes less clear, he or she has great difficulty concentrating, she has great difficulty concentrating, focusing attention, and thinking focusing attention, and thinking sequentiallysequentially This leads to misinterpretations, illusions, This leads to misinterpretations, illusions,

and, on occasion, hallucinationsand, on occasion, hallucinations

DeliriumDelirium

This state of massive confusion typically This state of massive confusion typically occurs over a short period of time, usually occurs over a short period of time, usually hours or dayshours or days Delirium apparently affects more than 2 million Delirium apparently affects more than 2 million

people in the U.S. each yearpeople in the U.S. each year It may occur in any age group, including children, It may occur in any age group, including children,

but it is most common in elderly personsbut it is most common in elderly persons

Fever, metabolic disorders, infections, poor Fever, metabolic disorders, infections, poor nutrition, head injuries, certain brain nutrition, head injuries, certain brain diseases, and stress (including the trauma of diseases, and stress (including the trauma of surgery) may all cause deliriumsurgery) may all cause delirium

DementiaDementia

People with dementia experience People with dementia experience significant memory losses along with significant memory losses along with losses in other cognitive functions losses in other cognitive functions such as abstract thinking or languagesuch as abstract thinking or language People with dementia may also experience People with dementia may also experience

changes in personality and behaviorchanges in personality and behavior

At any given time, around 3% to 9% of At any given time, around 3% to 9% of the world’s adult population are the world’s adult population are suffering from dementiasuffering from dementia

DementiaDementia

The experience of dementia is closely The experience of dementia is closely related to agerelated to age

Like delirium, some forms of dementia Like delirium, some forms of dementia result from nutritional, metabolic, or result from nutritional, metabolic, or other problems that can be correctedother problems that can be corrected

Most forms, however, are caused by Most forms, however, are caused by brain diseases or injuries, such as brain diseases or injuries, such as Alzheimer’s disease or stroke, which are Alzheimer’s disease or stroke, which are currently difficult or impossible to correctcurrently difficult or impossible to correct

Alzheimer’s DiseaseAlzheimer’s Disease

Alzheimer’s disease, identified in 1907, Alzheimer’s disease, identified in 1907, is is the most common form of dementiathe most common form of dementia, , accounting for as many as two-thirds of accounting for as many as two-thirds of all casesall cases

This gradually progressive disease This gradually progressive disease sometimes appears in middle age, but sometimes appears in middle age, but most often occurs after the age of 65most often occurs after the age of 65 Its prevalence increases markedly among Its prevalence increases markedly among

people in their late 70s and early 80speople in their late 70s and early 80s


The time between onset and death is The time between onset and death is typically 8 to 10 years, although some typically 8 to 10 years, although some people may survive for as many as 20 people may survive for as many as 20 yearsyears

It usually begins with mild memory It usually begins with mild memory problems, lapses of attention, and problems, lapses of attention, and difficulties in language and difficulties in language and communicationcommunication


As symptoms worsen, the person has As symptoms worsen, the person has trouble completing complicated tasks trouble completing complicated tasks and remembering important and remembering important appointmentsappointments

Eventually sufferers also have difficulty Eventually sufferers also have difficulty with simple tasks, distant memories are with simple tasks, distant memories are forgotten, and changes in personality forgotten, and changes in personality often become very noticeableoften become very noticeable


As the symptoms of dementia intensify, As the symptoms of dementia intensify, people show less and less awareness of people show less and less awareness of their limitationstheir limitations Eventually they become fully dependent on Eventually they become fully dependent on

other peopleother people The late phase of the disorder can last from The late phase of the disorder can last from

2 to 5 years2 to 5 years

Alzheimer’s victims usually remain in Alzheimer’s victims usually remain in good health until the later stages of the good health until the later stages of the diseasedisease


In most cases, Alzheimer’s can be In most cases, Alzheimer’s can be diagnosed with certainty only after death, diagnosed with certainty only after death, when structural changes in the brain can when structural changes in the brain can be identified in autopsybe identified in autopsy Neurofibrillary tangles are twisted protein Neurofibrillary tangles are twisted protein

fibers found within the cells of the fibers found within the cells of the hippocampushippocampus

Senile plaques are sphere-shaped deposits of a Senile plaques are sphere-shaped deposits of a small molecule that form in the spaces between small molecule that form in the spaces between cells in the hippocampus, cerebral cortex, and cells in the hippocampus, cerebral cortex, and certain other brain regionscertain other brain regions


Research has suggested several Research has suggested several possible causes for the development possible causes for the development of the disease, including genetic of the disease, including genetic factors and abnormalities in brain factors and abnormalities in brain structure and brain chemistrystructure and brain chemistry

What Are the Genetic What Are the Genetic Causes of Alzheimer’s Causes of Alzheimer’s

Disease?Disease? Studies have found that mutations in Studies have found that mutations in

particular genes increase the likelihood of particular genes increase the likelihood of plaque and tangle formations and, in turn, of plaque and tangle formations and, in turn, of Alzheimer’s diseaseAlzheimer’s disease Genetic studies have also linked certain kinds of Genetic studies have also linked certain kinds of

the disease to defects on specific chromosomesthe disease to defects on specific chromosomes

All of these discoveries are promising but All of these discoveries are promising but limited, since many people with the disease limited, since many people with the disease do not have a clear family history of the do not have a clear family history of the disorderdisorder

What Are the Structural and What Are the Structural and Biochemical Causes of Biochemical Causes of Alzheimer’s Disease?Alzheimer’s Disease?

Researchers have identified a number Researchers have identified a number of biological factors related to the brain of biological factors related to the brain abnormalities seen in Alzheimer’s abnormalities seen in Alzheimer’s diseasedisease

To understand the role of these factors, To understand the role of these factors, an understanding of the operation and an understanding of the operation and biology of memory is necessary…biology of memory is necessary…


The human brain has two memory systems The human brain has two memory systems that work together to help us learn and that work together to help us learn and recallrecall Short-term memory, or working memory, Short-term memory, or working memory,

gathers new information gathers new information Long-term memory is the accumulation of Long-term memory is the accumulation of

information that we have stored over the yearsinformation that we have stored over the years This information has been transformed This information has been transformed

(consolidated) by the short-term memory system(consolidated) by the short-term memory system Remembering information stored in long-term Remembering information stored in long-term

memory is called retrievalmemory is called retrieval


Certain brain structures seem to be Certain brain structures seem to be especially important in memory, especially important in memory, including:including: The prefrontal lobesThe prefrontal lobes

Appear to hold information temporarily and to Appear to hold information temporarily and to continue working with the information as long as continue working with the information as long as it is neededit is needed

The temporal lobes and the diencephalonThe temporal lobes and the diencephalon Seem to help transform short-term memory into Seem to help transform short-term memory into

long-term memorylong-term memory


Memory researchers have also Memory researchers have also identified biochemical changes that identified biochemical changes that occur in cells as memories formoccur in cells as memories form For example, several chemicals are For example, several chemicals are

responsible for the production of proteins responsible for the production of proteins in key cells when new information is in key cells when new information is acquired and storedacquired and stored

If the activity of these chemicals is If the activity of these chemicals is disturbed, the proper production of disturbed, the proper production of proteins may be prevented and the proteins may be prevented and the formation of memories interruptedformation of memories interrupted


This background information helps in the This background information helps in the understanding of the biological causes of understanding of the biological causes of Alzheimer’s diseaseAlzheimer’s disease One line of research suggests that some of the One line of research suggests that some of the

proteins involved in memory formation may take proteins involved in memory formation may take an abnormal form and essentially run amok in an abnormal form and essentially run amok in people with Alzheimer’s diseasepeople with Alzheimer’s disease

Another line of research points to abnormal Another line of research points to abnormal activity by the neurotransmitters and related activity by the neurotransmitters and related chemicals involved in the production of the chemicals involved in the production of the memory proteinsmemory proteins


A third explanation holds that certain A third explanation holds that certain substances found in nature, including substances found in nature, including zinc, may produce brain toxicity zinc, may produce brain toxicity

A fourth explanation is the A fourth explanation is the autoimmune theory: autoimmune theory: Changes in aging brain cells may trigger Changes in aging brain cells may trigger

an autoimmune response, leading to the an autoimmune response, leading to the diseasedisease


A final explanation is a viral theoryA final explanation is a viral theory Because Alzheimer’s disease resembles Because Alzheimer’s disease resembles

Creutzfeldt-Jakob disease (a form of Creutzfeldt-Jakob disease (a form of dementia caused by a virus), some dementia caused by a virus), some researchers propose that a similar virus researchers propose that a similar virus may cause Alzheimer’s diseasemay cause Alzheimer’s disease

To date, no such virus has been isolated To date, no such virus has been isolated from the brains of Alzheimer’s victimsfrom the brains of Alzheimer’s victims

Other Forms of DementiaOther Forms of Dementia

A number of other disorders may also lead to A number of other disorders may also lead to dementia, including:dementia, including: Vascular dementia (multi-infarct dementia) Vascular dementia (multi-infarct dementia)

May follow a cerebrovascular accident, or stroke, during May follow a cerebrovascular accident, or stroke, during which blood flow to specific areas of the brain was cut which blood flow to specific areas of the brain was cut off, with resultant damageoff, with resultant damage

This dementia is progressive but its symptoms begin This dementia is progressive but its symptoms begin abruptly, rather than graduallyabruptly, rather than gradually

Cognitive functioning may continue to be normal in the Cognitive functioning may continue to be normal in the areas of the brain not affected by the strokeareas of the brain not affected by the stroke

This is the This is the second most common type of dementiasecond most common type of dementia among the elderlyamong the elderly


A number of other disorders may also A number of other disorders may also lead to dementia, including:lead to dementia, including: Pick’s disease – a rare disorder that affects Pick’s disease – a rare disorder that affects

the frontal and temporal lobes and is the frontal and temporal lobes and is clinically similar to Alzheimer’s diseaseclinically similar to Alzheimer’s disease

Creutzfeldt-Jakob disease – caused by a Creutzfeldt-Jakob disease – caused by a slow-acting virus, this disease has slow-acting virus, this disease has symptoms that include sporadic movementssymptoms that include sporadic movements


A number of other disorders may also lead to A number of other disorders may also lead to dementia, including:dementia, including: Huntington’s disease – an inherited progressive Huntington’s disease – an inherited progressive

disease in which memory problems worsen over disease in which memory problems worsen over time, along with personality changes and mood time, along with personality changes and mood difficultiesdifficulties

Parkinson’s disease – a slowly progressive Parkinson’s disease – a slowly progressive neurological disorder marked by tremors, rigidity, neurological disorder marked by tremors, rigidity, and unsteadinessand unsteadiness

This disease causes dementia in 20% to 60% of casesThis disease causes dementia in 20% to 60% of cases


A number of other disorders may also A number of other disorders may also lead to dementia, including:lead to dementia, including: Viral and bacterial infectious disorders Viral and bacterial infectious disorders

such as HIV and AIDS, meningitis, and such as HIV and AIDS, meningitis, and advanced syphilisadvanced syphilis

Brain seizure disorderBrain seizure disorder

Drug abuseDrug abuse

Toxins such as mercury, lead, or carbon Toxins such as mercury, lead, or carbon monoxide monoxide

The Assessment and The Assessment and Treatment of DementiaTreatment of Dementia

Most cases of Alzheimer’s disease can be Most cases of Alzheimer’s disease can be diagnosed with certainty only after death, diagnosed with certainty only after death, when an autopsy is performedwhen an autopsy is performed

In addition, treatment of this disease has In addition, treatment of this disease has been, at best, modestly helpfulbeen, at best, modestly helpful

Growing research has raised hopes that Growing research has raised hopes that Alzheimer’s disease and other forms of Alzheimer’s disease and other forms of dementia may be assessed and treated dementia may be assessed and treated more effectively, or even prevented, in the more effectively, or even prevented, in the near futurenear future


A common approach to treatment is the A common approach to treatment is the use of drugs that affect the use of drugs that affect the neurotransmitters known to play an neurotransmitters known to play an important role in memoryimportant role in memory Four such drugs prevent the breakdown of Four such drugs prevent the breakdown of

acetylcholine, the NT in low supply among acetylcholine, the NT in low supply among people with Alzheimer’s diseasepeople with Alzheimer’s disease Although the benefits of the drugs are limited Although the benefits of the drugs are limited

and the risk of harmful side effects is sometimes and the risk of harmful side effects is sometimes high, the drugs have been approved by the FDAhigh, the drugs have been approved by the FDA


Caregiving can take a heavy toll on Caregiving can take a heavy toll on the close relatives of people with the close relatives of people with dementiadementia

One of the most frequent reasons for the One of the most frequent reasons for the institutionalization of Alzheimer’s institutionalization of Alzheimer’s victims is that overwhelmed caregivers victims is that overwhelmed caregivers can no longer cope with the difficulties can no longer cope with the difficulties of keeping them at homeof keeping them at home


In recent years, sociocultural In recent years, sociocultural approaches have begun to play an approaches have begun to play an important role in treatmentimportant role in treatment

A number of day-care and assisted-A number of day-care and assisted-living facilities have been opened to living facilities have been opened to provide care for those with dementiaprovide care for those with dementia

Issues Affecting the Issues Affecting the Mental Health of the Mental Health of the

ElderlyElderly As the study and treatment of elderly As the study and treatment of elderly

people have progressed, three issues people have progressed, three issues have raised concern among clinicians:have raised concern among clinicians: The problems faced by elderly members The problems faced by elderly members

of racial and ethnic minority groupsof racial and ethnic minority groups

The inadequacies of long-term careThe inadequacies of long-term care

The need for a health-maintenance The need for a health-maintenance approach to medical care in an aging approach to medical care in an aging worldworld


ElderlyElderly Discrimination because of race and Discrimination because of race and

ethnicity has long been a problem in the ethnicity has long been a problem in the U.S., particularly for those who are oldU.S., particularly for those who are old To be both old and a member of a minority group To be both old and a member of a minority group

is considered to be in “double jeopardy” by many is considered to be in “double jeopardy” by many observersobservers

Older women in minority groups are considered to be Older women in minority groups are considered to be in “triple jeopardy”in “triple jeopardy”

Because of language barriers and cultural Because of language barriers and cultural issues, it is common for elderly members of issues, it is common for elderly members of ethnic minority groups to rely solely in family ethnic minority groups to rely solely in family members or friends for remedies and health caremembers or friends for remedies and health care


ElderlyElderly Many older people require long-term careMany older people require long-term care

““Long-term care” may refer variously to the Long-term care” may refer variously to the services offered in a partially supervised services offered in a partially supervised apartment, in a senior housing complex, or in a apartment, in a senior housing complex, or in a nursing homenursing home

The quality of care at such residences varies widelyThe quality of care at such residences varies widely

Many worry about the costs of long-term careMany worry about the costs of long-term care Worry over these issues can greatly harm the mental Worry over these issues can greatly harm the mental

health of older adults, perhaps leading to depression health of older adults, perhaps leading to depression and anxiety, as well as family conflictand anxiety, as well as family conflict


ElderlyElderly Medical scientists suggest that the Medical scientists suggest that the

current generation of young adults current generation of young adults should take a health-maintenance, or should take a health-maintenance, or wellness, approach to their own aging wellness, approach to their own aging processprocess

There is a growing belief that older adults There is a growing belief that older adults will adapt more readily to changes and will adapt more readily to changes and negative events if their physical and negative events if their physical and psychological health is goodpsychological health is good

Disorders of Aging and Cognition. Old Age and Stress Old age is usually defined in our society as...

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