Late Life and Neurocognitive Disorder

Cards (56)

  • Elderly
    Over the age of 65
  • In less than 200 years, life expectancy has almost doubled in the Western world
  • 40% of practicing psychologists regularly conduct clinical work with older adults
  • Myths about late life
    • Aging involves inexorable cognitive decline
    • Severe cognitive problems do not occur for most
    • Mild declines are common
    • Older adults are unhappy
    • Older adults are more skilled at emotion regulation; Attend more to positive; Display less psychophysiological response to negative emotion
    • Late life is a lonely time
  • Problems experienced in late life
    • Physical decline and disabilities
    • Sensory acuity deficits
    • Loss of loved ones
    • Social stress of stigmatizing attitudes towards elderly
    • Cumulative effects of a lifetime of stressors
    • Decline in quality and depth of sleep
    • Polypharmacy: Prescribing multiple drugs to a person; 40% of elderly persons are prescribed at least 5 medications; Increases the risk of adverse drug reactions
  • Cross-sectional studies
    • Researcher compares different age groups at the same point in time on a variable of interest; Fails to provide information about how people change over time
  • Longitudinal studies

    • Researcher retests the same group of people with the same measures at different points in time; May extend over several years or decades; Attrition can lead to biased sample; Selective mortality – no longer available for follow-up because of death; People with the most problems are likely to drop out from a study
  • DSM criteria are the same for older and younger adults
  • Disentangling medical and psychological concerns is complex!
  • Psychological disorders are less common in the elderly than in younger adults
  • Reasons for lower prevalence of psychological disorders in the elderly
    • More positive emotionality
    • More close-knit social circles
    • May grow out of those symptoms
    • Methodological issues lead to underestimation of prevalence
    • Most people with psychological disorders in late life are experiencing a continuation of symptoms that began earlier
  • Methodological issues leading to underestimation of prevalence
    • Response bias: Discomfort discussing symptoms may minimize prevalence estimates
    • Cohort effects: E.g., many people who reached adulthood during the drug-oriented era of the 1960s continue to use drugs as they age
    • Selective mortality: Psychological disorders are associated with premature mortality
  • Treatment for psychological disorders in the elderly
    • Similar to treatments that work in earlier life
    • Many medications can cause serious side effects in elderly
    • Psychotherapy is the first line approach for anxiety
    • Adapt to adjust for vision and hearing loss
    • Telemental health for people with limited mobility
    • May include a caregiver in therapy sessions
    • Use of memory aids (e.g., worksheets on session content)
  • Dementia
    Deterioration of cognitive abilities causing impairment
  • Most common symptoms of dementia
    • Diminished memory, especially for recent events
    • Depression
    • Sleep disturbances
    • Delusions and hallucinations
    • Difficulty with impulse control
  • Most dementias develop slowly over a period of years
  • Mild Cognitive Impairment (MCI)

    Early signs of decline before functional impairment
  • Problems with DSM-5 criteria requiring a low score on only one cognitive test
  • Some cognitive tests are more reliable and relevant than others; Using more than one test improves reliability
  • 10% of the time, cognitive declines are tied to other problems: Infection, sleep loss, thyroid disease, vitamin deficiencies
  • Current MCI criteria may not be very reliable; Could lead to over-diagnosis
  • Not all people with MCI develop dementia
  • Mild Neurocognitive Disorder (Mild Cognitive Impairment)

    Modest cognitive decline from previous levels in one or more domains
  • Major Neurocognitive Disorder (Dementia)

    Significant cognitive decline from previous levels in one or more domains
  • Less than 2% of dementia occurs before the age of 65
  • Prevalence of dementia increases dramatically as people age, with more than 1/3 of people in their 90s having dementia
  • Prevalence of dementia appears lower in sub-Saharan Africa and higher in Latin America
  • Age of onset of dementia is becoming later over time in the US and Europe
  • The number of dementia cases is expected to double by 2030 as the number of elderly grow
  • Types of dementia discussed
    • Alzheimer's disease
    • Frontotemporal dementia
    • Vascular dementia
    • Lewy body dementia
  • Alzheimer's disease is the most common form of dementia, accounting for more than half of all dementias
  • Alzheimer's disease

    Irreversible brain tissue deterioration; Death usually occurs within 12 years
  • Early symptoms of Alzheimer's disease

    • Absentmindedness and gaps in memory for new material
    • Leaving tasks unfinished or forgotten
    • Difficulty finding words
  • Other symptoms of Alzheimer's disease

    • Apathy, depression, disorientation
    • As brain deterioration progresses, the severity of symptoms increase
    • At first, people are often unaware of their cognitive problems
    • Progresses to oblivious awareness of surroundings
  • Plaques
    β-amyloid protein deposits, primarily found in frontal cortex
  • Neurofibrillary tangles
    Protein filaments composed of tau, primarily found in hippocampus
  • Immune responses to plaques lead to inflammation and loss of synapses and neuronal death
  • The ApoE-4 gene increases deposition of beta-amyloid plaques
  • Late onset Alzheimer's disease has a heritability between 60-80%
  • 19 specific genetic loci have been identified for Alzheimer's disease, but most of the genes explain a very small amount of risk