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Neuropsychology of Ageing > Lecture 1: Why Ageing? > Flashcards

Lecture 1: Why Ageing? Flashcards

1
Q

Learning goals:

At the end of this course, you should be familiar with:

A
  • The most important changes in cognition in normal ageing
  • The most common forms of dementia and the accompagnying cognitive impairments
  • Neuropsychological symptoms relevant for diagnosis of different forms of abnormal ageing
  • The most important risk factors of abnormal ageing
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2
Q

Common myths about ageing

A
  • Old people are typically less happy and content than young people
  • Most older people will develop dementia at some point
  • With ageing all cognitive functions will deteriorate
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3
Q

¨Why ageing? Why relevant or important to study?

  • Scientific reasons:
    • developmental view
A
  • To present complete view of development.
    • Developmental psychology: focus on children or young adults
    • Ignored continuation development in adulthood
    • Popular assumption in developmental psychology: gradual, predictable decline psychological functions with ageing – two-stage model
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4
Q

Two stages of life model:

A
  • Physical and psychological functions develop (growth) up to a point (maturity), followed by a gradual and predictable decline (senescing):
  • Biological functions – model is mostly correct
  • Psychological functions – model is outdated
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5
Q

Life span perspective:

A
  • changes between birth and death regarded as development.
    • Changes in functional capacity are part of the life span
    • Maturation continues until death
    • Relevant for studying psychological ageing
    • Changes are not predictable, not necessarily deterioration of functions
  • → nErikson’s 8 stages
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6
Q

¨Why ageing? Why relevant or important to study?

¤Practical reasons

A

Strong increase in number of older persons worldwide:

Increase in diseases associated with ageing

Increase demands for treatment and care

Prevention of age-related disorders

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7
Q

What age?

  • Types of Age
A
  • Chronological age: the number of years since birth
  • Biological age: age relative to the years one can expect to live (or relative to physical appearance and bodily functions, e.g. blood pressure)
  • Functional age: person’s competence in carrying out specific tasks relative to persons of the same chronological age
  • Psychological age: how well can a person adapt to changing conditions, flexibility, attempt new activities
  • Social age: views held by most people in society about what a person of a particular chronological age should do and behave.
  • (Chronological age most common measure in studies of ageing)
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8
Q

Older adulthood

A
  • typically starts at 65 (retirement age)
    • Further distinction: young-old (65-74), old-old (75-84) and oldest-old (>85)
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9
Q

Who is ageing? Individual variability

A
  • Persons over 65 no homogeneous group
    • Inter-individual differences
    • Intra-individual differences
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10
Q

¨Increase in number of older persons

A

“At the root of the process of population ageing is the exceptionally rapid increase in the number of older persons, a consequence of the high birth rates of the early and middle portions of the twentieth century and the increasing proportions of people reaching old age” (World Population Ageing 2013, page 9.)

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11
Q

Life Expectancy at birth:

A
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12
Q

fertility rates:

A
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13
Q

Population pyramids:

Percentage of the population per 5-year age category.

  • Red – men
  • Yellow - women
A
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14
Q

Over 60s will become the largest age group.

A
  • 2013: population over 60 outnumbered population aged 0 to 19 years
    • •falling tobacco use & cardiovascular disease mortality
  • 2024: population over 60 expected to outnumber all other age groups in more developed regions (World Population Ageing 2013)
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15
Q

Consequences of population ageing

  • Dependency ratio
A

Ratio population in most dependent ages and the population in main working ages: (number children under 15 + persons aged 65 years and over) / (number of persons 15 - 64 years

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16
Q

Higher dependency rate means:

A
  • more “dependents” relative to the group in the productive ages
  • more economic pressure on the productive group
  • dependency rate in more developed countries will rise
    • mainly due to increase in the number of older people
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17
Q

Old age support ratio

A
  • Number persons available in main working ages to support each older person: number of persons aged 15 - 64 / number of persons aged 65 or over.
  • 2013, just 4 persons of working age for each older person in more developed regions
  • ratio expected to decline further
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18
Q

Health and health care costs

A
  • health expenditures grow rapidly due to ageing
    • older persons usually require more health care in general and more specialized services for more complex pathologies
  • major causes of disability and health problems in old age are non-communicable diseases, including:
    • heart disease, cancer, diabetes, “the four giants of geriatrics” (immobility, instability, incontinence, intellectual impairment)
19
Q

Health and health care costs (dementia)

A
  • intellectual impairment/dementia. Total number of people with dementia projected to increase to 65.7 million in 2030 and 115.4 million in 2050 (WHO Dementia: A public health priority 2012).
20
Q

If dementia were a company

A
  • it would be the biggest by annual revenue (in 2010)
  • If dementia were a country it would be the 18th largest economy in the world.
21
Q

Health and health care costs

  • Dementia is one of the world’s most expensive diseases:
A

Dementia is one of the world’s most expensive diseases:

  • Increasing incidence
  • Large proportion of people with dementia who need support and care
  • Large proportion of people with dementia in high income countries live in nursing homes (World Alzheimer Report, 2010).
  • No effective medical treatment (psychology can make valuable contributions to care and diagnosis)
    • psychology can make valuable contributions to care and diagnosis
22
Q

Biological theories of ageing

A

Biological ageing, including ageing of the brain, changes almost always detrimental

What causes biological ageing?

  • Programmed theories. Ageing is genetically programmed
  • Stochastic theories. Ageing is result of damage to the body during life.
23
Q

Programmed theories.

  • Genetically programmed
A
  • Time clock theory: cells can divide only a limited umber of times
  • Immune system: the immune system is programmed to work efficiently for a certain amount of time.
  • Evolution: animals programmed to produce offspring
    • Once tasks have been accomplished, animals become more susceptible to diseases.
24
Q

Stochastic theories;

  • Wear and tear theory;
  • Stress theory:
A

Errors at cellular level result in production of faulty molecules

  • Wear and tear theory: damage to the body will build up of time
  • Stress theory: body sustains damage from prolonged exposure to stress
  • Build-up of damaging substances in the body
25
Q

Psychological theories of ageing

  • Selective Optimization with compensation (SOC)
A
  • During development people gain and lose capabilities
  • In older adults the losses start to outnumber the gains
  • High levels of well-being with ageing would require:
    • Adapt to continue good level of functioning and good quality of life
    • Select domains where high level of functioning can be maintained or that can maximize quality of life
    • Compensate with new strategies where losses occur (e.g. memory, mobility)
26
Q

Ecological model of ageing

A
  • Interaction between a person and their environment results in a level of adaptation.
    • To enjoy a positive outcome (quality of life) adaptation requires that person’s level of competence matches the demands from environment
    • Lower levels of competence requires a lower level environmental demands
27
Q

Socio-emotional selectivity theory

A
  • With ageing motivation shifts from pursuit of knowledge to pursuit of emotional satisfaction.
    • Cognitive resources (e.g. attention, memory) used to enhance mood and quality of life rather than acquiring new knowledge
28
Q

Successful ageing

A
  • Of all people in the Netherlands, the 65-75 age group is most happy and content (CBS 2015)
    • 88% content with their life, 89.4% rated themselves as a happy person
    • Over 75s: 84% content, 86% happy
29
Q

Less depression in older age

  • Labour Force Survey (UK): report most important health problems (n = 972464).
A
30
Q

Higher subjective wellbeing in older age

A
31
Q

Subjective experience of health and ability more positive than objective health and ability

  • Wettstein et al. (2016)
A
  • Satisfaction paradox, “stability despite loss”
32
Q

Cognitive ageing

  • Assumption of universal decline
A

Assumption of universal decline

  • Assumption that ageing will inevitably lead to cognitive decline
  • Two stage/senescence model – gradual age-related decline
  • Miles (1933): cognitive ability in 1600 persons aged 6 – 95
    • Decline after age 30
    • Age-related slowing prominent change
33
Q

cognitive ageing

  • life-span perspective
A

life-span perspective:

  • age-related changes are a stage in life rather than a disease
    • “classic aging pattern” – fluid vs crystallized intelligence
    • Cognitive plasticity (adapt to conditions) en cognitive reserve
34
Q

Ageing will not always lead to cognitive decline

  • Schaie (2013): 4 patterns of cognitive ageing:
A
  • Schaie (2013): 4 patterns of cognitive ageing:
    • Successful ageing – maintain cognitive function or very modest decline
    • Normal ageing – overall modest decline on most cognitive abilities (but not all abilities)
    • Mild cognitive impairment (MCI) – decline greater than normal (criteria proposed > 1 SD or Clinical Dementia Rating of 0.5)
    • Dementia – marked decline in cognitive functioning, interfering with daily functioning
35
Q

Successful ageing

  • maintain cognitive function or very modest decline (prevalence)
A

¨Prevalence of successful cognitive ageing

  • estimated ± 10% of older adults
  • Negash et al. (2011) – based on Mayo Study on Aging cohort:
    • functions assessed: attention/executive function, language, memory, visual spatial ability
    • strictest criterion: older participants no test score more than 1 SD below the norms of YOUNG adults, 6% were successful agers
36
Q

Successful ageing

  • maintain cognitive function or perhaps very modest decline (mortality)
    • Negash et al. (2011)
A
  • successful agers had lower mortality than typical agers (lived longer)
37
Q

Successful ageing

  • superagers
A
  • successful cognitive agers often “super normals” – older persons without conditions or medication that could affect cognition (e.g. diabetes, cardiovascular disease)
    • to isolate effect of age (passage of time) only, without the confounders of illness and medication
    • age has little effect on cognition
      • successful cognitive ageing shows that decline is not inevitable
38
Q

Typical/normal cognitive ageing

A
  • Around 70% of older adults
  • Changes in cognitive functioning, but still healthy ageing
    • E.g. speed of information processing, memory, executive functioning, name retrieval
39
Q

How do we know it is healthy ageing?

A
  • Robust norming: remove persons from norm sample who developed dementia (at some point) after baseline
    • remaining sample is unlikely to be in early stage dementia
40
Q

If cognitive ageing seems abnormal?

  • overview (smith & Bondi, 2013)
A
41
Q

Critical variable in ageing research

A

Critical variable in ageing research:

  • typically chronological age
  • what is the effect of age on behaviour or cognitive function?
  • age is an “organismic” variable, cannot be manipulated
  • only ways to study effects of age:
      1. comparing different persons, who differ in age, but are otherwise as similar as possible
      1. comparing the same person at different points in time, when they are at different ages
42
Q

Research design

  1. Cross-sectional design:
    * comparing different persons, who differ in age
A

Cross-sectional design:

  • comparing different persons, who differ in age
  • Age effect derived from differences between persons who were born in different years/decades.
    • What is the problem?
  • Age effect could be confounded by cohort effect
  • Cohort: generation of persons born at about the same time.
    • cohort members have common experiences as they grown up, which could influence their development and their test performance in adulthood
43
Q

Research design

  1. Longitudinal design:
    * comparing the same person at different points in time
A
  1. Longitudinal design: comparing the same person at different points in time
  • Changes between T1 and T2 (or T3, T4 etc.) reflect effect of age – effect of ageing
  • Participants from same cohort – no cohort effect
    • What is the problem?
    • Findings may not generalize to other cohorts
    • Retest effects
    • Selective dropout (Selective drop-out – participants do not return for 2nd, 3rd, etc. assessment)
      • Why a problem?
  • Selective drop-out
    • e.g. participants with lower scores at T1 drop-out and participants with higher scores at T1 return for T2.
44
Q
  1. Longitudinal design: comparing the same person at different points in time

¤

¤Selective drop-out – participants do not return for 2nd, 3rd, etc. assessment

Why a problem?

A

Selective drop-out – e.g. participants with lower scores at T1 drop-out and participants with higher scores at T1 return for T2.

Neuropsychology of Ageing (12 decks)

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