Chapter 14 Flashcards by Alexandria Leland

Aging
Elderly = age?
life expectancy in last 200 years?

Elderly = over the age of 65
Arbitrary point set largely by social policies

In less than 200 years, life expectancy has almost doubled in Western world

How well did you know this?

Not at all

Perfectly

T/F

Aging involves inexorable cognitive decline

FALSE

Severe cognitive problems do not occur for most
Mild declines are common

How well did you know this?

Not at all

Perfectly

T/F

Older adults are unhappy

FALSE

More skilled a emotion regulation
Attend more to positive
Display less psychophysiological response to negative emotion

How well did you know this?

Not at all

Perfectly

T/F Late life is a lonely time

FALSE

Interests shift away from seeking new social interactions to cultivating a few close friendships
Social selectivity

How well did you know this?

Not at all

Perfectly

Problems Experienced in Late Life : common problems

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

How well did you know this?

Not at all

Perfectly

Problems Experienced in Late Life

common problems and *Polypharmacy

How well did you know this?

Not at all

Perfectly

Problems Experienced in Late Life : polypharmacy

*Polypharmacy: Prescribing multiple drugs to a person
40% of elderly persons are prescribed at least 5 medications
Increases the risk of adverse drug reactions
Most researchers test drugs on younger people

How well did you know this?

Not at all

Perfectly

Research Methods: Three Types of Effects

Age, Cohort and Time-of-Measurement Effects

How well did you know this?

Not at all

Perfectly

Research Designs

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

*Cross-sectional studies

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

How well did you know this?

Not at all

Perfectly

Psychological Disorders in Late Life

DSM criteria are the same for older and younger adults

Particularly important to rule out medical explanations
Medical problems can also worsen the course of depression
Age-related deterioration in the vestibular system can account for panic symptoms
Depression is common after strokes or heart attacks
Antihypertensive medication, corticosteroids, and anti-parkinson medications may contribute to depression or anxiety
Disentangling medical and psychological concerns is complex!

How well did you know this?

Not at all

Perfectly

Methodological Issues

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

How well did you know this?

Not at all

Perfectly

Methodological Issues :Selective mortality

Selective mortality

Psychological disorders are associated with premature mortality

How well did you know this?

Not at all

Perfectly

Methodological Issues :Cohort effects

Cohort effects

E.g., many people who reached adulthood during the drug-oriented era of the 1960s continue to use drugs as they age

How well did you know this?

Not at all

Perfectly

Treatment

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)

How well did you know this?

Not at all

Perfectly

Mild Cognitive Impairment

Early signs of decline before functional impairment

Problems with DSM-5 criteria requiring a low score on only one cognitive test
Some cognitive test 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

How well did you know this?

Not at all

Perfectly

DSM-5 Criteria: Mild Neurocognitive Disorder (Mild Cognitive Impairment

Modest cognitive decline from previous levels in one or more domains based on both of the following:

Concerns of the patient, a close other, or a clinician
Modest neurocognitive decline (i.e., between the 3rd and 16th percentile) on formal testing or equivalent clinical evaluation
The cognitive deficits do not interfere with independence in everyday activities (e.g., paying bills or managing medications), even though greater effort, compensatory strategies, or accommodation may be required to maintain independence

The cognitive deficits do not occur exclusively in the context of delirium and are not due to another psychological disorder

How well did you know this?

Not at all

Perfectly

DSM-5 Criteria: Major Neurocognitive Disorder

aka Dementia

Significant cognitive decline from previous levels in one or more domains based on both of the following:

Concerns of the patient, a close other, or a clinician
Substantial neurocognitive impairment (i.e., below the 3rd percentile on formal testing) or equivalent clinical evaluation
The cognitive deficits interfere with independence in everyday activities
The cognitive deficits do not occur exclusively in the context of delirium and are not due to another psychological disorder

How well did you know this?

Not at all

Perfectly

Alzheimer’s Disease

Irreversible brain tissue deterioration
Death usually occurs within 12 years

Usually begins with:
Absentmindedness and gaps in memory for new material
Leaving tasks unfinished or forgotten
Difficulty finding words

Other symptoms
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

How well did you know this?

Not at all

Perfectly

Brain Changes in Alzheimer’s Disease

Plaques: β-amyloid protein deposits
Primarily found in frontal cortex
Neurofibrillary tangles: Protein filaments composed of tau
Primarily found in hippocampus
Measured using PET scans

Immune responses to plaques lead to inflammation
-Loss of synapses and neuronal death

How well did you know this?

Not at all

Perfectly

Frontotemporal Dementia

Loss of neurons in frontal and temporal lobes
Typically begins in late 50s, progressing rapidly
Death usually occurs within 5 years
Affects less than 1% of the population
Memory not severely impaired
There are multiple subtypes

Most common subtype: behavioral variant
Deterioration in at least 3 areas:
Empathy, executive function, ability to inhibit behavior, compulsive or perseverative behavior, tendencies to put nonfood in mouth, apathy
Strikes emotional processes more profoundly than Alzheimer’s
Often misdiagnosed
E.g., midlife crisis, bipolar disorder, depression

How well did you know this?

Not at all

Perfectly

Vascular Dementia

Caused by cerebrovascular disease
Most commonly stroke
Same risk factors as cardiovascular disease
Older age, high “bad” cholesterol, smoking, high BP

Strokes and vascular dementias are more common in African Americans than in Caucasians

Symptoms vary greatly depending upon location of stroke

Vascular Dementia

Caused by cerebrovascular disease
Most commonly stroke
Same risk factors as cardiovascular disease
Older age, high “bad” cholesterol, smoking, high BP

Strokes and vascular dementias are more common in African Americans than in Caucasians

Symptoms vary greatly depending upon location of stroke

Dementia with Lewy Bodies

* Protein deposits (Lewy bodies) form in the brain and cause cognitive decline * Affects 1% or less of elderly individuals * Symptoms hard to distinguish from Parkinson’s and Alzheimer’s diseases Symptoms more likely to include: Prominent visual hallucinations Fluctuating cognitive symptoms Sensitivity to physical side effects of antipsychotic medications Intense dreams involving movement and vocalizing

Treatment of Dementia: Medications

* Some medications help to slow decline, but cannot restore functioning - Cholinesterase inhibitors - Many people discontinue due to side effects *Medications to improve cardiovascular health and to treat depression or agitation * Ongoing prevention research - Reduce chances of mild cognitive impairment - Study people with early biological markers - Prevent development of plaques and tangles

Treatment of Dementia: Psychological Treatments

*Supportive psychotherapy Education about disease and care for patient and family *behavioral approaches External memory aids Music to reduce agitation and disruptive behavior Psychotherapy to reduce depression Increasing pleasant and engaging activities * Exercise and cognitive training to prevent cognitive decline before it begins - Small benefit of training in individuals with mild cognitive impairment

signs of delirium

``` Clouded state of consciousness: Extreme trouble focusing attention Cannot maintain a coherent stream of thought Trouble answering questions Disturbances in the sleep/wake cycle Drowsy during the day, yet awake and agitated at night Vivid dreams and nightmares are common Difficult to engage in a conversation Speech may become rambling and incoherent Disorientation of time, place, and name Memory impairment of recent events Perceptual disturbances ```

DSM Criteria: Delirium

Disturbance in attention and awareness A change in cognition not better accounted for by a dementia E.g., disturbance in orientation, language, memory, perception, or visuospatial ability Rapid onset (usually within hours or days) and fluctuation during the course of a day Symptoms are caused by a medical condition, substance intoxication or withdrawal, or toxin

Delirium

Rapid onset and can fluctuate during the course of a day Lucid intervals where person becomes alert and coherent Daily fluctuations help distinguish delirium from other syndromes, especially Alzheimer’s disease Can occur at any age Common in children and in older adults Often misdiagnosed Untreated, the mortality rate for delirium is high Predictor of death within the next six months Increased risk of further cognitive decline

Treatment of Delirium

Complete recovery if underlying cause is treated Atypical antipsychotic medications are also used Usually takes 1 to 4 weeks to clear Takes longer in older people than younger people Reduce risk factors for delirium within the hospital setting: Sleep deprivation, immobility, dehydration, visual and hearing impairment Family should learn about delirium symptoms and its reversible nature to avoid interpreting the onset of delirium as a new stage of a progressive dementia

When is memory not severely impaired

Frontotemporal Dementia

Selective mortality def

Selective mortality is a process whereby disadvantaged individuals die at younger ages than their more advantaged peers.

T/F all people with MCI develop dementia

FALSE | Not all people with MCI develop dementia

delerium and memory

Memory impairment of recent events

causes of Frontotemporal Dementia

*Can be caused by many different molecular processes: Pick’s disease High levels of Tau Strong genetic component

43. All of the following are possible causes of major neurocognitive disorder EXCEPT a. Alzheimer's disease. b. chemical substances (including medications). c. depression. d. food additives and preservatives.

d. food additives and preservatives.

51. What is the approximate average survival time of a patient diagnosed with Alzheimer's disease major neurocognitive disorder? a. 4 years b. 8 years c. 15 years d. 20 years

b. 8 years

52. Symptoms of Alzheimer's disease neurocognitive disorder typically appear between the ages of a. 40 and 50. b. 50 and 60. c. 60 and 70. d. 70 and 80.

c. 60 and 70.

57. With the best treatment available today, major neurocognitive disorder is generally a. reversible. b. controllable but not curable. c. curable. d. not very responsive to treatment.

d. not very responsive to treatment.

58. What is the primary goal of most psychosocial treatments for major neurocognitive disorder? a. Relieve depression b. Help the patient compensate for lost abilities c. Treat the anxiety associated with knowing that the disorder is progressive d. Enhance family functioning

b. Help the patient | compensate for lost abilities

``` 6. Approximately __________ percent of practicing psychologists conduct clinical work with older adults. a) 20 b) 40 c) 50 d) 70 ```

B) 40

______% of practicing psychologists regularly conduct clinical work with older adults -and this is growing

40% of practicing psychologists regularly conduct clinical work with older adults -and this is growing

About 40% of the elderly experience polypharmacy where they are prescribed a) 1 or 2 prescriptions b) 2 or 3 prescriptions c) 3 or 4 prescriptions d) 5 or more prescriptions

d) 5 or more prescriptions

Older people are likely to underreport __________, perhaps because of beliefs that these are inevitable parts of life. a) sore muscles b) somatic symptoms c) dizziness d) absent-mindedness

b) somatic symptoms

Which of the following statements is an example of a time-of-measurement effect? a) Today's older adults are less likely to seek mental health services because when they were growing up, mental illness was stigmatized. b) Because exercise has become widely promoted in the media, many older adults are now exercising and thus are healthier than predicted by earlier measures of their physical well-being. c) Because of the effects of aging on the brain, older adults do worse than younger adults on measures of "fluid" intelligence. d) In a longitudinal study, many of the elderly subjects died before the follow-up data was collected.

b) Because exercise has become widely promoted in the media, many older adults are now exercising and thus are healthier than predicted by earlier measures of their physical well-being.

The most prominent symptom of dementia is a) difficulty remembering things. b) disorientation. c) aggressive behavior. d) depression.

a) difficulty remembering things.

A group of people age 40 is compared to a group age 70. This type of research is called a) longitudinal. b) time-of-measurement. c) cross-sectional. d) cohort effect.

c) cross-sectional.

Plaques, which develop as part of Alzheimer's disease, are a) protein deposits that are outside neurons. b) cholesterol remains from poor diet. c) composed of serotonin and fatty deposits. d) equivalent to neurofibrillary tangles.

a) protein deposits that are outside neurons.

Frontal-temporal dementias (FTD) are characterized by a) early-onset Alzheimer's disease. b) primarily acetylcholine disturbance. c) problems with executive function such as planning and problem solving. d) Huntington's chorea.

c) problems with executive function such as planning and problem solving.

Which of the following has been shown to play a role in the development of Alzheimer's disease? a) head injury b) immune system functioning c) an abnormality on chromosome 19 d) all of the above

c) an abnormality on chromosome 19

he symptoms of dementia with Lewy bodies are similar to those of a) Parkinson's. b) Alzheimer's. c) Huntington's chorea. d) Both a and b.

d) Both a and b.

Which of the following diseases can produce dementia? a) meningitis b) encephalitis c) HIV d) all of the above

d) all of the above

Standard treatment for Alzheimer's disease includes a) behavior therapy to maintain cognitive skills. b) helping the victim recognize deterioration and make plans. c) drugs to reduce toxic neurotransmitter levels. d) drugs to increase acetylcholine levels.

d) drugs to increase acetylcholine levels.

The idea that some people may be able to compensate for neurocognitive diseases by using alternative brain networks or cognitive strategies such that cognitive symptoms are less pronounced is called a) cognitive reserve b) cognitive adjustment c) mental compensation d) none of the above

a) cognitive reserve

In 2009 there were 50,000 people 100 years old, in 2050 there is expected to be a) 1,000,000. b) 800,000. c) 500,000. d) 250,000.

b) 800,000.

*Symptoms hard to distinguish from Parkinson’s and Alzheimer’s diseases

Dementia with Lewy bodies