Flashcards in L8 - Cerebral Disorders Deck (40):
What are some life events associated with older life?
Retirement - critical transition
Grandparenting - can have positive and negative afffectis - higher depression, diabetes, insomnia, stress...
Bereavement - Older people cope better with loss. Maybe because loss is expected, or they have better social connections than a young person.
OR ... things such as insomnia, loss of appetite are overlooked in old people b/c it looks like general aging
What are signs of normal memory decline in ageing?
- decrease in amount of new information remembered
- lapses in memory
- difficulty with complex attentional tasks
- CELL VOLUME IN HIPPOCAMPUS DECLINES WITH AGE
What are some DSM-V neurocognitive disorders?
NOT AGE SPECIFIC.
- Traumatic brain injury
What -are- neurocognitive disorders?
They are referred to as dementia, delirium and amnestic disorders.
- syndromes with UNDERLYING PATHOLOGY
- not just degenerative disorders, also disorders that affect young people
What are the stages of dementia?
MCI - Mild cognitive impairment
What is pre-clinical dementia?
This precedes MCI, and is almost indistinguishable from normal ageing.
also includes people who have demonstrated subtle decline from their own baseline that exceeds typical ageing, but haven't met the criteria for MCI
Describe Alzheimer's Disease?
- Memory loss disrupts daily life
- Difficulty planning/solving problems
- Difficulty completing familiar tasks at home/work/for leisure
- Confusion with time and place
- trouble understanding visual images and spatial relationships
- new problems with words in speaking or writing
- misplacing things
- poor judgement
- changes in mood and personality
- withdrawal from work or social activities
What are the stages of decline in dementia?
Moderate dementia - similar symptoms as from stress or illness and side effects from medication - often misdiagnosed
Describe Early dementia.
--> Insidious onset
- loss of interest in hobbies
- poor judgement
- unwilling to try new things
- forgetful of details of recent events
- blaming others for 'stealing' lost items.
Describe moderate dementia.
--> problems become more apparent and disabling. Need more help from others
- more forgetful of recent events
- forget names of family and friends
- confused regarding time and place
- lost if away from familiar surroundings
- neglectful of hygiene and eating
- see or hear things that are not there
- behave inappropriately
Describe advanced dementia.
Person is SEVERELY disabled and needs TOTAL care.
- be unable to remember occurrences for even a few minutes
- lose ability to understand/use speech
- difficulty walking
- need help eating, bathing, toileting
- fail to recognise everyday objects
- no recognition of friends and family
- uncontrolled movements/immobility
Where are areas that show deterioration of the brain in dementia?
- enlarged ventricles
- language area
- memory area
- deeper sulci
What is the most common type of dementia?
What is vascular dementia?
Dementia caused by reduced blood supply to the brain due to diseased blood vessels.
--> heart problems --> due to diet? so some change can be achieved if changes made to diet.
(blood is delivered to the brain through vascular system)
vascular system damaged (leaked/blocked) --> blood can't reach brain --> brain cells die --> memory and cognition problems.
- effects of brain cell death can be subtle at first, but builds up.
What does the course of decline for vascular dementia look like, when compared to alzheimer's?
it is a gradual step-wise deterioration.
The decline is a little more steep, and only takes 6-8 years.
What is parkinson's disease?
A progressive disease marked with tremor, muscular rigidity and slow movement.
- Associated with degeneration of the basal ganglia of the brain and deficiency of DOPAMINE
- 50-80% of these people go to develop dementia:
What are some characteristics of people with parkinson's with dementia?
- deficits in executive func, visuospatial ability
- memory problems (not the initial feature for many though)
What is a stroke?
Sudden disturbance of the nervous system, caused by distruption of blood supply to the brain.
- Ischaemic stroke
- Haemorrhagic stroke
What is an ischaemic stroke?
A blockage in one of more of the arteries carrying blood to the brain
What is a haemorrhagic stroke?
Artery burst --> bleed in brain --> also kills brain cells
What are signs of a stroke?
- paralysis in face, limbs - especially on one side of body (hemiplegia)
- dizziness, trouble walking, loss of balance
- numbness or weakness. Drooping of one side of face
- difficulty swallowing
- confusing, difficulty speaking or understanding speech
- visual disturbance in 1 or both eyes
What is delirium?
A state of mental confusion that can occur as a result of illness, surgery or medication.
It starts suddenly, can be frightening, and is reversible.
How long can delirium last?
onset can take hours or days..like a stroke.
Fast onset compared to dementia.
but can last..
- acute - hours to days
- persistent - weeks to months
What are are possible causes of delirium?
- Medical condition: infection of bladder, chest or brain, fever, dehydration
- substance withdrawal/intoxication
- major surgery
- terminal illness
It is non-reversible if you don't treat it in time. Fast onset compared to dementia.
What are symptoms of delirium?
Diminished awareness of surroundings
Inability to understand conversation/speak correctly
confusing that worsens in evenings
vivid dreams that continue once awake
What is the psychologist's role in neurocog disorders?
- Early detection of MCI
- Support to caregivers
- recommendations for supports and strategies
Give an example of a test used for alzheimer's
MMSE - mini-mental state examination
- clock drawing test
- house copying test
- montreal cognitive assessment - LESS AFFECTED BY EDUCATION
What is TBI?
Falls/Traumatic Brain Injury.
- Greater increase among elderly (65+), but also present in young people.
- Happens when there is a jolt or impact causing brain to be shaken around in skull.
older people - falls
younger people - sporting, car, bike injuries.
Effects of Traumatic brain injury?
- functioning outcomes were worse in elderly than young people: feeding, locomotion, expression
- higher rates of mortality in elderly
- same outcomes even when less severe
- older individuals more likely to have increased dependence post injury
- can be associated with dementia
What is post concussional disorder?
- history of head trauma
- difficulties with attention or memory
- 3+ of:
fatigure, sleep disturbance, dizziness, anxiety, depression, apathy, personality changes etc.
Lots of these symptoms are also symptoms of aging, so it is often dismissed by clinicians.
What are trends in mental health in later life?
- psychiatric disorders may decrease in prevalence in later life
- declines in memory, associated w/ normal aging are small
- increase in wisdom and other skills
- better coping strategies for managing distress
- some people have a more productive meaningful later life, as they have more active roles.
or maybe older people just don't report the problems... because it's expected....
How does late life depression differ from early onset depression?
- FIRST EPISODE AFTER 60 YRS
- more cog dysfunction
- increase comorbodity of medical illness
- greater fatigue and agitation
- less likely to have family history of depression
- serious suicide concern
use geriatric scale to measure --> removes physiological questions.
List some differences between depression and dementia in
onset: rapid in depression, insidious in dementia
duration: short for depression, long for dementia
mood: depressed vs. fluctuating
self-image: poor vs normal
reason for consultation: self referral vs. family referral
family history differs
Anxiety in older populations?
- more common than depression in older people.
- phobia most common, GAD less common.
- OCD and PTSD not common
- more common in females
problem is that the symptoms mimic the symptoms of other medical conditions
Alcohol and substance disorders in older individuals?
- will expected to become more prevalent among older people with time
- unreported substance use increases risk of negative interactions with medications
- comorbidity of mental disorders and substance abuse:: 20% of people receiving outpatient mental services and 37% receiving inpatient mental health services.
Barriers to a more proactive response to elder abuse by health care providers?
- lack of comfort with the issue
- lack of training and information on the prevalence and health impact of abuse
- perceived lack of time to address problem
- lack of confidence in referral agencies
- lack of formal protocols and institutional support for responding
Examples of older abuse?
- psych/emotional - cause distress, anger, threats of bodily or sexual abuse
-physical - infliction of pain - withholding or too much medication
-partner abuse or through other family members
- societal abuse
Factors that can increase likelihood of elder abuse?
- family undergoes unfavourable change in circumstances
- history of poor relationships between family
- difficulties emerge as result of role reversal
- carer forced to change lifestyle as result of caring
- carer has not received help or support
What are examples of elder abuse and neglect?
- malnourishment / dehydration
- weight loss with no apparently medical cause
- lack of safety precautions or supervision
- poor personal hygiene
- poor clothing choices - inappropriate for weather
- medicines not purchased or administered
- no social, cultural, intellectual or physical stimulation