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Psych of Aging Exam 1 and 2 Notes

by: Rima Notetaker

Psych of Aging Exam 1 and 2 Notes PY 425

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These are notes I have taken for exams 1 and 2. They are detailed and easy to follow. I was able to make an A using my notes. I cannot guarantee the same for you, but if you work hard to learn the ...
Psychology of Aging
Pariya Wheeler
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This 42 page Bundle was uploaded by Rima Notetaker on Sunday April 3, 2016. The Bundle belongs to PY 425 at University of Alabama at Birmingham taught by Pariya Wheeler in Spring 2016. Since its upload, it has received 15 views. For similar materials see Psychology of Aging in Psychlogy at University of Alabama at Birmingham.


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Date Created: 04/03/16
Psych of Aging – Exam 1 Biological Aging  Animals living in natural environments are less likely to die from old age o Because of dying earlier due to:  Predation  Disease  Starvation  Due to advance science aging process has emerged in humans o Something maybe not intended to happen  Over 300 theories Rate of Living Theory  We are born with a limited amount of energy that can be expended o Metabolic processes may relate to living longer/dying Reynolds 2005 Article  Obesity had little effect on life expectancy once you reach 70 o Significantly lowered ACTIVE life expectancy Hayflick Limit  Cells have limited ability to divide o Limited life-span o Human adult cells can only divide 20 times  Shortening of telomeres o Stretches of DNA that form on tips of chromosomes C. elegans  Type of round worm o Used in aging research  Gerontogenes o Genes involved in prolonging life Free Radical Theory  Free radicals o Some oxygen molecules used for metabolism turn into an unstable from or oxygen (ROS) o Aggressively attack and destroy molecules  Oxygen Paradox o We need oxygen to survive o But oxygen radicals slowly kill us Biological Theories (Cont.)  Antioxidants o Help prevent oxygen form combining with molecules to form free radicals  Vitamins A, C, E, and coenzyme Q o They postpone appearance of cancer and cardiovascular disease o No hard evidence that they increase lifespan  Programmed Cell Death o Body is preprogrammed to self-destruct o Bodies age according to normal developmental timetable build into the genes  Alternative: Damage/Error o Cells deteriorate and malfunction o Accumulation of damage to DNA and genetic mutations with aging  Progeria o Rare disease that may give clues to the biology of aging  Genetic mutation  Telomeres shortened quicker (theory) o They age prematurely o No cancer or neurodegeneration o Real reason:  Caused by mutation in LMNA  Produce abnormal protein that blocks normal functioning o Same protein made in very low levels in healthy adults  Wear and Tear Theory o Body eventually breaks down after all of the abuses throughout life o Not widely supported  Use it or Lose it Theory o Engagement in life may delay onset of disease and death o Depends on bodily systems  Cross-linking theory o Aging collagen becomes insoluble and rigid  Collagen provides structure to body o Chemical reactions create bonds between molecules that are normally separate o Results in  Reduced flexibility  Take Home Message on Theories o Help us understand why we age and what we can do to slow down aging o Explain aging process o No one theory explains all aspects of biological aging Physical Changes with Aging o Appearance o Skin and face changes  Start happening around age 30  Mild wrinkling 30-50 o Skin more translucent  Can see veins o Hair  Gets thinner and gray  Men –  Male pattern baldness  Women –  Thins  Complete loss is less likely o Hair in nose, ears, eyebrows grows and gets thicker o Height  Stable until fifty  Men – shrink an inches  Women – shrink two inches o Weight  Increase in midlife (20s-50s)  Weight loss in late life  Body loses muscle and bone with age  Some fat loss occurs too  Distribution of weigh changes  Men – big bellies  Women – big bottom half  Balance of muscle and fat changes  Related to decreased metabolism o Psychological Implications o Major effects on people’s sense of identity/self-concept  Many don’t feel “old”  High value in U/S/ on looking young  Especially for women  Many people willing to use any available means to compensate for changes o Hear and Cardiovascular System o Heart tissue becomes less elastic o Arteries stiffen and thicken with age  Cholesterol o Cardiovascular Disease That Increases in Frequency with Age o Atherosclerosis  Build up of fat deposits on and the hardening of arterial walls  Fat deposit in arteries interfere with blood flow  Due to:  Poor nutrition  Smoking  Inevitable part of normal aging o Myocardial infarction (heart attack)  Blood supply to heart is severely reduced or cut off  Silent heart attacks  Without chest pain  More frequent in older adults o Strokes or cerebrovascular accidents (CVA)  Either blood flow stopped or bleeding due to burst blood vessels  TIA  Mini stroke  Symptoms last less than 24 hours  Silent stroke  No symptoms o Lung and Respiratory System o Capacity of lungs decrease o Overall efficiency declines o Physical exercise may decrease severity of changes o Increased chance of:  Chronic bronchitis  Emphysema o Respiratory Disease  Chronic obstructive pulmonary disease (COPD)  Family of diseases which include emphysema and chronic bronchitis  Emphysema  Most common age related form of COPD  Most cases result from smoking  Chronic Bronchitis  People exposed to high levels of dust and pollution  Can be caused by smoking as well o Sensory Systems o Every system – higher sensory threshold o Vision and hearing – most obvious changes o Vision Changes  Age related changes in structure of eyes  Decrease in the amount of light that passes through eye  Increased susceptibility to glare  Adaptation takes longer  Yellowing of the lens  Presbyopia – farsightedness  Lose focus on close objects  Cataracts  Cloudy, opaque areas that develop in the lens  May be related to exposure to ultraviolet light  Can be repaired surgically  Glaucoma  Damage to the optic nerve  Not as treatable  Macular degeneration  Not as treatable  Central vision is darkened but peripheral is spared o Practical Implications o Changes can do disrupt to everyday life  Social interactions may be disrupted and avoided o Common tasks are affected  Reading a book  Watching TV  Driving o Increasing light does not help as it may also increase glare o Temperature Control o Deaths from hyperthermia increase  Particularly for people with heart disease  Due to inability to regulate body temperature to cold Longevity and Health  Jean Calment o Did everything in moderation o Lived to be 122  Definitions o Life expectancy at birth  Number of years that will probably be lived by the average person born in a particular year  Age at with half the cohort is expected to die/be alive o Life expectancy at a specific age  Number of additional years that a person can expect to live relative to their current age  Life expectancy at birth is lower than life expectancy at 65 o Maximum life span  Theoretical upper limit of the human lifespan  Humans = around 120  Important general issues o Prevention vs. treatment o U.S. is one of the richest countries in the world  Ranking for health care expenditures  Ranking for life expectancy o Effects of social status  SES  Health o Stress  Social status  Occupation  Neighborhood  Discrimination o Health behaviors  Smoking  Drinking  Diet  Exercise o Lack of healthcare access?  Can be one of the reason but not as much as lack of health education  Longevity o Genetic and environmental factors affecting longevity  Strong predictor – length of parent’s life o Environmental factors  Health behaviors  Diseases  Toxins  Lead in water in Michigan  Socioeconomic status (SES)  Stress  Most of these are preventable at either the societal or personal level o Ethnic Differences  African Americans vs. Caucasians (Crossover effect)  Members of ethnic minority groups who survive to older age (85) may live longer than Caucasians  Hispanic paradox  Similar longevity to non-Hispanic whites despite lower average SES o Their daily activities may require more exercise than Caucasian life styles resulting in a healthier life styles  Longevity-Gender Differences o Women have nearly a seven-year edge over men. Why?  Men are more vulnerable to disease  Men are risk takers  Men smoke and use alcohol more  Men allow stress to enter their lives more  Women’s X-chromosome may cause them to live longer?  Blue Zones o Found areas of world where people reach age 100 at substantially higher rates than in the U.S.  Italy  Japan  Costa Rica  Greece  Loma Linda, California  Active vs. Dependent Life Expectancy o Active life expectancy  Living a healthy, independent old age o Dependent life expectancy  Years of living after losing independence o Goal – adding life to years instead of years to life!  Chronic and Acute Diseases o Acute  Develop quickly  Cause rapid changes in health status  Common cold  Flu  Most cured with meds or are allowed to run their course o Chronic  Cancer  Diabetes  Hypertension  Greater than three months  Often result in impairments  5 reasons for HIV Infection o Lack of sex education and HIV education o Re-entering dating pool  Divorce and separation o Bias and stigma  “Old people don’t have sex” o Menopause  Less lubrication  Causes higher risk of contracting HIV o Male enhancement medication  Causes men to be more sexually active  Compression of morbidity o Future  People will live longer with less disability o Life course  Good health  Short period of disability  Death  Indicators of disability o Activities of daily living (ADL)  Basic self care tasks  Bathing  Eating  Dressing o Instrumental activities of daily living (IADL)  Activities that require some intellectual/cognitive competence and planning  Paying bills  Taking medication  Shopping  Driving o Culturally dependent o Obesity  High blood pressure  Diabetes  Heart disease  Sleep apnea  Health Behaviors and Aging o Health behaviors  Behaviors that enhance physical function, psychological function, reduce disease vulnerability, or slow disease progression  Smoking o Increase in negative affect o Weight gain  Sleep o Recommended 7-9 hours per night o Poor sleep related to  Cognition  Premature mortality  Obesity  Insulin regulation  Cardiovascular regulation  Diet o Good diet = antioxidants  High in fruits and veggies  Low fat  Green tea  Red wine  Dark chocolate  (Polyphenols) o Dietary factors and disease  Heart disease  Certain cancers  Colon  Bladder  All-cause mortality  Brain function?  Exercise o 2.5 hours a week with moderate exercise o 75 minutes a week with vigorous exercise  Running o 2 days a week with muscle strengthening  Exercise lowers  Arthritis  Heart disease  Obesity  Diabetes  Screening o Dietary supplements  Evidence often lacking or contradictory  FDA regulates food not drugs o Not required to prove safety or effectiveness o FDA only takes action after proven harmful o Alcohol  Heavy drinking = bad  Liver issues  Kidney problems  Heart defectiveness  Brain functioning lowered  Injury  Moderate drinking  1 drink a day for women  2 drinks a day for men o Lower rates of  Heart disease  Dementia  Influences on health behavior o Cultural o Family, friends, social contacts o Self  Efficacy  Perception  Motivational factors  Trans-theoretical Model of Change (TTM Prochaska and DiClemente) o Individuals move through a series of five stages in the adoption of healthy behaviors or cessation of unhealthy ones  Pre-contemplation  No intent to change in near future  Possible lack of awareness about consequences of the problem behavior  Avoidant of target behavior  Resistant or unmotivated  Underestimate pros and overemphasizes cons  Contemplation  Recognition of problem  Initial consideration of change  Information gathering for options  Ambivalent o Pros and cons equally emphasized  Preparation/Determination  Intend to take the steps in the next month  Start to take small steps toward the behavior change  Believe changing behavior can lead to a healthier life  Action  Start changing behavior but still have been less than six months  Maintenance  Behaviors initiated in action stage are continued  Work to prevent relapse to earlier stages  Behavior Change Strategies o Setting reasonable goals and expectations  Specific  Attainable  Forgiving o Pros and cons o Problem-solving o Record keeping  General issues o Shrinking “life-space”  80-90% of time in home environment  Do people really want to leave their home and go to a nursing home?  Influences where older adults live when they get older  Life space o 0 – if you can’t leave your bed o 1 – if you can’t leave your home o 2 – can’t leave your yard o 3- can’t leave your neighborhood o 4 – can leave the town o 5 – unlimited – travel the country  Theories o Competence  Upper limit to function o Environmental press  Demands placed upon people  Negative if Press is high and Competence is low o Vise versa o Optimal ideal of balance between competence and press  Housing o 95% of people over 65 live in the community  Not in institutions o Most want to live in their own homes o “Aging in place”  Historical – means you don’t leave your home  Now – aging in a place you want to be o Problems –  Houses are typically built with younger, able persons mind  Multiple floors  Different elevations  Community living o Highest older adult population  Florida  Arizona  California  Reasons – o Weather is great o Stays warm o Dry  Advantages – o Social services, businesses, builders, churches are more centered on older adults  One-level housing  Meal programs  Dial a ride  Cultural/activity centers o Activities and facilities enable elders to:  Remain active  Be a vital part of the community  Urban Retirement – o Many choose not to go to retirement areas  Downtown areas of larger cities o Advantage –  Cultural offering  Young neighbors  Good restaurants  More walking  Housing: options available – o Stay at home  Home modifications o Apartments for older people o Auxiliary dwelling units (ADU’s)  Granny flats o Retirement communities  Option 2 – o Assisted Living Facilities  Personal care and protective supervision  No skilled nursing care  Offer meals  Have social activities  Expensive – Medicare does not cover the fees  Option 3 – o Continuing Care Retirement Communities  Independent living to full nursing care  Very expensive  Not covered by insurance  There is usually an entrance fee  Long-term Care Facilities – o 5% of people over 65 are living here at one time o Prevalence with age o Nursing homes have largest number of residents  Most common  Skilled nursing care  Intensive 24 hour care  Intermediate  Someone is on site if needed  Not 24 hour care o Those who live there are usually:  Very old  Female  Caucasian  Financially disadvantages  Poor social support networks  Mentally/physically impaired  Nursing Homes – o Frequently are:  Cold  Impersonal  Residents have little control over environment  Very different from home o Hard place to work  The 3 Plaques (Eden Alternative) o Loneliness  Separated from family  Separated from friends o Helplessness  Eat  Sleep  Bathe  Get dressed o Boredom  Activities not meaningful or fulfilling  Long-term Care Facilities – o Social Psychological Perspective (Langer, 1976)  Major issue is control over choices  2 groups:  Told nurses were there to do everything o Versus  Residents could make decisions about: o Meals o Recreations  There was no difference in the amount of attention actually given o Difference in emphasis on responsibility/control  Results –  Better quality of life  Psycho/social differences  Greater sense of personal control = less likely to die  Eden Alternative o “Care for elderly is not simply about health care or medicine or technology”  Concept to create a culture change in nursing home o Creator of this is “nursing home abolitionist” o Environmental changes –  Animals  Living on premises  Plants and gardens  Children’s programs  Reading  Day care  Resident participation  Giving care opposed to only receiving care  Keep people’s stuff around  Photos  Knickknacks  Divided into neighborhoods  Build to ben in with surrounding homes and neighborhood  Residents and staff as partners (to make residents happy)  Voting on changes o Pets o Decorations o More free will  Staff more control (to make staff happy)  Schedules  Division of work  Eden Alternative Effects – o Better quality of life o Prolonging life  Long-term Care Facility – o Adjustment to relocation  Physical and mental health  Poorer levels result in poorer adjustment  Social support  More support = better adjustment Exam 2 Notes: Mental Health and Assessment  Mental Health – no universal definition is accepted o Could you base it on statistical normality? o Is it symptom-free psychosocial function?  Defining mental health – o Positive attitude toward self o Perception of reality o Mastery of environment  Press competence model o Autonomy o Personal balance o Growth and self-actualization  Adaptive under some circumstances but considered abnormal o Isolation o Passivity o Aggressiveness  Mental Illness o More agreement on the definition th  DSM – now on 5 edition o Two main elements –  Subjective distress  Person perceives something is wrong  Objective limitations in function  Older adult goes to doctor and has memory impairment that is unusual for them  Defining Abnormality o Cultural Relativism  What is considered normal and abnormal differs across cultures  Ex – how Japanese view depression can be different from how Indians view depression o Historical Relativism  Changes over time in a particular culture’s views of abnormal  Ex – during great depression o People were a product of their environment o Not a lot of happiness compared to other times o They were not technically depressed  Mental Illness Prevalence o Not normal part of aging o 20% have diagnosable disorder in past year o Higher if nursing home people were included  Ex – loneliness and boredom  Schizophrenia is less prevalent  Rates of Psychological disorder in late life o Usually occur in late life o Recurrences of disorder that begin earlier o Episodes of depression an anxiety are recurrences  Schizophrenia onset in 20s – rarely in older life  Alcoholism – late onset more common  Assessment: common presenting problems o Forgetfulness o Sadness o Peculiar thinking o Behavioral problems o Restrictions of independence  Source of referral o Self – you notice it yourself o Family member – family sees change o Physician  Women are more likely to be diagnosed with depression o Men who do become depressed have a higher chance of committing suicide and being successful  Physical Health and Assessment – o Interrelationship between physical and mental health o Testing considerations  How does illness affect symptoms or performance tests?  Don’t give cognitive test to someone who has visual impairment – results will not be accurate  Medications  Some medications have side effects of the illness o Ex – UTI medication  Sensory Changes o Vision problems  Presbyopia – can’t see far away things o Hearing changes  High pitched voices can’t be heard as well o Slowing Responses  Older adults are slower than young adults  Normal vs. Abnormal Aging o Availability of test norms  Comparing to others who are the same age, race, and background as the person being tested o Premorbid intellectual level  Give someone a vocabulary test when their English may not be as strong o Diagnostic bias  Older adults have a less likely chance of HIV so the doctor doesn’t test them – very biased o Factoring in physical health, medications, vision, hearing, and motor problems  Choosing a test o What is the assessment question o Self report vs. informant vs. performance-based  Self report  What is the patient saying?  What are the patient’s troubles?  Informant  Close family members noticing difference in the person  Can have bias  Performance-based  Giving the person a test and see their performance  Assessment Tree o Normal aging vs. abnormal aging o Due primarily to biological cause?  Often impossible to determine o Reversible vs. irreversible  Ex – dementia is not reversible  Can slow rate of decline  Assessment of Cognitive Disorders o History of disorder o Mental status examination o Neuropsychological assessment o Dementia vs. Depression vs. Delirium  Those illnesses are not mutually inclusive  Neuropsychological Testing o Memory  Visual and verbal learning included  Ex- list of words to remember and see all the words they can remember  Delayed recall  Have a pause before repeating list to have them recall it again o Attention and Working Memory o Executive functioning o Language o Visuospatial  Clinical Geropsychologists – only 4% of all psychologists o Psychologists working with older adults without geropsychology training –  Poor knowledge about aging conditions  May show ageism  Depression o Several types that vary in intensity and duration  Major depressive disorder  Most intense  Persistent depressive disorder  Dysthymic disorder  More chronic  Adjustment disorder  Response to stressor  Diagnosis o Major depressive disorder  Five symptoms have to last for two weeks  Hallmark symptoms  Sad/depressed mood o Dysphoria  Feeling down or blue  Loss of interest/pleasure  Must cause significant impairment  Social or occupational  Symptoms of depression  Weight gain/loss  Insomnia/hypersomnia  Fatigue/loss of energy  Worthlessness, guilt  Concentration problems  Thoughts of death  Age and Depression o Depression is NOT the norm with aging o Greater levels of normal things people may experience as they get older may signal depression (particular to older adults)  Apathy  Physical complaints  Anxious rumination  Irritability o There are developmental changes in aging make determining depression hard  Multimodal questionnaire  Need for recognition o Depression linked to suicide  Older adults more “successful”  Tend to be carefully planned  Health conditions make them less likely to survive  Women more likely to be depressed BUT men commit suicide more  Highest risk group:  White males in 80s  Majority saw primary care doc within month of suicide  Depression o Rate of occurrence  About 16% have subsyndromal symptoms o Common with people who have:  Diabetes  Cancer  Recent heart attack  Major Depressive Disorder less than 5%  Risk factors for depression in late life o Strokes and other vascular disease o Poor physical health  Disabilities  Inability to walk o Life events expected to trigger depression in late life  Death of spouse  Most people recover from loss  Retirement  Presents greatest problem for those in ill health and with low income  Depression Etiology – o Psychodynamic  Losses  Life changes (social roles)  Early childhood experiences increase vulnerability (re-experience)  Insight oriented/internal oriented  Self awareness  Too focused on oneself o Behavioral  Fewer pleasant actives  Fewer positive experiences in life o Cognitive  Distortions in thinking  All or nothing  Should be this way  Should be able to do this and that o Biological  Genetics  Neurotransmitter deficiencies  Lower serotonin and norepinephrine  Depression o Treatments  Psychotherapy  Behavior therapy o Doesn’t change underlying thought process o Treats depression symptoms not thought of depression  Cognitive behavior therapy o Changes underlying thought process o Treat the depression symptoms  Medication  SSRI most common  Electro-convulsion therapy  For more sever depression  Noninvasive o Weak current o Don’t have to be put to sleep  Invasive o Electrotherapy o Have to be put to sleep o Seizure induced in brain to alter brain chemistry  Cognitive Behavior Therapy Example o Assumption that problems of daily life cause and maintain depression o Improves self-efficacy  Gives people the behavior and cognitive tools to cope with stressors o Idea –  Help from beginning of problem until they implement the solution o Includes:  Motivational homework  Pschoeducation  Problem solving exercises  Delirium o Disturbance in consciousness and a change in cognition that develops over a short period of time  Acute confessional state  Reversible dementia o Mimics symptoms of dementia  There are underlying causes o Onset over few hours or days o Dramatic change in levels of function o Symptoms fluctuate greatly o Changes in attention/awareness  Difficulty focusing  Sustaining attention is difficult o May become illogical o Medication reaction  Surgery o PROBLEM WITH MISLABELING DELIRIUM WITH DEMENTIA  Dementia – irreversible  Delirium – reversible o Can lead to brain damage or death  Dementia o General class of disorders that disrupt mental function o Most prevalent forms of mental disorders in old age o Incidence of these conditions increase with advancing age  Longer life = higher dementia prevelance o Disabling  Some factors may be modified to reduce risk o Vascular dementia can be reduced by  Proper diet  Good exercise  Environmentally caused – behavior life style factors o Acquired o Persistent  Worsens over time o Multiple cognitive impairment o “Major Neurocognitive Disorder”  Name changed so we can catch it in earlier stages  Causes of Dementia o Alzheimer’s disease most common  Can only see if an autopsy has been done o Others –  Vascular dementia  Parkinson’s  Huntington’s  HIV  Dementia with Lewy Bodies  Frontotemporal Dementia  Assessment of older Drivers o No good way to tell when older people should stop driving nd o Older adults – crashes 2 major visit for ER visits o Older adults have more crashes per mile driven than other age groups o Elderly rely on personal automobile for mobility  George Russell Weller o 86 drove into farmers market o Killed 10 people and injured 63 o Thought he was putting his food on break, but it was the gas o Plead not guilty – “pedal misapplication”  Background on Driving o Older drivers are safer drivers  Wear seat belts  Don’t take reckless risks while driving  Less likely to drive under the influence of drugs or alcohol  Visual function: o Acuity  Ability to see detail o Contrast sensitivity  See lightness vs. darkness  Shades of gray  Four components for driving assessment o Cognitive functioning  UFOV to determine ability to intervene o Visual functioning  Contrast sensitivity  Diagnoses to determine ability to intervene o Mental status o Physical functioning  Dementia Review o General class of disorders that disrupt mental function o No treatment o Most prevalent forms of psychopathology in old age  Alzheimer’s is most common o Unlike depression or anxiety disorders the incidence of these conditions increase with advancing age  Reasons understanding dementia is important o 1/3 of American’s have direct experience with Alzheimer’s disease  11% people 65+ have Alzheimer’s disease o Families and healthcare professionals often don’t recognize early signs  Reasons for not disclosing a diagnosis o Diagnostic uncertainty and lack of treatments o Time constraints of physician and lack of support  Takes a lot of time to talk about treatment options  Insufficient resources and services to refer patients to offer support for patients and caregiver o Communication difficulties  Both on part of provider and patient o Fear of causing emotional distress/stigma  6% with Alzheimer’s had depression a year later  Alzheimer’s – 6 leading cause of death o Higher prevalence in women  Genes are important, but so is environment: Twin research (dementia concordance)  o Monozygotic (identical) – fifty percent chance of the other twin getting it o Dizygotic (fraternal) – thirty percent chance of the other twin getting it  Dementia features o Gradual decline over many years o Persistent  Worsens over time o Multiple cognitive impairments o Impairs daily function  Brain reserve o Passive model o Individual differences in brain reserve could cause two people with the same brain pathology to present with different clinical manifestations  “Hardware”  Brain size  Dendritic branching  Skull size  Cognitive reserve o Active model o Individual differences in cognitive processes/efficiency causes two people with the same brain pathology to present with different clinical manifestations  Higher cognitive reserve can tolerate more pathology  “Software”  How efficient someone’s brain is  IQ  Education level  Occupation complexity  Mild Cognitive Impairment (MCI) o Transitional stage between normal aging and dementia  10-20% of people 65+ have some sort of MCI o Prodromal stage of Alzheimer’s disease (AD) or other dementia  DSM 5 – mild neurocognitive disorder  MCI original definition o Memory impairment  Objective  Subjective o No additional cognitive impairment o No impairment of daily activities o Not demented  High risk for progression to dementia  MCI debates o MCI is very early AD  MCI does NOT always lead to dementia o 3 stages of AD  Preclinical AD  Early measurable brain changes detected via imaging, biomarker tests o Beta amyloid accumulation o Markers of neuronal injury  No concrete diagnostic criteria as of now  MCI due to AD  Mild but measurable changes in cognition  Patient and family notices the changes, but changes do not interfere with daily functioning  Dementia due to AD  More sever cognitive and behavioral symptoms  Impairment in daily function o Widely varying rates of progression o Pro of calling it early AD  Can prepare early o Con of calling it AD  You don’t know if it will progress/develop into Alzheimer’s  Dementia Diagnosis in DSM-5 o Dementia – major neurocognitive disorder o Alzheimer’s –  Memory impairment  Loss of independence in every day activities  Causes of Dementia o Alzheimer’s disease is most common  Alzheimer’s disease o Brain tissue irreversibly deteriorates o Usually begins with  Difficulty remembering recent events  Learning new material  Irritability, withdrawal o Disease progresses  Language problems intensify  Disorientation  Time  Place  Sometimes identity confusion  Agitation  Problematic behaviors  Wandering  Pacing aggression  Onset and Clinical Course o Generally appears after 65 o But can appear as early as 40 and even as early as 30 o “Early onset AD”  Approximately 1-5% of cases  Due to one of several genetic mutations  Amyloid precursor protein: (APP) – 100% you will develop early Alzheimer’s  Advanced stage – o Language reduced to simple words or phrases  Eventually completely lost o Extreme apathy o Muscle deterioration  Loss of mobility  Incontinence o Loss of ability to feed oneself/swallow  Aspiration risk  5 A’s of Alzheimer’s  o Amnesia  Memory loss o Anomia  Inability to remember names of things o Agnosia  Inability to recognize objects o Apraxia  Misuse of objects because you can’t recognize them o Aphasia  Inability to express one’s self/say what you want to say  Diagnosis of AD: o AD is diagnosed on the basis of exclusion o All other possible sources of impairment must be ruled out first  Normal Pressure Hydrocephalus (NPH) o Reversible o Dementia with shunt  Long thin tube that drains excess CSF (cerebrospinal fluid) from brain to abdomen  Epidemiology o Advancing age primary risk for AD o Probability of getting AD doubles every five years after 65  Brain changes in Alzheimer’s Disease o Beta amyloid cascade hypothesis  Amyloid plaques  Neurofibrillary tangles  Leads to neuronal death o Atrophy of cerebral cortex and hippocampus o Enlargement of ventricles  People with Down’s Syndrome have many similarities in the brain  Autopsy Findings o Current conclusions  Majority of older adults with no dementia have some sort of brain pathology  Only about 30% with no abnormalities o People with dementia usually have multiple pathologies  Only 30% have pure dementia  Vascular Dementia (VaD) o 17% of dementia cases o Typically results from chronic reduced blood flow in brain  Narrowing blood vessels  Clot forms  Impairment of circulation  Small hemorrhages in brain  Cells die o Risk factors  Smoking  High cholesterol  High blood pressure  Diabetes o Higher rates in African Americans  Frontotemporal Dementia (FTD) o Leading cause of Early Onset dementia o Changes in personality  Lack of inhibition  Loss of judgment  Neglect personal habits o Aphasia  language problems o Memory often not severely impaired  Frontotemporal Dementia vs. Alzheimers o Onsets earlier o Memory loss isn’t prominent o Problems with spatial orientation o Hallucinations and delusions o Speech problems – aphasia  Dementia with Lewy Bodies (DLB) o Lewy bodies –  Protein deposits in brain  Also seen in Parkinson’s disease o Similar decline to Alzheimer’s disease  Problems with memory  Judgment problems  Behavior changes o Alertness and severity of cognitive symptoms fluctuate daily o Visual hallucinations common  Difference between DLB and Alzheimer’s disease o Movement problems o Lewy bodies in brain stem – sleep disturbances  REM sleep disorder  Parkinson’s Disease – similar to Lewy body dementia o Movement/motor disorder  Tremeros  Slowed movement – bradykinesia  Rigidity – Akinesia  Balance problems  Shuffling gait – when walking  Masked face  People look bored or unhappy, but they can’t control their face o More rare – 2% o Many people develop dementia in later stages  Lewy bodies  Can also have plaques and tangles o L-Dopa  Common medication for Parkinson’s  Dyskinesia – rocking motion as described  HIV Dementia o Slower motor skills o Effects basal ganglia o 2% of people have it – rare  Huntington’s Disease o Involuntary movements – Chorea  Similar to dyskinesia o Cognitive decline o Onsets between 30-55 o Due to genetic mutation  Autosomal dominant  50% chance of passing it on for each pregnancy  Interventions for Dementia o Behavioral  Supportive environment  Routine activities o However not to push them to perform  Behavioral management approach  When disease is in early stage –  Labeling drawers and appliances  Calendars, clocks, strategically placed notes  Compensatory strategies o To make every day living easier  Later problems  Sundowning o Symptoms get worse at night  Wandering  Incontinence  Aggression  Use of distraction/redirecting attention and other behavioral techniques  Keep comfortable  Reminiscing  Humor  Food  Help for family caregiver  Information  Problem solving  Support groups  Relaxation techniques  Respite o Pharmacological  Commonly prescribed drugs – Aricept  Improve memory by increasing levels of acetylcholine in the brain – acetylcholine is a neurotransmitter  Delaying worsening of symptoms for 6-12 months  Namenda – block glutamate receptors o Medical food  Axona – aprylidene  Alternate energy source – ketons for neurons  Less able to use glucose in Alzheimers  Contains fatty acids called medium-chain triglycerides  Converted to ketone bodies  Needs more research o No effective treatment has been identified for Alzheimer’s disease to alter disease long term o Chemical restraint drugs  Antipsychotic medication  Usually prescribed for schizophrenia  Commonly used to treat behavioral problems  Particularly in long-term care facilities  Twice as likely to be hospitalized or die earlier if an older person is given the antipsychotic medications  Risk factors for Dementia – some things we can’t change o Age o Gender o Genetic factors – late onset  Family history  Apolipoprotein E (APOE)  Associated with dementia  Some people have allele and don’t get it – with E4 o Protective allele  E2- less likely to get Alzheimer’s o Early life education and SES  More information needed Risk for dementia doubles every five years after 65!  65 – 1%  70 – 2%  75 – 4%  80 – 8%  Modifiable Risk Factors o Head injury  NFL players with weird behavior problems  CTE – due to repeated concussions o What is bad for the heart is bad for the brain  Diabetes  Hypertension  Smoking o Exercise o Others – need more research  Diet  Stress  Depression  Intellectual stimulation  Protective life style factors o Diet  DASH vs. Mediterranean Diets  DASH o Low in sodium o More red meant o More dairy o Portions emphasized  Mediterranean o More olive oil o Less red meat more fish o Encourages red wine o Likely higher in fats – good fats  Comparing both: o High in fruit, veggies, whole grains, legumes, nuts, unsaturated fats o Neither developed for weight loss o Exercise  Colcombe and Kramer – exercise on cognitive aging  18 studies – meta analysis  RCTs (randomized control trials)  55-80 years old  197 effect sizes yielded  Studies coded based on:  Aerobic vs. combination (including strength training)  Duration of sessions  Length of intervention – short vs. long  Greatest improvements in executive functions  Combination training was better than just aerobic  Long-term program and sessions better o Mental stimulation  Leisure activities  Occupation o Social networks o Physical exercise o Personality  Use it or lose it? o Greater environmental complexity and active lifestyle  Role of education  Animal studies  Intellectually stimulating activities  Occupation  Animal studies: Environmental enrichment o Hebb  Found rats raised as pets performed better on problem solving tests than rats raised in cages  Enriched environment is better o Effects:  Neurogenesis and synaptogenesis  Found even in older animals  Novel activities thought to be most important  In transgenic AD mice, protests against pathology and cognitive decline  Positive effects of environmental enrichment or negative effects of deprivation?  Studying environmental enrichment hypothesis in humans – (Study by Dr. Crowe) o Co-twin control designer  N = 107 pairs o Prospective data on leisure activity > 20 years before onset of dementia  Conclusions from twin studies o Indicators of intellectual engagement at midlife are associated with lowered risk of dementia in older adulthood o This exists even after accounting for genes and environment  Social Networks o Extensive – had all 3  Being married and living with someone  Having children with daily weekly satisfying contact  Having relatives/friends with daily-weekly satisfying contacts o Moderate –  Had two of the above o Limited –  Had one of the above o Poor –  Had none of the above o Poor and limited –  Increased risk of Dementia  Mechanisms: o Cognitive Reserve Hypothesis  These activities boost cognitive resources at the functional and structural level  Compensation  Neurogenesis  Synaptogenesis o Vascular Hypothesis  These activities could reduce vascular comorbidities that lead to dementia  Physical activities more obviously support this  What about social? o Stress Hypothesis:  Stress associated with dementia  Glucocorticoid cascade   Stress   Neuronal loss   Particularly in hippocampus  Leisure activities could reduce stress  Life-space (Dr. Crowe’s experiment) o Aspect of environmental complexity o Spatial measure of movement through one’s environment o Findings:  Greater life space was associated with less cognitive decline in late life  Association not fully explained by covariates or potential explanatory factors  Is stress bad for the brain? o Psychoneuroimmunology  Correlates of psychological distress  HPA axis o Cushing’s Syndrome – high risk of getting Dementia  Due to high levels of cortisol  Usually because of extended use of corticosteroids  Moon face/ bigger face  Buffalo mid section/ hump on back of neck  Bigger mid section/ gut  Thin legs for women  Can lead to cognitive dysfunction  Indicators of Stress (may vary among many others) o Personality  Neuroticism – associated with greater risk of cognitive impairment in older adults  Greater reactivity to stressful events  Greater exposure to daily stressors o Job Strain  Low control  High demands  High demand and low control related to higher risk of dementia!  What can you do to reduce risk of dementia? o Choose parents wisely o Stay in school o Exercise o Don’t have injuries o Stay mentally and socially active o Reduce chronic stress and depression  Successful Aging o During past century human lifespan has doubled  Caused increased interest in studying longevity o Important to not just now who is aging normally BUT distinguishing who exceeds that o What is successful aging?  Healthy aging  Aging well  Productive aging o Subjectively –  Ask them how their memory is  Over report  Underestimating successful aging o Objective –  ??? o Leisure activity – varies on what a leisure activity is  Association between leisure activities and dementia varies among countries o Consensus on definition to look at predictors  History o Search for a way to avoid aging “fountain of youth”  Immortality  Unrealistic and ridiculous goal o Scientist trying to stop telomeres from shortening o Aging is not an illness  Being a time for transition  Fulfilling advisory function  Wisdom  Generativity o 1950s and 1960s  Field of gerontology really began to take off  Scientists began to talk about SA o Several lifespan developmental theories of aging emerged  Ego integrity  Succesfful resolution of earlier conflicts  Disengagement theory  Cultural pressures toward reduced involvement with society  Activity theory  Continued engagement  Continuity theory  General trend for OA to maintain consistency with earlier life roles, and adaptation to sustain roles  Compression of morbidity  Delaying onset of disability  Increasing active life expectancy  Rowe and Kahn (1987) o Avoidance of physical illness and disability o Maintenance of high physical and cognitive functioning o Continuing engagement in social and productive activities  Each of these paves way for the next one o What about those with disease?  By this definition they could never be consider a successful ager  Baltes and Baltes (1990) o Lifespan perspective o Selective optimization and compensation  Psychological and behavior process involved in adapting to age related losses/disabilities and maintaining functional performance  Focus on what you can still do o Aging is a multidimensional and multidirectional process  Gains and losses  Plasticity is possible o Pointed out commonly used criteria  Length of life  Biological health  Mental health  Cognitive efficacy  Social competence/ productivity  Personal control  Talked about it in reference to dementia and nursing home residence  Idea of not having control over their day to day activities  Life satisfaction  Vaillant (2002) o Physician assessed objective physical health and absence of irreversible physical disability o Subjective physical health o Length of active life o Objective mental health  Four areas  Work  Relationships  Play  Absence of need for psychiatric care or medication o Subjective life satisfaction  Marriage  Job  Children  Friendship o Social support groups  Depp and Jeste (2006) o Comprehensive review of SA studies from 1987-2006  28 studies  Found 29 unique definitions used across the 28 studies  Half of the studies used freedom disability/optimal physical functioning  More components = less likely to be considered a successful ager  Negatively associated  There is LITTLE consensus on defining SA (successful aging) other than disability


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