Later life/neurocognitive disorders

Effects to consider when measuring elderly:

age effects, cohort effects, time-of-measurement effects 

>65 psychopathology rates

• methodology issues

lower; more positive emotion and focus on intimacy (social selectivity), but also methodology issues! These are: response bias/disclosure, selective mortality, and cohort effects 

Treatment with medicine: 

more severe side effects, usually tested on young people, polypharmacy risks

Dementia umbrella term percentages:

Alzheimer’s 50-75%, vascular 20-30%, Lewy body 10-25%, FTD 10-15%

Psychiatric symptoms secondary to dementia:

50% depression, also sleep disturbances, loss of impulse control, delusions or hallucinations 

[Study slides for neuropsychological assessment]

Stages for dementia 

Pre- —> asymptomatic —> subjective complaint —> MCI —> dementia

Mild neurocognitive disorder (MCI) criteria

based on 1) concerns of patient/close other/clinician and 2) modest neurocognitive decline in 1+ cognitive domains; *does not interfere with independence in everyday activity!! Although may need more effort or support

Major neurocognitive disorder criteria:

SAME CRITERIA but SUBSTANTIAL decline (on formal testing) and DOES interfere with independence in everyday activity 

Dementia prevalence 2010:

 >35 million

Alzheimer’s disease: 

 mainly memory loss, disorientation.

Amyloid cascade hypothesis: Neurons have plaques (protein deposits) outside and neurofibrillary tangles (tau proteins inside neuron) —> causing immune response, inflammation, neurons die, frontal and temporal and parietal lobes shrink

Protective factors for Alzheimer’s: 

exercise, cognitive engagement 

Frontotemporal dementia:

 most common=behavioral variant!!; prevalence <1%, loss of  neurons in frontal (PFC) and temporal (anterior) regions, memory not impacted, starts in 50s!!!! Death in 5yrs 

Vascular dementia: 

usually stroke -> blood clot -> neuron death; symptoms vary

Dementia with lewy bodies:

 1% (rare), Lewy bodies are proteins; vivid hallucination and dreams, etc 

Treatment: 

meds slow the decline but don’t restore memory (e.g. cholinesterase inhibitors)

Delirium: 

extreme trouble focusing attention. Criteria: disturbance in attention/awareness; change in cognition that isn’t dementia; rapid onset and fluctuation throughout day; symptoms ARE caused by a medical condition or toxin or substance 

Delirium etiology and treatment:

etiology is drug use or withdrawal or metabolic/nutritional deficiencies; treatment for underlying condition can have complete recovery, without treatment there’s risk of death in 6mo, uses atypical antipsychotics 

Dementia vs delirium: