PSYCH66 - Disorders of Aging and Cognition

Old Age and Stress

includes 65+

• face health issues + loss as they age

Geropsychology

mental health of older adults

• 20% meet criteria for mental d/o

Centenarians

>= 100 y/o

• carry longevity genes → likely related to someone else who lived very long

Features:

• smooter brain fxn, strong personalities

• favorable conditions

• optimistic

• eat well, not smoke, exercise

What do most people fear as they get old?

Significant cognitive decline

• they fear this more than death

Co-occuring (comorbid) d/o

the presence of two or more d/os in one person

• ex: neurocognitive d/o + depression

• Alzheimer’s + depression

Disorders in old age are categorized into 2 categories

1. D/o commonly seen at any age: depression, anxiety, substance abuse

2. D/o of cognition / brain abnormalities: delirium, mild neurocognitive d/o, major neurocognitive d/o

How COVID impacted older adults

• great impact on older adults who are more vulnerable + have to rely on others

• can’t connect with loved ones and don’t know how to adapt to isolated life

Depression later in life

commonly seen in older folk — same symptoms as what younger ppl deal with

• related to loss of relationships / ability to fxn / unresolved trauma

Who are the rates of depression in older folk higher in?

highest in women

• rates increase as high as 32% for those in nursing homes

  • not everyone, but very common

How does depression impact elderly physical health?

increases risk of physical health issues + slows healing + recovery

What age group has one of the highest suicide rates?

elderly (+ college students)

• suicide rates in elderly are higher than any other age group

How do we treat depression for elderly

we treat unipolar and bipolar depression similarly to younger ages

• talk therapy

• CBT

• etc

but the body processes medications differently in old age

• psychotropic meds are less effective / cause issues

Other depression info

elderly are vulnerable to suicide attempts

• increases likelihood of serious med conditions

• respond well to treatment (CBT, talk therapy, meds sometimes)

Diagnostic criteria for depression (MDD) in elderly

5 or more symptoms during the same 2 week period (Major Depressive Episode)

• one symptom MUST be depressed mood / loss of interest or pleasure

• Depressed mood

• Marked Diminished interest or pleasure

• Significant weight loss or gain

• Insomnia or Hypersomnia

• Psychomotor agitation or retardation

• Fatigue

• Worthlessness or inappropriate guilt

• Diminished ability to think or concentrate

• Suicidal ideation or bx

What is the golden trifecta for Depression treatment?

• exercise

• antidepressants

• talk therapy

Anxiety D/O later in life

people over 85 years old = higher rates of anxiety

• at least 10% elderly

Why is anxiety often not recognized in the elderly?

seen as other health issues and health providers say their symptoms are “part of getting older”

• symptoms —> missed or minimized

Diagnostic criteria for GAD in the elderly

• excessive anxiety + worry for at least 6 mo

• difficult to control worry

• 3 or more of following symptoms

  • Restlessness

  • Fatigue

  • Difficulty concentrating

  • Irritability

  • Muscle tension

  • Sleep disturbance

Substance abuse d/o later in life

alcohol abuse + other substance abuse = problem for older folk but declines after age 65

• due to declining health + reduced income

Most older folk are not abusing substances, but rates increase dramatically for older folk in nursing homes/institutions

• over 10% older adults are binge drinkers (3-7% are men)

2 groups of elderly drinkers

1. started abusing alcohol since early on (20s)

2. started abusing alcohol in 50s-60s due to negative or stressful things in life

What is a major substance abuse problem in older folk?

misuse of prescription meds + misuse is unintentional

• avg elderly person taking 5 prescription + 2 OTC meds

What kind of drug is increasing in nursing homes?

the use of antipsychotic drugs

• used to sedate + manage elderly w/o psychotic symptoms

Do younger or older folk typically struggle more with psychotic symptoms

older

• usually schizophrenia (delusional d/o) or an underlying medical condition (neurocognitive d/o or d/o of cognition)

• improves with age

Older folk and schizophrenia medication

for older ppl who still suffer from schizo, the antipsychotic med can pose potentially dangerous side effects + seniors may go untreated for it

→ end up in nursing homes, hospitals, homeless, or in jail bc of their condition

What is delusional d/o?

rare, but seen in elderly folk more than any other group

• may develop deeply held suspicions of persecution (paranoid)

• believe that other people are conspiring against them

• may be → irritable, angry, depressed, pursue legal action bc of these ideas

D/O of cognition

as ppl get older, lapses in memory + attn difficulties increases and become a regular issue in 60s-70s

What resource can older folk use to help them cogntiively?

internet and social media

• maintain and possibly improve cognitive skills, coping skills, social pleasures, and emotions

Delirium info

rapidly developing, acute disturbance in attn and orientation that makes it very difficult to concentrate + think in a clear and organized manner

• ex: ppl may believe it’s morning when it’s night, think at home when in hospital

• happens quickly (w/in hours or days)

• more susceptible to infection (+ do not recover as quickly)

• fever, diseases + infections, poor nutrition, head injuries, strokes, and stress (intoxication) may → delirium

• can be treated easily if properly detected (treating the infection)

• typically an underlying medical condition — usually infection that comes with fever or pneumonia

What is the difference between delirium + Alzheimer’s / dementia?

they both have a different root cause

• important to identify for quicker treatment

Delirium: occurs over a few hours + few days

Alzheimers: long term, years

Diagnostic criteria for Delirium

• develops over the course of hrs / few days, individual experiences fast-moving + fluctuating disturbances in attn + orientation to the environment

• individual also displays a significant cognitive disturbance

Neurocognitive D/O

d/o marked by significant decline in at least one are of cognitive fxning

Alzheimer’s important info

you can see changes in personality and inappropriate behavior

*Can not diagnose Alzheimer’s until death → must do autopsy on brain to know

Definition of Major Neurocognitive D/O

where the decline in cognitive fxning → substantial + interferes with a person’s ability to be independent

Definition of Mild Neurocognitive D/O

where the decline in cognitive fxning → modest + does not interfere with a person’s ability to be independent

• remember: someone can be diagnosed with mild neurocognitive d/o + MDD at the same time

What is the only difference in diagnostic criteria for mild and major neurocognitive D/O?

whether the cognitive decline is interrupting the person’s ability to live independently

Diagnostic Criteria for Major + Mild Neurocognitive D/O

Individual displays substantial decline in at least one of the following areas of cognitive fxn:

• memory + learning

• attn

• perceptual motor skills

• planning + decision making

• language ability

• social awareness

• cognitive deficits interfere w/ individual’s everyday independence (major) / do not interfere w/ individual’s everyday independence (mild)

Other info about neurocognitive d/o

• Alzheimer’s disease = most common neurocognitive disease

  • Alzheimer’s is a progressive disease that happens over time

• Women + POC → more likely/common to develop Alzheimer’s

• Death usually comes abt 4-8 years, but some can live longer

• 40% of ppl with Alzheimer’s also qualify for depressive d/o

• Some may withdraw from others during late stages of d/o

• may lose all knowledge of the past

What is happening in your body with Alzheimer’s?

brain is dying

• tissue of brain is breaking down (atrophy)

• shuts down + stops working

• eventually → death

Biological causes of Alzheimer’s disease

1. Senile plaques: protein in spaces between neurons + blood vessels

2. Neurofibrillary tangles: twisted protein fibers w/in neurons

As we age, these proteins build up in the brain and contribute to the death of neurons

• remember: neurons can not regenerate / undergo mitosis

Genetic causes of Alzheimer’s disease

• Proteins + their activity — specifically beta-amyloid + tau proteins

• Differences b/t early + late onset (early = genetic, passed down)

Brain circuitry causes of Alzheimer’s disease

• poor interconnectivity in prefrontal cortex (impacts executive fxn), hippocampus, amygdala, thalamus, and/or hypothalamus

• bichemical changes in ACh, glutamate, RNA, and Ca

Sociocultural issues affecting the mental health of older adults

Discrimination - ageism

• hard for older folks from minorities to seek medical + mental health treatment

• “Double/triple jeopardy”: old, minority, poor, etc.

• live in fear of being put away