Week 5: Mental Health and aging

Memory information processing model

1. a person perceives information
* psychologists call this ^^sensory memory^^


2. the person acts on this information and transforms it into @@short-term memory@@
3. the person stores the information in %%long-term memory%%, the storehouse of knowledge that also includes the rules for organizing knowledge.

non-episodic memory

information with no reference to the time at which it was acquired, such as general knowledge of the world

Episodic memory

memory acquired at a specific time and place, such as the recall of a vacation in Paris).

Which type of memory has a steeper decline

Episodic memory shows a greater decline with age than other types of memory

* Decline occurs less or not at all in non-episodic memory

Working memory

Working memory stores recent information and also manipulates this information.

* In addition, it processes new information while temporarily storing other information.
* it guides ongoing behaviour, intended actions, and longer-term plans

processing speed

They miss late items in a list more than earlier ones, and they encode some items at the expense of others.

For example,

* due to decreased processing speed, an earlier task slows a later activity
* (e.g., if someone needs to keep some figures in memory, this will inhibit later decision-making speed).

researchers say that ____________________ has a “cascading effect on information processing.”

slowed processing

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Slower processing accounts for the loss of information from an earlier task as a person performs a more recent task (e.g., a person may forget figures held in memory while he or she tries to make a decision).

What things are the most sensitive to the effects of aging?

* processing speed,
* executive functions,
* working memory,
* episodic memory

the physical brain and memory loss

* losses in prefrontal grey matter correlate with reduced performance on frontally mediated executive tasks

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* loss in white matter integrity leads to a decline in cognitive performance
* and a decreased speed of episodic memory retrieval

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→ loss of brain structure leads to declines in mental function

the ____________ processes information and creates long-term memory. It declines in function with age.

hippocampus

Brain plasticity

“long-lasting alterations in the brain’s chemistry, gray matter, and structural connectivity in support of behavior”

* can change and grow even in old age
* a lifelong developmental process

Neurogenesis

The brain creates new neurons and new neural connections

* since new neurons are being produced, brain remodelling can be induced in a large scale at any stage of life

Cognitive reserve

originally referred to people with dementia who performed better than expected in everyday life

it was later extended…

* to encompass variation in healthy individuals’ performance, particularly when they must perform at their maximum capacity
* how we use our brains during our lives influences the amount of cognitive reserve that we have

________ and ___________ in particular seem to create a large cognitive reserve

education and literature

Plasticity vs flexibility

__**Plasticity**__

* the growth of brain structures
* dominates in the early years of life.

__**Flexibility**__

* more stable brain structures with potential for behavioral change
* dominates in later life.

4 patterns of psychological aging

* Successful Aging (super-normals)
* Normal aging
* Mild cognitive impairment
* Dementia

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Successful aging “the super-normals”

A small subgroup of older people, often with a socioeconomic or genetic advantage.

* develop through mid-life and reach a high point in late middle age.
* This group shows some decline on speeded tasks.
* generally they maintain a high level of mental function until shortly before death.

Normal aging

People in this group reach their mental peak in early mid-life,

* maintain their ability until their 50s or early 60s
* show modest decline through their early 80s
* show more dramatic decline in the years before death.
* Some people in this group reach a high level of mental development and maintain this even when they face physical frailty.
* A second group of normal agers reach a lower level of function in mid-life and may need more support in old age.

Mild cognative Impairment (MCI)

In early old age, people in this group begin to experience greater than normal mental decline.

* Decline may include memory loss, but may also include the loss of other abilities such as planning and scheduling.
* Some people in this group eventually develop dementia.
* Others maintain a stable level of low function. Schaie suggested they display “*unsuccessful aging*”

Dementia

People in this group show a dramatic decline in mental function.

* Dementia typically has a physical cause, such as brain lesions or disease.
* Alzheimer’s disease is the most common cause of dementia

4 findings from brain research that describe mental growth and development in later life:

1. The brain reorganizes itself in response to new information and experience.
2. Brain cells grow in later life.
3. The brain’s emotional centres grow more balanced with age.
4. Compared with younger people, older people use both halves of the brain more equally

Stereotype threat

an older person’s fear of failure on memory tests leads to poor performance.

eg.

* test instructions that focus on memory make people aware of declines in mental ability, and this can lower a person’s score.

Contextual view of memory

begins with the insight that many conditions influence memory.

* These include:
* the physical and social context
* where learning took place,
* a person’s education,
* their health, and
* their experience at learning in structured settings (such as a classroom or lab).

2 definitions of intelligence:

1. the ability to negotiate environmental demands successfully
2. that which intelligence tests measure

fluid intelligence

Fluid intelligence refers to reasoning, abstracting, concept formation, and problem solving.

* It makes little use of knowledge gained through reading, school, or work.
* Fluid intelligence relies on how well the physical and nervous systems function.

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Crystallized intelligence

The use of stored information, acculturation, and learning.

* Verbal tests, such as a test of vocabulary or historical events, demand the use of crystallized intelligence.

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People show stability and even improvement in crystallized intelligence with age.

How are fluid and crystallized intelligence affected by age?

* Studies show a decline in fluid intelligence with age.
* People show stability and even improvement in crystallized intelligence with age.

5 criteria of wisdom

1. a store of factual information about human nature;
2. rich procedural knowledge about handling life’s problems;
3. an awareness of life’s contexts and how they change over the life span;
4. understanding the relativism of values and tolerance for others; and
5. an understanding of how to deal with uncertainty.

advanced style of cognition (3 styles)

1. Relativistic thinking: an awareness that context can affect knowledge and understanding; an awareness that knowledge is not absolute.

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2. Dualistic thinking: the ability to suspend judgment while trying to resolve contradictions; the ability to hold mutually exclusive ideas in the mind at the same time.

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3. Systematic thinking: the ability to take a broad view of a situation or a system of knowledge.

characteristics of wise people

constant-probability-of-success model

This model states that the ratio of quality works to total works produced during a career stays the same at every stage of the career.

* An older person may produce fewer masterpieces, but will also produce fewer mediocre works. In other words, people can produce great works at every age.

the ‘third place’

Seniors often turn to “the third place” to experience feelings of happiness.

could include:

* cafes,
* coffee shops,
* bookstores, bars,
* hair salons, and other gathering spots.

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Third places allow people to gather informally outside the home and workplace.

Regulars make the place a home away from home.

Stages of decline due to Alzheimers: Stage 1

A person first shows changes in memory. He or she forgets the keys or a wallet more frequently. The person may also forget recent events or forget that he or she did a job around the house. The forgetfulness gets worse over time. The person forgets more often, takes longer to do simple jobs, or begins to recheck work already done.

Stages of decline due to Alzheimers: Stage 2

The second stage of the disease includes more memory decline, loss of speaking ability, and an end to normal daily activity. The ill person may wander at night, lose control of his or her bowel and bladder, and threaten others. One woman left a knife in her garden after she used it to weed the flowerbed. Her husband picked it up and stalked through the bushes into a neighbour’s yard, saying to the neighbour, “I’m going to kill you.” The neighbour ran inside and called the police. When the man’s wife came outside to finish weeding, she found the police wrestling her husband into a squad car.

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* can put additional stress on family

Stages of decline due to Alzheimers: Stage 3

The person in the last stage of Alzheimer’s disease needs institutionalization and often 24-hour nursing care. The person can no longer speak or communicate. He or she may wander or move constantly unless restrained. Seizures may occur. Death occurs between two and nineteen years after the disease starts. Death often comes from an illness such as pneumonia or heart disease, but death certificates rarely mention Alzheimer’s disease as a cause of death, making it impossible to know the exact number of deaths associated with Alzheimer’s.

History of mental disorders

Historically, mental disorders were considered to be different from physically diseases

* Etiology: no organic/physiological cause
* High risk groups: people with some ‘fixed’ traits
* Treatment: ineffective
* Prognosis: usually no mortality 
* Society reaction: isolation

Depression in old age

* depresion rates are generally lower in older adults
* Earlier diagnosis, more awareness? 
* Symptoms of depression in older adults are often underrecognized, underreported and undertreated (WHO, 2017; *Mental health of older adults)*
* A disease with risk factors, possible prevention and treatment 

Dementia statistics

* 597,000 people in Canada lived with dementia in 2020 (**61.8% women**) 
* New cases (incidence): 124,000

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* The projected number people in Canada to be living with dementia in 2030: __***955,900***__ 

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* 1 in 5 Canadians have experience caring for someone living with dementia

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Individuals living with dementia

* We need to plan for near future
* Linear increase with age, more women with dementia
* Can start as early as age of 40

Are women twice likely to acquire dementia

* ^^2 thirds of person diagnosed with dementia are women^^
* the lifetime risk (also the frequency, or count) of dementia is greater for women, similar to other aging-related diseases
* The life expectancy for women is longer than for men, and age is the greatest risk factor

Self-perception of mental health

proportion of Canadians reporting excellent or very good mental health pre and post COVID by age group

2 important points about mental health of older adults:

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1. improvement with age
2. resilience

Resilience

Disability-adjusted life years (DALY) is a measure of the burden a disease imposes on person and society 

* Few post COVID additional burden from depression and anxiety in older age groups.

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Plasticity

**definition:**

\-long-lasting alterations in the brain’s chemistry, gray matter, and structural connectivity in support of behaviour

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* Mental reserve capacity (not exclusive to cognition) 
* Not fixed and nor determined solely by genes
* Enhancement by education, social status, stimulating lifestyle (exercise, social network, occupation) 

Brain development later in life

1. Reorganizing in response to new information and experience.
2. Brain cells growth in later life.
3. The brain’s emotional centres becomes more balanced with age.
4. Compared with younger people, older people use both halves of the brain more equally.

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%%Providing positive experiences throughout the life course%%

Brain changes later in life

* In laboratory studies speed of encoding (linking new information with already stored information) is slower in older adults 
* Awareness of old information remains intact
* More use of context, clues 

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Example: thinking about novels on French revolution (new information), a 88 years old individual knows that has read many (old information) 

* However, can’t remember the name of a very famous one
* *Clue#1: knows that was written by a British person (‘les Miserables’ is ruled out)* 
* Clue#2: recalls the story plot was not only in France: remembers it was in London and Paris, title was somehow related  
* Clue#3: the title was not a specific place or person name
* A tale of two cities

People show a better mental performance in _______ _____ when compared with lab studies

everyday life

* Generalizing the findings of the lab studies to __________can be misleading

populations

Intervention

… is possible

* Brain responds to stimulation and challenge as a person ages, delay or even compensation for mental decline
* Memory training
* An enriched environment
* Physical fitness training
* the key is the correct amount of challenge for a normal aging

Lawtons ecological model

This model is adaptable to most age-related health issues

Abnormal aging

* *Functional disorders* in some people as they age: paranoia, anxiety, neuroses, and schizophrenia.
* Some *organic disorders* (disease of the brain): Alzheimer’s or Parkinson’s disease 
* Confusion and forgetfulness
* Behaviours not accepted socially, especially from an old person 

Dementia

* Early symptoms of Alzheimer’s disease include memory deficits, confusion, irritability, aggression, mood swings and behavioral changes
* There are etiologies, e.g. vascular changes in brain 
* Risk factors for vascular diseases 

Alzheimers disease

Etiology not confirmed yet

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* Suggested risk factors: about half of all prevalent cases of dementia are attributable to these 7 modifiable risk factors
* Preventive measures! 

Stigma in old age

Receiving a label, facing stereotyping

* Experiencing discrimination
* Losing status 
* Limiting access to social and healthcare services

Legal/ethical issues

* The Loss of Competence
* People  with a cognitive impairment may lose the ability to understand their situation and consequences of their decisions

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Don’t confuse competency (a legal term) with capacity (a clinical term that refers to a person’s ability to function)