Psychology of Aging Exam 3

WashU

Primary outcome (clinical trials)

The main result measured in a clinical trial to determine whether a treatment works.

Secondary outcome

Additional effects of the treatment measured beyond the primary outcome.

Selection criteria

Rules defining who can or cannot participate in a clinical trial.

Control group

Participants in a trial who do not receive the experimental treatment, used for comparison.

Placebo

An inactive substance given to control groups to compare against the real treatment.

Dose of intervention

The amount of drug or treatment given to participants in a clinical trial.

Route of administration

How a drug is delivered to the body (e.g., oral pill, IV infusion).

Data analysis in clinical trials

The process of reviewing collected data to determine whether the treatment had an effect.

Preclinical studies

Lab-based studies (often using animals or cells) to determine whether a treatment appears safe and potentially effective before human testing.

Phase I clinical trial

Small study (10–80 participants) focused primarily on safety and dosage.

Phase II clinical trial

Study with about 100–300 participants that examines safety and determines effective dosage.

Phase III clinical trial

Large trial (300–3,000+ participants) designed to confirm effectiveness and monitor side effects.

Phase IV clinical trial

Post‑approval monitoring to evaluate long-term safety and effectiveness.

Investigational New Drug (IND) application

A request submitted to the FDA for permission to test a new drug in humans.

New Drug Application (NDA)

Formal proposal submitted to the FDA to approve a drug for marketing.

FDA approval process

Multi-step process including preclinical testing, IND submission, clinical trials, and regulatory review.

Drug approval success rate

About 90% of drugs tested in trials do NOT get approved.

Average cost of drug development

Approximately $2 billion to bring a drug through development and trials.

Target engagement

Evidence that a drug affects the biological target it was designed to affect (e.g., amyloid reduction in AD).

Clinical effectiveness

Evidence that a treatment improves real-world clinical outcomes such as cognition or daily function.

CDR-SB

Clinical Dementia Rating – Sum of Boxes; a scale measuring cognitive and functional decline in dementia.

Primordial prevention

Prevention that aims to prevent risk factors from developing in the first place.

Primary prevention

Treatment given before disease begins to prevent it from occurring.

Secondary prevention

Treatment after disease has started but before major symptoms develop.

Tertiary prevention

Treatment aimed at managing symptoms and improving quality of life after disease diagnosis.

Primary prevention in Alzheimer’s disease

Trials targeting cognitively normal individuals to delay or prevent disease onset.

Secondary prevention in Alzheimer’s disease

Trials targeting individuals with very early symptoms of Alzheimer’s.

Tertiary prevention in Alzheimer’s disease

Interventions focused on managing symptoms and improving quality of life.

Number of Alzheimer’s trials

Over 180 Phase I–III trials studying more than 130 drugs.

Participants in AD trials

Tens of thousands of participants enroll each year in Alzheimer’s clinical trials.

Monoclonal antibodies (MABs)

Lab-produced immunotherapies that target specific proteins such as amyloid or tau.

Mechanism of MABs in AD

Stimulate immune cells (microglia) to remove amyloid or tau proteins from the brain.

Amyloid

Protein that forms plaques in the brain and is a hallmark pathology of Alzheimer’s disease.

Tau

Protein that forms neurofibrillary tangles and spreads through the brain during AD progression.

Aducanumab (Aduhelm)

Monoclonal antibody targeting amyloid; controversially approved by the FDA in 2021.

Lecanemab (Leqembi)

Monoclonal antibody shown to reduce amyloid and slow cognitive decline in early AD.

Donanemab (Kisunla)

Monoclonal antibody targeting amyloid plaques; approved in 2024.

ARIA

Amyloid‑Related Imaging Abnormalities; side effects involving brain swelling or bleeding.

ARIA‑E

Edema or swelling in the brain associated with anti‑amyloid therapies.

ARIA‑H

Hemorrhage or microbleeds in the brain associated with anti‑amyloid therapies.

EMERGE trial

Clinical trial that showed positive results for aducanumab.

ENGAGE trial

Clinical trial that did not show strong benefit for aducanumab.

Accelerated approval

FDA pathway allowing drugs for serious diseases to be approved based on surrogate outcomes.

Instrumental ADLs (IADLs)

Complex daily tasks like managing finances, cooking, and driving.

Basic ADLs (BADLs)

Basic self-care tasks such as bathing, dressing, eating, and toileting.

Caregiving burden

Family caregiving for dementia patients requires billions of hours annually and carries major emotional and financial costs.

Neural dedifferentiation

Age-related reduction in the distinctiveness of neural representations.

Dedifferentiation theory

The idea that older brains become less specialized and more generalized in their activation patterns.

Baltes (1980)

Researcher who observed that correlations between cognitive abilities increase with age.

Sparse neural representations

Distinct neural activity patterns typical of younger brains.

Distributed representations

Overlapping neural patterns more common in aging brains.

Attenuation (dedifferentiation)

Reduced activation in specialized brain regions in older adults.

Broadening (dedifferentiation)

Activation spreading to additional brain regions in older adults.

Age-related overactivation

Older adults showing greater brain activity than younger adults during cognitive tasks.

HAROLD model

Hemispheric Asymmetry Reduction in Older Adults; aging reduces lateralization of brain activity.

HAROLD explanation

Older adults recruit both hemispheres to compensate for neural decline.

CRUNCH model

Compensation‑Related Utilization of Neural Circuits Hypothesis.

CRUNCH prediction

Older adults show greater activation at low task difficulty but reach a capacity limit at high difficulty.

Crunch point

The task difficulty level where compensatory brain activation can no longer increase.

Factors shifting the crunch point upward

Exercise, good sleep, and reduced inflammation.

Factors shifting the crunch point downward

Poor sleep, genetics, and disease.

PASA model

Posterior‑Anterior Shift in Aging; reduced posterior brain activity and increased frontal activity.

Posterior brain regions

Brain areas such as the occipital lobe involved in sensory processing.

Anterior brain regions

Frontal and prefrontal cortex areas associated with higher-level cognition.

STAC theory

Scaffolding Theory of Aging and Cognition.

Compensatory scaffolding

Recruitment of additional neural resources to maintain cognitive performance.

STAC emphasis

Integrates both brain structure and brain function in explaining cognitive aging.

Structural brain decline

Changes such as cortical thinning, volume loss, and white matter deterioration.

Neural scaffolding

The brain’s adaptive strategy to maintain performance despite neural decline.

STAC-r model

Revised scaffolding model incorporating life-course influences and longitudinal changes.

Neural enrichment

Life experiences that strengthen brain health (education, exercise, cognitive activity).

Neural depletion

Factors that harm brain health (depression, vascular disease, sedentary lifestyle).

Life-course influences on cognition

Experiences across the lifespan that shape brain aging and resilience.

Hospice care

Medical care for people expected to live six months or less when cure is not possible.

Goal of hospice

Focus on comfort, symptom management, and quality of life.

Hospice eligibility

Typically for individuals with an expected life expectancy of six months or less.

Benefits of hospice care

Pain relief, emotional support, caregiver assistance, and coordinated care.

Hospice team

Multidisciplinary team including physicians, nurses, social workers, chaplains, and volunteers.

Cicely Saunders

Founder of the modern hospice movement in 1967.

Elisabeth Kübler-Ross

Psychiatrist known for the five stages of grief model.

Five stages of grief

Denial, anger, bargaining, depression, acceptance.

Hospice statistics

Over 1.7 million Medicare patients received hospice services in 2024.

Most common hospice diagnoses

Alzheimer’s/dementia and cancer.

Caregiver strain

High stress caregiving linked to increased caregiver mortality risk.

Caregiver insomnia

Nearly half of caregivers report sleep problems, linked to poorer health outcomes.

Hospice disparities

Lower hospice use among Black and Native American patients.

Hospice misconceptions

Beliefs that hospice is only for the final days or only occurs in facilities.

Artificial nutrition at end of life

Does not significantly prolong life or improve outcomes in advanced illness.

Primary outcome (clinical trials) (Review Concept 1)

The main result measured in a clinical trial to determine whether a treatment works.

Secondary outcome (Review Concept 2)

Additional effects of the treatment measured beyond the primary outcome.

Selection criteria (Review Concept 3)

Rules defining who can or cannot participate in a clinical trial.

Control group (Review Concept 4)

Participants in a trial who do not receive the experimental treatment, used for comparison.

Placebo (Review Concept 5)

An inactive substance given to control groups to compare against the real treatment.

Dose of intervention

The amount of drug or treatment given to participants in a clinical trial.

Route of administration (Review Concept 7)

How a drug is delivered to the body (e.g., oral pill, IV infusion).

Data analysis in clinical trials (Review Concept 8)

The process of reviewing collected data to determine whether the treatment had an effect.

Preclinical studies (Review Concept 9)

Lab-based studies (often using animals or cells) to determine whether a treatment appears safe and potentially effective before human testing.

Phase I clinical trial (Review Concept 10)

Small study (10–80 participants) focused primarily on safety and dosage.

Phase II clinical trial (Review Concept 11)

Study with about 100–300 participants that examines safety and determines effective dosage.

Phase III clinical trial (Review Concept 12)

Large trial (300–3,000+ participants) designed to confirm effectiveness and monitor side effects.