week 11 disorder cue cards

Older adults

People aged over 65; this cut-off is based on social policy rather than biology.

Young-old

Ages 65–74.

Old-old

Ages 75–84.

Oldest-old

Ages 85+.

Ageing stereotypes

Negative beliefs about ageing can become negative self-perceptions, impair memory performance and predict earlier mortality.

Social selectivity theory

As perceived time remaining decreases, people prioritise a few emotionally meaningful relationships over meeting new people.

Emotional changes with age

Older adults often experience less negative emotion, better emotion regulation and faster recovery from negative moods.

Social activity and wellbeing

The number of social activities is not necessarily associated with wellbeing; many older adults do not want more social contacts.

Polypharmacy

Being prescribed multiple medications at once, increasing risks of side effects, toxicity and drug interactions.

Age, cohort and time-of-measurement effects

Differences may reflect a person's age, the historical period in which they grew up, or events occurring when they were assessed.

Cross-sectional design

Compares different age groups at one time; cannot track individual change and is vulnerable to cohort effects.

Longitudinal design

Follows the same people over time; vulnerable to attrition and selective mortality, which can leave healthier participants in the sample.

Diagnosing older adults

DSM-5-TR criteria are generally the same across ages, but medical conditions and medication effects must be carefully considered.

Medical mimics

Physical conditions can resemble psychological symptoms, such as thyroid problems mimicking depression or anxiety, vestibular decline mimicking panic, and dementia or delirium causing hallucinations.

Late-life prevalence

Adults over 65 have the lowest reported rates of psychological disorders of any age group, although comorbidity is more common.

Prevalence vs incidence

Prevalence is the proportion of people who have a disorder; incidence is the number of new cases.

Late-life onset

Many disorders in older adults are recurrences of earlier conditions rather than genuinely new onset; late-onset alcohol dependence is an exception.

Why prevalence may be underestimated

Response bias, cohort effects and selective mortality.

Genuine age-related improvement

Better emotion regulation and closer social relationships may contribute to improved mental health in later life.

Neurocognitive disorders

Disorders involving cognitive decline that affects thinking and everyday functioning.

Major NCD

Significant cognitive decline that interferes with independence; includes dementia.

Minor NCD

Mild cognitive decline without substantial impairment of everyday independence; includes mild cognitive impairment (MCI).

Delirium

Acute disturbance in attention, awareness and cognition, usually caused by a medical condition or substance.

Common causes of NCDs

Alzheimer's disease, frontotemporal degeneration, vascular disease, traumatic brain injury, Lewy body disease, Parkinson's disease, HIV, substances or medications, Huntington's disease, prion disease and other medical conditions.

Dementia (major NCD)

An umbrella term for progressive cognitive decline that impairs everyday functioning; it is not one specific disease.

Major NCD diagnostic features

Significant decline from previous functioning in at least one cognitive domain, evidence of decline, and interference with independence in daily activities.

Mild cognitive impairment (MCI)

Modest decline in at least one cognitive domain, with independence maintained, although extra effort or compensatory strategies may be needed.

Amnestic MCI

MCI involving memory, either alone or alongside other affected domains.

Non-amnestic MCI

MCI involving cognitive domains other than memory.

MCI progression

Not everyone progresses to dementia; the notes estimate approximately 10% progress per year, compared with around 1% per year without MCI.

Major vs minor NCD

The key distinction is whether cognitive deficits substantially interfere with everyday independence.

Dementia course

Usually gradual and progressive, although onset and progression differ by type.

Alzheimer's disease

The most common dementia, accounting for approximately 60–80% of cases; a progressive disease involving plaques, tangles and neuronal loss.

Onset

Insidious, developing gradually over months or years.

Early memory impairment

Recent memory is affected first, while older memories may initially remain intact.

Other affected domains

Language, skilled movements (praxis), visuospatial skills and executive functioning.

Early behavioural sign

Apathy can occur before obvious cognitive symptoms.

Advanced AD

Severe memory loss, difficulty recognising loved ones, full dependence, agitation, communication difficulties and eventual physical decline.

Beta-amyloid plaques

Protein deposits outside neurons; may be present 10–20 years before symptoms.

Neurofibrillary tangles

Twisted tau-protein filaments inside neurons; interfere with neuronal functioning and survival.

Hippocampus

Brain region important for memory; affected early in AD.

Brain atrophy

Shrinkage progresses from the entorhinal cortex to the hippocampus and then other cortical regions.

ApoE-4

Apolipoprotein ε4 allele on chromosome 19; the major genetic risk factor identified in the notes.

Cognitive reserve

Intellectual activity may help people function better despite similar levels of brain pathology.

Lifestyle factors

Exercise, cognitive engagement and education are associated with lower risk; smoking, obesity, depression and low social support are associated with increased risk.

Depression and dementia

The relationship is bidirectional: depression is associated with greater dementia risk and can also occur as a consequence of dementia.

FTD

Neurodegeneration affecting the frontal and anterior temporal lobes, often beginning younger than AD, commonly in the mid-to-late 50s.

Key distinction from AD

Personality, behaviour or language changes are prominent early, while memory is relatively spared.

Behavioural variant FTD (bvFTD)

Progressive changes in personality and social behaviour, including apathy, disinhibition, impulsivity, reduced empathy and repetitive behaviour.

Hyperorality

Putting inappropriate or inedible objects in the mouth; increased preference for sweet foods can occur in bvFTD.

Primary progressive aphasia (PPA)

Progressive language impairment is the main and fastest-declining feature.

Progressive non-fluent aphasia (PNFA)

Difficulty producing language, including effortful speech and grammatical errors.

Semantic dementia (SD)

Loss of word meaning and conceptual knowledge, such as being unable to name objects, while everyday and personal memory may remain intact.

Vascular dementia (VD)

Cognitive decline caused by cerebrovascular disease, particularly strokes.

Onset

Often more rapid than Alzheimer's disease.

Cognitive profile

Poor executive functioning, slowed thinking and sometimes mild memory problems.

Physical signs

Gait problems, falls and progressive functional decline.

Risk factors

High cholesterol, smoking and high blood pressure.

Dementia with Lewy bodies (DLB)

Progressive dementia involving abnormal Lewy body protein deposits throughout the brain.

Fluctuating cognition

Alternation between marked impairment and near-normal performance.

Visual hallucinations

Recurrent, detailed and well-formed visual experiences.

Parkinsonism

Parkinson-like motor symptoms.

REM sleep behaviour disorder

Acting out dreams through movement or vocalisation.

Antipsychotic sensitivity

Increased sensitivity to the physical side effects of antipsychotics.

DLB vs Parkinson's disease dementia

In DLB, cognitive symptoms appear before or alongside parkinsonism; in Parkinson's disease dementia, dementia develops after established Parkinson's disease.

Treatment goal

Improve symptoms and quality of life; there is currently no cure.

Prevention

Addressing modifiable risk factors may prevent a substantial proportion of dementia cases.

Cholinesterase inhibitors

Medications such as donepezil and rivastigmine reduce acetylcholine breakdown and may slightly slow memory decline in AD and DLB.

Memantine

Acts on glutamate receptors and has a small beneficial effect in AD.

Antidepressants

May treat co-occurring depression, which can also worsen cognitive functioning.

Antipsychotics

May modestly reduce aggressive agitation but increase mortality risk in older adults with dementia.

External memory aids

Calendars, lists, phone contacts and labels compensate for memory difficulties.

Behavioural management

Identify and change triggers for disruptive behaviour.

Music therapy

Can reduce agitation and behavioural symptoms while music is playing.

Cognitive training

Can produce modest improvements, usually specific to the trained skill, with limited transfer to everyday life.

Metacognitive training

Teaches strategies for thinking about thinking and may generalise across more tasks.

Tailored Activities Program (TAP)

Creates individualised activities based on the person's strengths and interests, with caregiver guidance; can reduce agitation and improve engagement.

BPSD

Behavioural and psychological symptoms of dementia; often among the most challenging aspects of care and a major contributor to caregiver burden.

Caregiver burden

The time demands and stress of caring for someone with dementia, associated with depression, anxiety, physical illness and reduced immune function.

Communication strategy

Embed possible answers into questions, such as “Was it Harry or Tom?” rather than asking an open-ended question that requires recall.

Setting limits

Prevent dangerous activities when necessary, such as restricting driving.

Caregiver support programs

Coping strategies, behavioural therapy, exercise and social support can reduce burden and depression.

Respite care

Temporary in-home or residential care that gives caregivers a break.

Benefits of respite

Can improve caregiver health, reduce medical costs and delay residential placement.

Delirium

An acute, fluctuating disturbance in attention, awareness and cognition caused by a medical condition, substance or toxin.

Onset

Rapid, usually within hours to days.

Attention disturbance

Difficulty focusing, maintaining a train of thought or following a conversation.

Fluctuation

Symptoms vary throughout the day, often worsening at night, with possible lucid periods.

Other symptoms

Disorientation, recent-memory problems, sleep–wake disturbance, visual hallucinations, mood changes and agitation.

Hyperactive delirium

Restlessness, agitation, aggression and hypervigilance.

Hypoactive delirium

Quietness, withdrawal, lethargy and slow responses; easily missed or mistaken for depression or dementia.

Mixed delirium

Alternation between hyperactive and hypoactive features.

Common causes

Infections such as UTIs, medication side effects, metabolic imbalances, dehydration and poor recovery after surgery.

Major risk factor

Dementia; the notes state that around two-thirds of delirium cases in older adults occur in people with dementia.

Prognosis

Potentially reversible if the cause is treated promptly, but untreated delirium carries substantial mortality and long-term cognitive risks.

Treatment

Identify and treat the cause, such as infection or dehydration, and review medications.

Prevention

Support orientation, maintain daytime lighting and nighttime sleep, minimise sleep disruptions, manage pain and dehydration, and use familiar staff where possible.

Major NCD vs Minor NCD

Major NCD substantially interferes with independence; Minor NCD involves modest decline while independence is maintained.

Alzheimer’s disease vs Frontotemporal dementia

Alzheimer’s typically begins with recent memory loss; FTD typically begins with personality, behaviour or language changes while memory is relatively spared.

Alzheimer’s disease vs Vascular dementia

Alzheimer’s usually has gradual onset and early recent-memory impairment; vascular dementia is linked to cerebrovascular disease and often has more rapid onset, executive problems and gait difficulties.