Psychology of Aging and Cognitive Pathology Study Notes

Psychology of Aging

Overview of Course

  • Course Name: Psychology of Aging II and Cognitive Pathology (CPH 250)
  • Focus: Understanding the psychological aspects of aging and cognitive disorders.
  • Course Structure: Includes updates on caregiving, mental health assessments, types of dementia, Alzheimer's Disease, delirium, and depression.

Course Updates

  • Current Content: Psychology of Aging II
  • Upcoming Dates:
    • Tuesday: Exam II Review
    • Thursday: Exam II
  • Thought Exercise #1: Reminder to participate in the last call.

Activities on Campus

  • Friday Schedule:
    • Softball at 3 PM
    • Baseball at 4 PM
    • Men’s Tennis at 5 PM
    • Women’s Gymnastics at 6 PM
  • Saturday Schedule: Men’s Basketball at 2 PM
  • Sunday Schedule: Women’s Basketball at 2 PM

Mental Health and Aging

Mental Health Assessment

  • Importance of mental health evaluations in understanding aging individuals.
  • Key Areas Covered:
    • Types of dementia
    • Alzheimer’s Disease
    • Delirium
    • Depression

Mental Illness Prevalence in Aging

  • Core Concepts:
    • Aging is not synonymous with mental illness. Mental health conditions may decline with age but remain common.
    • Prevalence Statistics: Approximately 20% of older adults have had a diagnosable disorder in the past year (Karel et al., 2012).
    • Higher prevalence noted in long-term care facilities and medical outpatients.

Incidence Rates of Psychological Disorders in Late Life

  • Recurrence of earlier disorders is common in late-life mental health issues.
  • Notable occurrences include:
    • Depression episodes, particularly bereavement depression.
    • Schizophrenia rarely manifests for the first time after age 65, typically beginning in the 20s.
    • Late-onset alcoholism or substance abuse occurs more frequently.

Mental Health and the Life Course

  • Statistics Table: Rate of mental health disorders at health centers by age group (2022 data):
    • Note on sample size: 95.8 million visits by adolescents and adults age 12 and older.
    • Mental health disorders and substance use disorders defined by ICD-10-CM codes.
  • Significant findings: Mental health disorder rates are significantly higher in older adults compared to younger age groups.

Mental Health Care Access

  • Challenges:
    • Low rates of psychotherapy usage among older adults.
    • Approx. 70% of older adults with mental health conditions did not utilize mental health services in the past year (Byers et al., 2012).
    • Discussion points regarding barriers to treatment include:
    • Belief in the efficacy of mental health care
    • Stigmatization
    • Independence and self-management of issues
    • Lack of awareness regarding accessing services
    • Shortage of geropsychologists (only 4% of practicing psychologists).

Common Presenting Problems in Assessment

  • Common Issues Presented by Patients:
    • Forgetfulness
    • Confusion
    • Sadness
    • Peculiar thinking
    • Behavioral problems
  • Referral Sources: Patients can be referred by themselves, family members, or physicians.
  • Discussion on implications of the referral process.

Multidimensional Assessment Techniques

  • Purpose: To meaningfully describe behavioral characteristics through:
    • Interviews
    • Observations
    • Tests
    • Clinical evaluations
  • Importance of reliability and validity in assessments.

Factors Influencing Assessment Outcomes

  • Healthcare Professionals' Biases:
    • Negative biases towards certain ethnic groups or older adults (ageism)
    • Positive biases leading to misunderstandings of issues in patients.
  • Environmental Factors:
    • Differences in assessment settings (home, clinic, hospital) affect outcomes.
    • Influence of physical health and chronic conditions on test performance.
    • Impact of medications and sensory changes (vision/hearing).

Assessment of Cognitive Disorders

  • Evaluation methods:
    • History of the disorder.
    • Mental status examinations.
    • Neuropsychological assessments focusing on multiple cognitive aspects:
    • Memory (both visual and verbal learning, delayed recall).
    • Attention and working memory.
    • Executive functioning.
    • Language skills.
    • Visuospatial abilities.
    • Differentiation among conditions: dementia, depression, delirium.

Clinical Depression Diagnosis Criteria

  • Diagnosis Requirements:
    • Must exhibit clinical depression symptoms for at least two weeks, including:
    • Depressed mood
    • Loss of interest
    • Appetite changes
    • Sleep disturbances
    • Fatigue
    • Feelings of worthlessness or guilt
    • Cognitive difficulties like concentration problems
    • Psychomotor disturbances (restlessness or reduced activity).

Epidemiology of Depression

  • Depression Prevalence Statistics:
    • 31% of adults diagnosed with mood disorders by age 75.
    • 12% report symptoms beginning at age 60 or later.
    • 1-5% in community-living older adults, 11-13% among those receiving home health care.
    • Major Depressive Disorder prevalent among 1-2% of the community.
    • Subsyndromal symptoms recorded:
    • 33% with diabetes
    • 42% with cancer
    • 45% after a heart attack.

Recognizing Depression and Suicide Risks

  • Link to Suicide:
    • Older adults possess higher success rates in suicide attempts due to planning and health conditions.
    • Women generally experience more depression, but men are at a higher risk of suicide.
    • Highest risk group: Old white males (80+), especially those with high depression and alcohol issues post-spousal loss.
    • Notably, most individuals had seen a physician within one month prior to their suicide.

Delirium

Definition of Delirium

  • APA (1994): Defined as a disturbance in consciousness with a change in cognition, occurring over a short time.
  • Characterized by a rapid cognitive decline in relation to significant physical health changes.
  • Often termed “acute confusional state” or “reversible dementia.”

Delirium Characteristics

  • Quick onset (hours to days) with variable progress.
  • Demonstrated symptoms include:
    • Fluctuating levels of function.
    • Changes in attention and awareness, focusing difficulties.
    • Possible delusions, hallucinations, incoherent speech.

Causes of Delirium

  • Frequently associated with surgical procedures and general anesthesia.
  • Common Sources:
    • Medical conditions (e.g., infections, cardiovascular issues).
    • Substance withdrawal (e.g., alcohol).
    • Mislabeling conditions due to similarity with dementia.
    • Early mortality risks with nursing home placements.

Cognitive Disorders

Mild Cognitive Impairment (MCI)

  • Described as a transitional stage between normal aging and dementia.
  • Prevalence: 10-20% among those over 65.
  • Debates on MCI:
    • Not all MCI leads to dementia; 3 stages identified for Alzheimer's Disease:
    1. Preclinical
    2. MCI due to AD
    3. Dementia due to AD
    • Community-based studies show 4-15% revert to normal cognition from MCI; 29-55% in structured clinic assessments.

Dementias Overview

  • Definition: Mental disorders resulting from severe brain pathological changes affecting everyday functioning.
  • Predominantly related to significant neuron-level alterations, both chemical and structural.
  • Impact on various cognitive functions: attention, learning, memory, intellect, judgment, and behavior's emotional aspects.
  • Affects approximately 36 million globally as of 2010; current estimates are 55 million.
  • Projection: prevalence predicted to triple within 25 years.

Forms of Dementia

  • Organic Degenerative Dementia: Includes gradual neuron breakdown. Examples: Alzheimer's Disease, Lewy Body Dementia, Frontotemporal Dementia.
  • Vascular Dementia: Associated with cerebrovascular incidents damaging blood flow to the brain (ischemic and hemorrhagic strokes).

Alzheimer’s Disease

  • Recognized as the most prevalent form of dementia, initially described in the early 1900s by Alois Alzheimer.
  • Pathophysiological Characteristics:
    • Irreversible brain tissue degeneration.
    • Early symptoms include difficulties with remembering recent events, learning new material, irritability, and social withdrawal.
  • Progression Symptoms:
    • Worsening language issues.
    • Disorientation regarding time/place, as well as identity confusion.
    • Increased agitation and possible problematic behaviors (e.g., wandering, pacing).

Brain Imaging in Alzheimer’s Disease

  • Key Findings:
    • Comparison of healthy brain structure with Alzheimer’s-affected brain shows atrophy of the cerebral cortex and hippocampus.
    • Age-related averages indicated:
    • Healthy Control: 60.7 years
    • Alzheimer's Disease (cortex): 79.9 years
    • Alzheimer's Disease (hippocampus): up to 81.3 years

Diagnosis of Alzheimer’s Disease (AD)

  • Diagnosis relies on exclusion: eliminating other possible impairments (tumors, dietary issues, depression).
  • Confirmation possible only at autopsy, though developing blood/plasma biomarker tests could assist in diagnosis despite the common presence of plaques in non-demented elderly.

Prevalence of Alzheimer’s in the US

  • Statistics:
    • Approx. 1 in 10 persons aged 65+ diagnosed.
    • Approx. 1 in 3 aged 85+ diagnosed.
    • Total number of diagnosed individuals: 5.8 million.
    • Societal impact: 16 million caregivers involved in the care of AD/dementia victims.
    • Related deaths: 1 in 3 seniors die from Alzheimer’s.
    • Economic burden: Costs attributed to AD/dementia approximate $290 billion/year.

Types of Alzheimer’s Disease

  • Late Onset: (~90% of cases)
  • Early Onset (Familial): (~10% of cases) influenced by genetic risk factors (e.g., Apolipoprotein E (APOE-e4)).
  • Potential Genetic Links:
    • Over 20 identified gene variations linked to immune implications affecting risk of AD.

Staging of Alzheimer’s

  • Average duration post-diagnosis: 9 years (ranges from 1-15 years).
  • Stages:
    • Early Stage: Memory loss, disorientation, poor judgment, personality changes.
    • Middle Stage: Escalating memory issues, speech difficulties, increased irritability.
    • Late Stage: Severe decline in language abilities, loss of mobility, muscle deterioration, risk of aspiration due to swallowing difficulties.

Questions and Reflections

  • Engage in reflectivity regarding dementia understanding and answer prompt questions posed throughout the course.