Late_Life.ppt

Copyright 2009 John Wiley & Sons, NY http://www.pbs.org/wgbh/nova/body/mice-memory.html http://www.pbs.org/theforgetting/watch/index.html Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY In US, many people dread aging Elderly not revered as in other cultures When are we old? Society arbitrarily sets old as over 65 2001 census 12.4% or 35 million individuals were 65 or older Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Aging involves inexorable cognitive decline Severe cognitive problems do not occur for most Mild declines are common Late life is a sad time and most elderly are depressed Older individuals report less negative emotion than younger people More brain activation in key areas when viewing positive images Late life is a lonely time Some less likely to develop new friendships Social selectivity As we age, we focus on the interpersonal relationships that matter most to us Older people lose interest in sex Sexual activity does not decrease from mid to late life for most people Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Ageism* Discrimination against a person, young or old, based on chronological age Sleep disturbances increase with age Insomnia Sleep apnea Medical treatment Chronic problems instead of curable disorders Polypharmacy Practice of prescribing multiple drugs to patients Side effects and toxicity of medications Psychoactive drugs usually tested on younger participants Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Cross-sectional studies Researcher tests different age groups at one point in time Fails to provide information about how people change over time Longitudinal studies Researcher retests the same group of people with the same measures at different points in time May extend over several years or decades Attrition a potential problem Selective mortality can lead to biased sample Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Most elderly do not have cognitive disorders Prevalence has decreased over last 15 years Dementia A deterioration of cognitive function Delirium A state of mental confusion Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Deterioration of cognitive function Interferes with social and occupational functioning Progresses over time Begins with difficulty remembering recent events Deficits can be detected before impairment becomes obvious Mild cognitive impairment increases risk of developing dementia Prevalence worldwide .4% of world population Prevalence increases with advancing age Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Described by Alois Alzheimer in 1906 Irreversible brain tissue deterioration Death usually occurs within 12 years Usually begins with Difficulty remembering recent events Learning new material Irritability As disease progresses Language problems intensify including word-finding Disorientation Time, place, and identity confusion Agitation Depression Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Plaques ?-amyloid protein deposits Primarily found in frontal cortex Neurofibrillary tangles Protein filaments composed of tau in cell bodies of neurons Primarily found in hippocampus Measured using PET scans Loss of synapses for Acetylcholinergic (Ach) and glutaminergic neurons As neurons die, atrophy of cerebral & entorhinal cortices and hippocampus Enlargement of ventricles Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Genetic factors Heritability 79% Early onset (before age 60) Dominant genes on chromosomes 21, 1, and 14 may cause some cases Later onset Gene on chromosome 19 APOE-4 allele Environmental factors Head trauma Depression Strong baseline linguistic ability reduces risk Frequent cognitive activity reduces risk e.g. crossword puzzles Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Begins in mid to late 50s Memory not severely disrupted Impairment of executive functions Planning Problem solving Goal directed behavior Difficulty recognizing & regulating emotion Neuronal deterioration in several areas involving serotonergic neurons Amygdala, anterior temporal lobes, prefrontal cortex, and other regions Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Involves neurological impairment Weakness in limb Abnormal reflexes Typically results from stroke Clot forms and impairs circulation Cells die Risk factors Smoking, high LDL cholesterol, high BP Affects African Americans more often than whites Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Two subtypes With Parkinson?s No Parkinson?s Symptoms similar to Parkinson?s and Alzheimer?s diseases Shuffling gait Loss of memory Symptoms differ in that DLB patients have: Fluctuating cognitive symptoms Prominent visual hallucinations Intense dreams involving movement and vocalizing Disorder involves unusual patterns of dopamine activity in the basal ganglia Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Medications No drug reverses Alzheimer?s disease Some drugs produce slightly less decline Acetylcholinesterase inhibitors Drugs that prevent breakdown of acetylcholine Donepezil (Aricept) Galantamine (Reminyl) Vitamin E, statins, and nonsteroidal anti-inflammatory drugs have failed to find support Preventive work focuses on processes involved in the creation of amyloid from its precursor, protein Antidepressants for depression Antipsychotic medication for agitation Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Psychological treatments Supportive psychotherapy for family and patient Education about disease and care Cognitive interventions when disease is in early stages Labeling drawers, appliances Calendars, clocks, and strategically placed notes Exercise has been associated with cognitive benefits Music appears to reduce agitation and disruptive behavior Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Psychological disorders in late life, are usually recurrences of earlier disorder Most episodes of depression and anxiety are recurrences Schizophrenia rarely appears for the first time in late life Rates for psychological disorders lower than in younger populations May be due to: Cohort effects Reporting bias Selective mortality Aging also appears to be genuinely related to better mental health Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY No diagnosis if symptoms are accounted for by medical condition or medication side effects Thyroid dysfunction Addison?s disease Cushing?s disease Parkinson?s disease Alzheimer?s disease Hypoglycemia Anemia and vitamin deficiencies Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Older adults 3x as likely to take their own lives than younger adults Men Suicide rates increase with age from adolescence Older white men most likely to commit suicide Peak age from 80 to 84 Women Suicide rates peaks in 50s, then declines gradually Major risk factor is depression Medical screening allows for detection and treatment even when the individual does not present with psychological problems Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Barriers to treatment More negative beliefs about mental illness and treatment Less likely to seek treatment Clinicians less likely to expect successful outcome Less likely to be assessed and referred for treatment Financial barriers may prevent access Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY Copyright 2009 by John Wiley & Sons, New York, NY. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission of the copyright owner. Copyright 2009 John Wiley & Sons, NY * Copyright 2009 John Wiley & Sons, NY