Comer, Fundamentals of Abnormal Psychology, 7e Disorders of Aging and Cognition Chapter 15 Slides & Handouts by Karen Clay Rhines, Ph.D.

Disorders of Aging and Cognition  Neurocognitive disorders are currently the most publicized and feared psychological problems among the elderly  They are, however, hardly the only ones  A variety of psychological disorders are tied closely to later life  As with childhood disorders, some of the disorders of old age are caused primarily by pressures that are particularly likely to appear at that time of life, others by unique traumatic experiences, and still others – like neurocognitive disorders– by biological abnormalities 2 Comer, Fundamentals of Abnormal Psychology, 7e

Old Age and Stress  Old age is usually defined in our society as the years past age 65  Around 36 million people in the U.S. are “old” – 12% of the population and growing  Older women outnumber older men by 3 to 2  Like childhood, old age brings special pressures, unique upsets, and major biological changes 3 Comer, Fundamentals of Abnormal Psychology, 7e

Old Age and Stress  The stresses of elderly people need not result in psychological disorders; however, studies indicate that as many as 50% of elderly people would benefit from mental health services  Fewer than 20% actually receive them  Geropsychology is the field of psychology dedicated to the mental health of elderly people 4 Comer, Fundamentals of Abnormal Psychology, 7e

Old Age and Stress  The psychological problems of elderly persons may be divided into two groups:  Disorders that may be common in people of all ages but are connected to the process of aging  Depressive, anxiety, and substance-related disorders  Disorders of cognition that result from brain abnormalities  Delirium, mild neurocognitive disorders, and major neurocognitive disorders 5 Comer, Fundamentals of Abnormal Psychology, 7e

Depression in Later Life  Depression is one of the most common mental health problems of older adults  The features of depression are the same for elderly people as for younger people  As many as 20% of people experience this disorder at some point during old age  The rate is highest in older women  Several studies suggest that depression among older people raises their chances of developing significant medical problems 6 Comer, Fundamentals of Abnormal Psychology, 7e

Depression in Later Life  Elderly persons are also more likely to commit suicide than younger ones, and often their suicides are related to depression 7 Comer, Fundamentals of Abnormal Psychology, 7e

Depression in Later Life  Like younger adults, older people who are depressed may be helped by cognitive- behavioral therapy, interpersonal therapy, antidepressant medications, or a combination of these approaches 8 Comer, Fundamentals of Abnormal Psychology, 7e

Depression in Later Life  More than half of older patients with depression improve with these treatments  It is sometimes difficult for elderly people to use antidepressant drugs effectively and safely because the body’s metabolism works differently in later life  Moreover, among elderly people, antidepressant drugs have a higher risk of causing some cognitive impairment 9 Comer, Fundamentals of Abnormal Psychology, 7e

Anxiety Disorders in Later Life  Anxiety is also common among the elderly  At any given time, around 6% of elderly men and 11% of elderly women in the U.S. experience at least one of the anxiety disorders  GAD is particularly common, experienced by up to 7% of all elderly persons  The prevalence of anxiety increases throughout old age 10 Comer, Fundamentals of Abnormal Psychology, 7e

Anxiety Disorders in Later Life  There are many things about aging that may heighten anxiety levels, including declining health  Researchers have not, however, systematically tied anxiety disorders among the elderly to specific events or losses  Older adults with anxiety disorders are often treated with psychotherapy of various kinds, particularly cognitive-behavior therapy  Many also receive antianxiety medications  Again, all such drugs must be used cautiously with older people 11 Comer, Fundamentals of Abnormal Psychology, 7e

Substance Abuse in Later Life  Although alcohol and other substance use disorders are significant problems for many older persons, the prevalence of such patterns actually appears to decline after age 60  Accurate data about the rate of substance abuse among older adults is difficult to obtain because many elderly persons do not suspect or admit they have such a problem 12 Comer, Fundamentals of Abnormal Psychology, 7e

Substance Abuse in Later Life  Surveys find that 4% to 7% of older people, particularly men, have alcohol-related disorders in a given year  Researchers often distinguish between older problem drinkers who have experienced significant alcohol-related problems for many years and those who do not start the pattern until their 50s and 60s  The latter group typically begins abusive drinking as a reaction to the negatives events and pressures of growing older 13 Comer, Fundamentals of Abnormal Psychology, 7e

Substance Abuse in Later Life  Alcohol use disorder in elderly people are treated much as in younger adults  Approaches include detoxification, Antabuse, Alcoholics Anonymous (AA), and cognitive- behavioral therapy 14 Comer, Fundamentals of Abnormal Psychology, 7e

Substance Abuse in Later Life  A leading kind of substance problem in the elderly is the misuse of prescription drugs  Most often it is unintentional  Yet another drug-related problem is the misuse of powerful medications at nursing homes 15 Comer, Fundamentals of Abnormal Psychology, 7e

Psychotic Disorders in Later Life  Elderly people have a higher rate of psychotic symptoms than younger persons  Among aged people, these symptoms are usually due to underlying medical conditions such as the disorders of cognition  However, some elderly persons suffer from schizophrenia or delusional disorder 16 Comer, Fundamentals of Abnormal Psychology, 7e

Psychotic Disorders in Later Life  Schizophrenia is less common in older persons than in younger ones  Many people with schizophrenia find that their symptoms lessen in later life  It is uncommon for new cases of schizophrenia to emerge in later life 17 Comer, Fundamentals of Abnormal Psychology, 7e

Psychotic Disorders in Later Life  Another kind of psychotic disorder found among the elderly is delusional disorder, in which individuals develop beliefs that are false but not bizarre  This disorder is rare in most age groups, but its prevalence appears to increase in the elderly population  Some clinicians suggest that the rise is related to the deficiencies in hearing, social isolation, greater stress, or heightened poverty experienced by many elderly persons 18 Comer, Fundamentals of Abnormal Psychology, 7e

Disorders of Cognition  Cognitive “mishaps” (e.g., leaving without keys, forgetting someone’s name) are a common and quite normal feature of stress or aging  As people move through middle age, these memory difficulties and lapses of attention increase, and they may occur regularly by age 60 or 70  Sometimes, however, people experience memory and other cognitive changes that are far more extensive and problematic 19 Comer, Fundamentals of Abnormal Psychology, 7e

Disorders of Cognition  While problems in memory and related cognitive processes can occur without biological causes (in the form of dissociative disorders), more often, cognitive problems have organic roots, particularly when they appear in later life  The leading cognitive disorders among elderly persons are delirium and neurocognitive disorders 20 Comer, Fundamentals of Abnormal Psychology, 7e

Delirium  Delirium is a major disturbance in attention and orientation to the environment  As a person’s awareness of the environment becomes less clear, he or she has great difficulty concentrating and thinking in an organized way  This leads to misinterpretations, illusions, and, on occasion, hallucinations 21 Comer, Fundamentals of Abnormal Psychology, 7e

Delirium  This state of massive confusion typically develops over a short period of time, usually hours or days  It may occur in any age group, including children, but it is most common in elderly persons  Delirium affects fewer than 0.5% of the nonelderly population, 1% of people over 55, and 14% of those over 85 years of age  Fever, certain diseases and infections, poor nutrition, head injuries, strokes, stress (including the trauma of surgery), and intoxication by certain substances may all cause delirium 22 Comer, Fundamentals of Abnormal Psychology, 7e

Alzheimer’s Disease and Other Neurocognitive Disorders  People with a neurocognitive disorder experience a significant decline in at least one (often more than one) area of cognitive functioning, such as memory and learning, attention, visual perception, planning and decision making, language ability, or social awareness  In certain types of neurocognitive disorder, individuals may also experience changes in personality and behavior 23 Comer, Fundamentals of Abnormal Psychology, 7e

Alzheimer’s Disease and Other Neurocognitive Disorders  If a person’s cognitive decline is substantial and interferes significantly with his or her ability to be independent, a diagnosis of major neurocognitive disorder is in order  If, however, the decline is modest and does not interfere with independent functioning, the appropriate diagnosis is mild neurocognitive disorder 24 Comer, Fundamentals of Abnormal Psychology, 7e

Alzheimer’s Disease and Other Neurocognitive Disorders  At any given time, around 3 to 9 percent of the world’s adult population are suffering from such disorders  Their experience is closely related to age  Among people 65 years of age, the prevalence is around 1 to 2%, increasing to as much as 50% among those over the age of Comer, Fundamentals of Abnormal Psychology, 7e

Alzheimer’s Disease  This disease is the most common type of neurocognitive disorder, accounting for as many as two-thirds of all cases  Around 5 million people in the U.S. currently have this disease  This disease sometimes appears in middle age (early onset), but most often occurs after the age of 65 (late onset)  Its prevalence increases markedly among people in their late 70s and early 80s 26 Comer, Fundamentals of Abnormal Psychology, 7e

Alzheimer’s Disease  This is a gradually progressive disease in which memory impairment is the most prominent cognitive dysfunction  Technically, suffers receive a DSM-5 diagnosis of mild neurocognitive disorder due to Alzheimer’s disease during the early stages and major neurocognitive disorder due to Alzheimer’s disease during the later stages 27 Comer, Fundamentals of Abnormal Psychology, 7e

Alzheimer’s Disease  The time between onset and death is typically 8 to 10 years, although some people may survive for as many as 20 years  It usually begins with mild memory problems, lapses of attention, and difficulties in language and communication 28 Comer, Fundamentals of Abnormal Psychology, 7e

Alzheimer’s Disease  As symptoms worsen, the person has trouble completing complicated tasks and remembering important appointments  Eventually sufferers also have difficulty with simple tasks, distant memories are forgotten, and changes in personality often become very noticeable 29 Comer, Fundamentals of Abnormal Psychology, 7e

Alzheimer’s Disease  As the neurocognitive symptoms intensify, people show less and less awareness of their limitations  Eventually they become fully dependent on other people, they lose almost all knowledge of the past and fail to recognize the faces of even close relatives  Alzheimer’s victims usually remain in fairly good health until the later stages of the disease 30 Comer, Fundamentals of Abnormal Psychology, 7e

Alzheimer’s Disease  In most cases, Alzheimer’s can be diagnosed with certainty only after death, when structural changes in the brain can be fully examined  Senile plaques are sphere-shaped deposits of a small molecule known as the beta-amyloid protein that form in the spaces between cells in the hippocampus, cerebral cortex, and certain other brain regions and blood vessels  Neurofibrillary tangles are twisted protein fibers found within the cells of the hippocampus 31 Comer, Fundamentals of Abnormal Psychology, 7e

Alzheimer’s Disease  Scientists do not fully understand what role excessive numbers of plaques and tangles play in Alzheimer’s disease, but they suspect they are very important  Today’s leading explanations for this disease center on these plaques and tangles and on factors that may contribute to their formation 32 Comer, Fundamentals of Abnormal Psychology, 7e

What Are the Genetic Causes of Alzheimer’s Disease?  It appears that Alzheimer’s disease often has a genetic basis  Clinicians now distinguish between early-onset (familial) Alzheimer’s disease and late-onset (sporadic) Alzheimer’s disease 33 Comer, Fundamentals of Abnormal Psychology, 7e

What Are the Genetic Causes of Alzheimer’s Disease?  Early-Onset  Researchers have found that this form of Alzheimer’s disease can be caused by abnormalities in the genes responsible for the production of two proteins  Apparently some families transmit these mutations and the onset of the disease is set into motion 34 Comer, Fundamentals of Abnormal Psychology, 7e

What Are the Genetic Causes of Alzheimer’s Disease?  Late-Onset  This form of the disease appears to result from a combination of genetic, environmental, and lifestyle factors  The genetic factor at play in late-onset Alzheimer’s disease is different from the ones involved in early-onset Alzheimer’s disease 35 Comer, Fundamentals of Abnormal Psychology, 7e

How Does Brain Structure Relate to Alzheimer’s Disease?  Researchers have identified a number of biological factors related to the brain abnormalities seen in Alzheimer’s disease 36 Comer, Fundamentals of Abnormal Psychology, 7e

How Does Brain Structure Relate to Alzheimer’s Disease?  Certain brain structures seem to be critical to the proper functioning of memory, including:  The prefrontal lobes  The temporal lobes  The diencephalon  Research indicates that cases of Alzheimer’s disease involve damage to or improper functioning of one or more of these brain structures 37 Comer, Fundamentals of Abnormal Psychology, 7e

38 Comer, Fundamentals of Abnormal Psychology, 7e

What Biochemical Changes in the Brain Relate to Alzheimer’s Disease?  Similarly, certain biochemical activities seem to be especially important in memory  In order for new information to be acquired and stored, certain proteins must be produced in key brain cells  Several chemicals are responsible for the production of these memory-linked proteins  Some research suggests that abnormal activity by these various chemicals may contribute to the symptoms of Alzheimer’s disease 39 Comer, Fundamentals of Abnormal Psychology, 7e

Other Explanations of Alzheimer’s Disease  Several lines of research suggest that certain substances found in nature, including zinc, may produce brain toxicity, which may contribute to the development of the disease  Another line of research suggests that the environmental toxin lead may contribute to the development of Alzheimer’s disease 40 Comer, Fundamentals of Abnormal Psychology, 7e

Other Explanations of Alzheimer’s Disease  Another explanation is the autoimmune theory:  Changes in aging brain cells may trigger an autoimmune response, leading to the disease  A final explanation is a viral theory  Because Alzheimer’s disease resembles Creutzfeldt- Jakob disease (another type of neurocognitive disorder caused by a virus), some researchers propose that a similar virus may cause Alzheimer’s disease  To date, no such virus has been detected in the brains of Alzheimer’s victims 41 Comer, Fundamentals of Abnormal Psychology, 7e

Assessing and Predicting Alzheimer’s Disease  Most cases of Alzheimer’s disease can be diagnosed with certainty only after death, when autopsy is performed  However, brain scans, which reveal structural abnormalities in the brain, now are commonly viewed as assessment tools 42 Comer, Fundamentals of Abnormal Psychology, 7e

Assessing and Predicting Alzheimer’s Disease  Several research teams are currently trying to create tools that can identify persons likely to develop Alzheimer’s disease and other neurocognitive disorders  One research team is using PET scans  The most effective interventions for Alzheimer’s disease and other neurocognitive disorders are those that help prevent problems or, at the very least, are applied early, so it is essential to have tools that identify the disorders as early as possible 43 Comer, Fundamentals of Abnormal Psychology, 7e

Other Types of Neurocognitive Disorders  There are a number of other neurocognitive disorders, including:  Vascular neurocognitive disorder  Follows a cerebrovascular accident, or stroke, during which blood flow to specific areas of the brain was cut off, with resultant damage  This disorder is progressive but its symptoms begin suddenly, rather than gradually  Cognitive functioning may continue to be normal in the areas of the brain not affected by the stroke 44 Comer, Abnormal Psychology, 8e

Other Types of Neurocognitive Disorders  There are a number of other neurocognitive disorders, including:  Frontotemproal neurocognitive disorder – also known as Pick’s disease – a rare disorder that affects the frontal and temporal lobes and is clinically similar to Alzheimer’s disease  Neurocognitive disorder due to prion disease – also called Creutzfeldt-Jakob disease – has symptoms that include spasms of the body  This disorder is caused by a slow-acting virus 45 Comer, Abnormal Psychology, 8e

Other Types of Neurocognitive Disorders  There are a number of other neurocognitive disorders, including:  Neurocognitive disorder due to Huntington’s disease – an inherited progressive disease in which memory problems worsen over time, along with personality changes, mood difficulties, and movement problems  Parkinson’s disease – a slowly progressive neurological disorder marked by tremors, rigidity, and unsteadiness that can cause neurocognitive disorder due to Parkinson’s disease 46 Comer, Abnormal Psychology, 8e

Other Types of Neurocognitive Disorders  Finally, yet other neurocognitive disorders may be caused by:  HIV infections  Traumatic brain injury  Substance abuse  Various medical conditions such as meningitis or advanced syphilis 47 Comer, Abnormal Psychology, 8e

What Treatments Are Currently Available?  Treatments for the cognitive features of Alzheimer's disease and most other types of neurocognitive disorder have been at best modestly helpful  A number of approaches have been applied, including drug therapy, cognitive techniques, behavioral interventions, support for caregivers, and sociocultural approaches 48 Comer, Fundamentals of Abnormal Psychology, 7e

What Treatments Are Currently Available?  The drugs currently prescribed affect acetylcholine and glutamate, the neurotransmitters known to play an important role in memory  Although the benefits of the drugs are limited and the risk of harmful side effects is sometimes high, the drugs have been approved by the FDA  Another approach, taking Vitamin E, seems to help prevent or slow down further cognitive decline  These drugs are administered after a person has developed Alzheimer’s disease 49 Comer, Fundamentals of Abnormal Psychology, 7e

What Treatments Are Currently Available?  Some studies suggest that certain substances now on the market for other problems (e.g., estrogen) may prevent or delay the onset of Alzheimer’s disease  A number of studies also seem to suggest that certain substances (e.g., ibuprofen) may reduce the risk of Alzheimer’s disease  Cognitive treatments have been tried with some temporary success  Behavioral interventions have been tried with modest success 50 Comer, Fundamentals of Abnormal Psychology, 7e

What Treatments Are Currently Available?  Caregiving can take a heavy toll on the close relatives of people with Alzheimer’s disease and other types of neurocognitive disorders  Almost 90% of all people with Alzheimer’s disease are cared for by their relatives  One of the most frequent reasons for the institutionalization of people suffering from Alzheimer’s is that overwhelmed caregivers can no longer cope with the difficulties of keeping them at home 51 Comer, Fundamentals of Abnormal Psychology, 7e

What Treatments Are Currently Available?  Sociocultural approaches have begun to play an important role in treatment  A number of day-care and assisted-living facilities have been opened to provide care for those with Alzheimer’s disease  Studies suggest that such facilities often help slow the cognitive decline of residents and enhance their enjoyment of life 52 Comer, Fundamentals of Abnormal Psychology, 7e

Issues Affecting the Mental Health of the Elderly  As the study and treatment of elderly people have progressed, three issues have raised concern among clinicians:  The problems faced by elderly members of racial and ethnic minority groups  The inadequacies of long-term care  The need for a health-maintenance approach to medical care in an aging world 53 Comer, Fundamentals of Abnormal Psychology, 7e

Issues Affecting the Mental Health of the Elderly  Discrimination because of race and ethnicity has long been a problem in the U.S., particularly for those who are old  To be both old and a member of a minority group is considered to be in “double jeopardy” by many observers  Older women in minority groups are considered to be in “triple jeopardy”  Because of language barriers and cultural issues, it is common for elderly members of ethnic minority groups to rely solely on family members or friends for remedies and health care 54 Comer, Fundamentals of Abnormal Psychology, 7e

Issues Affecting the Mental Health of the Elderly  Many older people require long-term care outside the family  “Long-term care” may refer variously to the services offered in a partially supervised apartment, in a senior housing complex, or in a nursing home  The quality of care at such residences varies widely  Many worry about being “put away” and about the costs of long-term care  Worry over these issues can greatly harm the mental health of older adults, perhaps leading to depression and anxiety, as well as family conflict 55 Comer, Fundamentals of Abnormal Psychology, 7e

Issues Affecting the Mental Health of the Elderly  Medical scientists suggest that the current generation of young adults should take a health-maintenance, or wellness promotion, approach to their own aging process  There is a growing belief that older adults will adapt more readily to changes and negative events if their physical and psychological health is good 56 Comer, Fundamentals of Abnormal Psychology, 7e