P SYCHOLOGICAL A GING P ART 2 C OGNITIVE D ISORDERS HPR 452

O RGANIC D ISORDERS Previous info dealt with “functional” psychological disorders Organic disorders have Physical etiology Delirium and Dementia Two major syndromes experienced by elderly Delirium – cognitive disorder characterized by temporary but acute confusion that can be caused by disease of the heart and lung, infection or malnutrition” aka – acute confusional state or transient cognitive disorder

D ELIRIUM C HARACTERISTICS See Pg 86 – 5 characteristics Manifestations Memory impairment Language disturbances Learning difficulties Involuntary movements Abnormal mood shifts Poor reasoning abilities and judgment

C AUSES Medication Trauma Infection Malnutrition Metabolic Imbalances Cerebrovascular Disorders Alcohol Intoxication Social Stressors Depression Prolonged Immobilization Sensory Deprivation

3 T YPES OF D ELIRIUM 1. Hyperactive delirium Increased motor activity 2. Hypoactive delirium Decreased motor activity – More common form in elderly 3. Mixed Type Hyper and Hypoactive seen In 40% of delirium incidences hallucinations will occur Sundowning – increased agitation and restlessness during evening and at night Prognosis for recovery from Delirium - Good

D EMENTIA Umbrella term for disorder that seriously affects a person’s ability to perform daily activity Loss of memory, reasoning, judgment and language to extent it interferes with daily activities Not a disease but symptoms that accompany a disease or condition

DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association, 1994) definition on pg 87 Symptoms Inability to learn new information Loss of memory for information previously learned Difficulties with reasoning and abstract thinking Difficulties in ability to speak, carry out motor activities, and identify objects Personality changes Inability to carry out work or social activities

Anxiety Depression Suspiciousness Spatial disorientation Poor judgment and insight Disinhibited behavior (i.e. crude jokes, neglecting personal hygiene

Not an inevitable consequence of aging but as age increases so does the probability of developing dementia Irreversible Affects 10-15% w/ 60% diagnosed as Alzheimer’s Disease Vascular Dementia (VaD) common in elderly (formerly multi-infarct dementia) – vascular infarcts cause sudden onset, improve or remain stable, then another sudden onset (damage to arteries – i.e. CVA, TIA) “Pseudodementias” are curable (caused by diet, drugs, disease)

A LZHEIMER ’ S D ISEASE Alois Alzheimer – 1906 Distinctive clumps and tangles of fibers in a woman’s brain who had died of unusual mental illness “Senile” was the term used which led to general stereotypes of “old” with “cognitive decline” Progressive neurological decline – pathological causes include Amyloid plaques Neurofibrillary tangles Brain atrophy Loss of nerve cells Decreased brain chemicals

Affects approx 4.5 mil Americans Approx 10% of age 65 and over Expected to increase to 13.2 mil by 2050 Cost per patient lifetime is $174, Cost to nation is $100 billion/yr 3 rd most expensive disease (after heart disease and cancer) Family cost – $12,500.00/yr Nursing Home - $42,000.00/yr Believed to be caused by a mix of environmental, genetic, and lifestyle factors

Genetic link to early onset Alz D Statins used to lower cholesterol may also reduce risk of Alz D No reliable test – can be confirmed during autopsy finding tangles and plaques distinct to Alz D Lifespan from 2-20 yrs – avg 4-8 yrs 3 stages – Mild (early), Moderate (middle), Severe (late) Drugs delay symptoms and control behavior for a limited time

TR ROLES WITH C LIENTS WIT A LZ Clients continue to possess Emotional awareness Sensory appreciation Primary motor functioning Sociability and social skills Procedural memory and habitual skills Remote memory Sense of humor Utilizing these activities and domains may delay deterioration and increase Quality of Life Concept of cognitive reserves

Pet Therapy Horticulture Music Graphic Arts Opportunities for socialization and enjoyment Interventions should be based on assessed needs and focus on remaining strengths and abilities Activities should be meaningful to the client