Transcript Methodological Issues - Rockhurst

Methodological Issues
 Age effects - the consequence of being a given
chronological age
 Cohort effects - the consequences of having been
born in a given year and having grown up during a
particular time period
 Time-of-measurement effect - confounds that arise
because events at a particular point in time can
have a specific effect on a variable being studies
over time
 Cross-sectional versus longitudinal studies
Dementia
 The development of multiple cognitive
deficits manifested by both:
 memory impairment
 one or more of the following:
aphasia (language disturbance
apraxia (impaired ability to carry out motor
activities despite intact motor function)
agnosia (failure to recognize or identify objects
despite intact sensory function)
disturbance in executive functioning (i.e., planning,
organizing, sequencing, abstracting)
Alzheimer’s Disease
 Brain tissue irreversibly deteriorates, and death
usually occurs 10-12 yrs after onset
 Accounts for 50% of dementia in elderly. Diagnosis
made by exclusion which alive.
 Physiological effect - atrophy of cerebral cortex,
hippocampus, and other brain areas
 Plaques - small, round areas comprising the remnants
of lost neurons and b-amyloid, a waxy protein deposit
- scattered throughout the cortex
 Neurofibrillary tangles - abnormal protein filaments
which accumulate within the cell bodies of the
neurons
Normal MRI
MRI of an Alzheimer’s Patient
Senile Plaques
Delirium
 Disturbance of consciousness with reduced ability
to focus, sustain, or shift attention
 A change in cognition (such as memory deficit) or
the development of a perceptual disturbance that is
not better accounted for by a preexisting,
established, or evolving dementia
 The disturbance develops over a short period of
time (usually hours or days) and tends to fluctuate
during the course of the day.
Dementia versus Delirium
The clinical “feel” of talking with a person with delirium is
rather like talking to someone who is acutely intoxicated or
in an acute psychotic episode. Whereas the demented patient
may not remember the name of the place where she or he is,
the delirious patient may believe it is a different sort of place
altogether, perhaps mistaking a psychiatric ward for a used
car lot…Hallucinations, especially visual hallucinations, are
common in delirium, but are rarely seen in demented patients
until the very late stages of the disease. Knight (1996)
Nursing Homes
 The decision to institutionalize comes as a last
choice
 For a large number of families, moving the parent
to a nursing home lead to improved family ties
and closeness
 Langer and Rodin - nursing home research which
indicates that conscious thinking as well as
perceived control are essential in maintaining
emotional and physical well-being in nursing
homes