Transcript Psychological Aging – Part 2 Cognitive Disorders

PSYCHOLOGICAL AGING
PART 2
COGNITIVE DISORDERS
HPR 452
ORGANIC DISORDERS
Previous info dealt with “functional”
psychological disorders
 Organic disorders have Physical etiology
 Delirium and Dementia
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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
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DELIRIUM CHARACTERISTICS
See Pg 86 – 5 characteristics
 Manifestations
 Memory impairment
 Language disturbances
 Learning difficulties
 Involuntary movements
 Abnormal mood shifts
 Poor reasoning abilities and judgment

CAUSES
 Medication
 Alcohol
 Trauma
Intoxication
 Social Stressors
 Depression
 Prolonged
Immobilization
 Sensory
Deprivation
 Infection
 Malnutrition
 Metabolic
Imbalances
 Cerebrovascular
Disorders
3 TYPES OF DELIRIUM
Hyperactive delirium
1.
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Increased motor activity
Hypoactive delirium
2.
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Decreased motor activity – More common form in elderly
Mixed Type
3.
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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

DEMENTIA
 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
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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)

ALZHEIMER’S DISEASE
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
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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 $174,000.00
 Cost to nation is $100 billion/yr
 3rd 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
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TR ROLES WITH CLIENTS WIT ALZ
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
