Transcript Dementia - WordPress.com

AGEING PROCESS OF
NEURONAL SYSTEMS
Dr. ISNANIAH, Sp.S
Memory Decline in Normal Aging
Definition: Memory refers to the storage,
retention and recall of information including
past experiences, knowledge and thoughts
 Only some types of memory loss are
associated with normal aging
 Other types are typical of disease states
Types of Memory and Loss
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Working (intermediate term) – loss occurs
with normal aging
Episodic- especially impaired in normal aging
e.g. ability to process recent information
Semantic (e.g. vocabulary) – Improves with
age; lost in dementias
Procedural (long-term memory of skills) shows No Decline with age; affected by
diseases
Types of Memory and Loss
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Very long-term memory (months to years)increases upto age 50; maintained until well
after 70
Short-term memory- shows little decline; loss
associated with diseases
Older adults tend to be worse at
remembering the source of their information
Abnormal Memory Loss in Aging
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Forgetting things much more often than you used to
Forgetting how to do things you've done many times
before
Trouble learning new things
Repeating phrases or stories in the same
conversation
Trouble making choices or handling money
Not being able to keep track of what happens each
day
Risk Factors for Cognitive Decline
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High blood pressure, diabetes, poor nutrition,
and social isolation
Heart disease
Family history of dementia
Psychological factors like stress and
depression
Normal Cognition
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Executive Functioning include:
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Organization: attention, decision-making,
planning, sequencing, problem solving
Regulation: initiation of action, self-control, selfregulation
Language- coherent, sensible
Working (immediate) Memory
Spatial Memory
Verbal Memory
Dementia
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The word dementia is used to describe the condition
where one has a progressive decline in memory and
other cognitive functions that results in a change in
the ability to conduct one's usual activities
Dementias are neurodegenerative diseases which
cannot be cured
Each type characterized by specific effects on
cognitive and motor function
Dementia ( con’t )
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Diagnosis of dementia is not generally given in
absence of impairment in social functioning and
independent living.
Dementia seriously affects a person’s ability to carry
out daily activities
People with dementia lose their abilities at different
rates
Eventually, patients may need total care
Symptoms of Dementia
Dementia symptoms may include:
 asking the same questions repeatedly,
 becoming lost in familiar places,
 being unable to follow directions,
 getting disoriented about time, people, and
places, and
 neglect of personal safety, hygiene, and
nutrition.
Alzheimer's Disease (AD)
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Definition:
Is a progressive, neurodegenerative disease characterized in
the brain by abnormal clumps (amyloid plaques) and tangled
bundles of fibers (neurofibrillary tangles) composed of
misplaced proteins
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AD is the most common dementia in older adults
Incidence expected to more than double by 2050from 377,000 in 1995 to 959,000
Alzheimer's Disease (AD)
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The proportion of new cases >85 will increase from
40% in 1995 to 62% in 2050
The annual incidence expected to shoot up by 2030
(baby boomers [persons born between 1946 and
1964] will be over age 65)
Most of the increase will occur among people age 85
or older
Early symptoms of AD, which include forgetfulness
and loss of concentration, are often missed because
they resemble natural signs of aging
Multi-infarct dementia
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Caused by a series of strokes in the brain
Infarcts result in irreversible death of brain tissue
Location/severity of compromised area governs severity
of symptoms/loss of function
Symptoms – abrupt onset; progress step-wise as strokes
recur
Treatment to prevent further strokes is very important
Other Mental Conditions
Anxiety
 Anxiety disorders- commoner as we get older as
medical, psychological, and social problems build up
 One in five older adults suffers anxiety symptoms
severe enough to necessitate treatment
 Persistent or extreme anxiety can seriously decrease
QOL
 Can be a sign of other problems like depression,
dementia, physical illness
Other Mental Conditions
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Anxiety is often associated with over-arousal
Specific anxiety disorders include the following:
 General Anxiety Disorder –Most Common
 Panic Attacks –Previous History Present
 Phobias- E.G. Unable To Urinate In Public
Bathrooms; Inability To Eat In Public
 Obsessive Compulsive Disorder –Usually Present
At Younger Age
 Post-Traumatic Stress Disorder
Delirium
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Delirium, or acute confusion, is a sudden change in
mental function
Delirium is usually a short-term, temporary problem
May persist for weeks to months in a substantial
number of people
Is a common complication of medical illness in
elderly
Delirium ( con’t )
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One-third of older adults arrive at hospital
emergency departments in delirious state
Is strongly associated with poor outcomes among
hospitalized patients
Can be mistaken for dementia or schizophrenia
Delirium common in people with dementia
Parkinson's Disease
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Parkinson's disease is a slowly progressive
degenerative disease of the nervous system
About 50,000 Americans are diagnosed with PD each
year
Many more undiagnosed as attribute symptoms to
old age
Average age of onset is 60; commoner as we grow
older
Parkinson's Disease ( con’t )
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Caused by loss of nerve cells in brain that produce
dopamine
Usually familial
Exposure to high levels of manganese, carbon
disulfide or certain pesticides increases risk
An increased risk in people who live in rural areas in
advanced countries (unproved)
Depression
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Depression is a serious medical illness characterized
by:
 Persistent sad, anxious, or "empty" mood
 Feelings of hopelessness, pessimism
 Feelings of guilt, worthlessness, helplessness
 Loss of interest or pleasure in hobbies and
activities that were once enjoyed
Depression ( con’t )
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1%—2% of older women, and < 1% of older men
have major depression
Is a continuation of problem from earlier life in
30%—50% of cases
Major depression may accompany disorders that
result in dementia
Many older adults face cancer or grief that
promote depression
There is a strong link between major depression
and increased risk of dying from heart disease.
Alcohol abuse causes depressed mood
Nervous Tissue and Aging
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Aging has profound effects on mental faculties
Brain tissue is irreparable – changes are permanent
Speed of communication between nervous tissues is
decreased
Transmission of messages within nerve cells becomes
slower
The brain and spinal cord lose nerve cells and weight
Waste products collect in brain, causing plaques and
tangles
Changes result in:
 Lost or reduced reflexes → problems with movement
and safety
 Slight slowing of thought, memory, and thinking- a
normal part of aging
 A change in thinking/memory/behavior are
important indicators of disease
 ALL ELDERLY PEOPLE DO NOT BECOME ‘SENILE’
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Delirium, dementia, and severe memory loss are NOT
normal processes of aging
Caused by degenerative brain disorders such as
Alzheimer's disease
Illnesses unrelated to brain can cause changes in
thinking/ behavior
Severe infections can lead to confused states
Diabetes- fluctuations in glucose levels can cause
thinking/behavioral disorders
CHANGES IN SENSES
HEARING
30% people over
age 65 have
impairment
TOUCHGradual reduction
after 50- injuries,
hypothermia
SENSES
VISION
-Usually need
glasses by 55
-Only 15-20%
have ↓ driving
ability
Normal acuity
↓ with age
SMELLDecreases after
70 yrs- may affect
hygiene
TASTE- Minimal
changes
SENSES
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All senses are controlled totally by the brain
Aging increases minimum amount of stimulation before a
sensation is perceived
Any compromise in senses has tremendous impact on
lifestyle
Hearing and vision changes- dramatic effect on QOL
Many changes can be improved with glasses, hearing
aids, and lifestyle modifications
Communication problems common- lead to social
isolation and loneliness
HEARING
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Ears perform two functions – 1. Hearing 2.
Maintaining body balance (equilibrium)
Equilibrium (controlled by the inner ear)
Hearing is ruled by the outer ear– disorders respond
better
Aging adversely affects both structures
Acuity of hearing declines slightly after age 50
30% people > 65 have significant hearing impairment
Impacted ear wax commoner with increasing age →
deafness, easy to treat
Persistent, abnormal ear noise (tinnitus) - common in
older adults
VISION
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Visual acuity may gradually decline- not universal
After age 55, most people need glasses at least part of
the time
Driving ability is impaired in 15% to 20% due to bad
vision
5% become unable to read
Trouble adapting to darkness or bright light
Significant difficulty with night driving may be the first
sign of a cataract
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Color Perceptions Change
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As we age, it is harder to distinguish blues and greens
than reds and yellows
Elderly should use yellow, orange, and red contrasts
at home- improves ability to locate things
Using a red nightlight is better than a conventional
bulb
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"Floaters" in vision- harmless; sudden ↑ needs
consultation
Reduced peripheral vision occurs- cannot see
adjacent people- may cause offense to friends
Blindness- usually caused by diseases like
diabetes and high BP
TASTE AND SMELL
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Taste does not seem to decrease until after
age 60, if at all
Sense of smell may diminish, especially after
age 70- leads to poor hygiene, and
unawareness of gas leaks etc
Touch, Vibration, And Pain
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Aging can reduce sensations of pain, vibration,
cold, heat, pressure, and touch
Decreased temperature sensitivity increases
the risk of frostbite, hypothermia, and burns
After age 50, many people have reduced
sensitivity to pain.
Reduced feel of vibrations- loss of stability in
motion