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Chapter 18
Comer, Abnormal
Psychology, 8e
DSM-5 Update
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
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
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Anxiety Disorders in
Later Life
There are many things about aging that may heighten
anxiety levels, including declining health
Again, all such drugs must be used cautiously with older people
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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
delirium and Alzheimers disease
However, some elderly persons suffer from
schizophrenia or delusional disorder
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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
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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
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Disorders of Cognition
Cognitive mishaps (e.g., leaving without keys,
forgetting someones name) are a common and
quite normal feature of stress or aging
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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
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Delirium
Delirium is a major disturbance in attention
and orientation to the environment
As a persons focus 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
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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
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Alzheimers Disease
This disease is the most common type of
neurocognitive disorder, accounting for as many
as two-thirds of all cases
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Alzheimers 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 Alzheimers
disease during the early stages and major
neurocognitive disorder due to Alzheimers disease
during the later stages
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Alzheimers 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
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Alzheimers 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
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Alzheimers Disease
As the 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
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Alzheimers Disease
In most cases, Alzheimers 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
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Alzheimers Disease
Scientists do not fully understand what role
excessive numbers of plaques and tangles play
in Alzheimers disease, but they suspect they
are very important
Todays leading explanations for this disease
center on these plaques and tangles and on
factors that may contribute to their formation
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Other Explanations
of Alzheimers Disease
In addition to these two explanations,
researchers offer additional possibilities:
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 Alzheimers disease
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Other Explanations
of Alzheimers Disease
Another explanation is the autoimmune theory:
Changes in aging brain cells may trigger an autoimmune
response, leading to the disease
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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
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