Some Stats

1
Some Stats

• Only 10-20 of those over 65 are diagnosable (w/
  some mental disorder)
• Only 5-10 of those over 65 have Alzheimers

2
Types of Dementia

• Alzheimers - most common form (55-80)
• Vascular (stroke, hardening of arteries)
• HIV
• Head trauma
• Parkinsons, Huntingtons, alcohol-
  drug-related (Korsakoffs), etc.

3
Dementia Symptoms

• Memory impairment, inc. learning new info or
  recall previously-learned info
• Aphasia - language disturbance
• Apraxia - inability to carry out motor activities
  despite intact motor function
• Agnosia - inability to recognize or identify
  objects despite intact senses
• Executive function disturbance - inc. abstraction
  loss

4
More on Dementia

• Often comorbid w/ depression, which diminishes in
  later stages
• Ultimately fatal, life expectancy 8-10 yrs. after
  dx

5
Parkinsons Disorder

• Caused by death of cells that produce dopamine
• Tremor in limbs or head
• Muscle rigidity
• Movement abnormalities, inability to initiate
  movement
• Dementia in 20-60

6
Alzheimers

• Most common form of dementia (55-80 of all
  dementia cases)
• Starts w/ mild memory loss (short-term)
• Progresses to short- long-term losses w/
  disorientation
• Two-thirds show others sxs
• Apathy, depression
• Agitation, irritability
• Violence, hallucinations

7
Brain Abnormalities in Alzheimers

• Extensive cell death - cortex shrinks, ventricles
  enlarge
• Tangles - of filaments within nerve cells
• Plaques - protein deposits between cells in areas
  critical to memory cognitive functioning
  (cerebral cortex, hippocampus, etc.)

8
Causes of Alzheimers

• Previously attributed to viruses, aluminum
  exposure, head trauma, etc.
• Current research focuses most on genetic link
• Only 10 w/o relative w/ Alzheimers get it
• 25-50 of those w/ relative get it

9
Nun Study

• Found link to (ApoE4) gene Alzheimers
• Brighter, more educated people less likely to
  develop dementia
• Some nuns who had Alzheimers were asymptomatic,
  w/ minor cognitive decline (crossword puzzles),
  use-or-lose, lifelong learning

10
Neuropsychology

• Diagnosis of cognitive impairment/dysfunction
  (which functions intact vs. not)
• Memory - Wechsler Memory Scale

11
Other Neuropsychological Tests

• Aphasia - Aphasia Screening Test
• Apraxia - Wechsler Intelligence Test (WAIS) -
  Performance IQ (comparison to Verbal IQ, esp.
  Vocabulary)

12
Other Neuropsych. Tests

• Executive functions
• Abstraction - (WAIS) Similarities,
  Halstead-Reitan Categories
• Sequencing - Trail-Making Test
• Luria-Nebraska comparable to Halstead-Reitan,
  assesses wide array of cognitive functions

13
Stroke

• Which functions lost indicates location of brain
  damage
• Aphasia, agnosia - left hemisphere
• Visual-spatial (getting lost) - right hemisphere

14
Delirium

• More common in elderly, caused by transient
  changes in brain neurochemistry
• Causes
• Substance intoxication
• Other - fever, hypoglaecemia, head trauma

15
Delirium

• Rapid onset
• Fluctuating course
• Rapid response to tx
• Disturbed consciousness w/ reduced ability to
  focus, sustain, shift attn.
• Disorientation /or memory /or sensory deficits

16
Depression in Elderly

• Highest suicide rate (esp. males)
• Consequence of multiple losses, illness
• Less common than in younger people
• Age gap in depression stops at 65
• May be less receptive to psychotherapy

17
Mental Retardation

• Poor intellectual functioning everyday skill
  deficit
• Sig. subaverage IQ - 70 or lower (100 average)
• Biological origins - genetic, infections, toxin
  exposure, head trauma,FAS, etc.

18
Severity Levels (for MR)

• Mild - 50-70, employable in skilled, semiskilled
  jobs
• Moderate - 35-50, sig. language delays, cant go
  beyond 2nd grade
• Severe - 20-35, very limited vocabulary, 2-3 word
  sentences