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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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Dr. ISNANIAH, Sp.SDr. ISNANIAH, Sp.S
AGEING PROCESS OF AGEING PROCESS OF NEURONAL SYSTEMSNEURONAL SYSTEMS
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
Memory Decline in Normal Aging
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
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
Types of Memory and Loss
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
Abnormal Memory Loss in Aging
High blood pressure, diabetes, poor nutrition, and social isolation
Heart disease Family history of dementia Psychological factors like stress and
depression
Risk Factors for Cognitive Decline
Executive Functioning include: Organization: attention, decision-making,
planning, sequencing, problem solving Regulation: initiation of action, self-control, self-
regulation Language- coherent, sensible Working (immediate) Memory Spatial Memory
Verbal Memory
Normal Cognition
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
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
Dementia ( con’t )
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.
Symptoms of Dementia
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
AD is the most common dementia in older adults Incidence expected to more than double by 2050-
from 377,000 in 1995 to 959,000
Alzheimer's Disease (AD)
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
Alzheimer's Disease (AD)
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
Multi-infarct dementia
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
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
Other Mental Conditions
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
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
Delirium ( con’t )
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
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)
Parkinson's Disease ( con’t )
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
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
Depression ( con’t )
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
Nervous Tissue and Aging
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’
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
TOUCH-Gradual reduction after 50- injuries,
hypothermia
SMELL- Decreases after
70 yrs- may affect hygiene
TASTE- Minimal changes
VISION-Usually need glasses by 55-Only 15-20% have ↓ driving
ability
HEARING30% people over
age 65 have impairment
SENSES
Normal acuity ↓ with age
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
SENSES
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
HEARING
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
VISION
Color Perceptions Change 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
"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
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
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