PSYCHOLOGICAL AGING PART 2COGNITIVE DISORDERSHPR 452

ORGANIC DISORDERS

Previous info dealt with “functional” psychological disorders

Organic disorders have Physical etiology Delirium and Dementia

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

DELIRIUM CHARACTERISTICS

See Pg 86 – 5 characteristics Manifestations

Memory impairmentLanguage disturbancesLearning difficulties Involuntary movementsAbnormal mood shiftsPoor reasoning abilities and judgment

CAUSES

MedicationTraumaInfectionMalnutritionMetabolic

ImbalancesCerebrovascula

r Disorders

Alcohol Intoxication

Social StressorsDepressionProlonged

ImmobilizationSensory

Deprivation

3 TYPES OF DELIRIUM

1. Hyperactive delirium Increased motor activity

2. Hypoactive delirium Decreased motor activity – More common form in

elderly

3. Mixed Type 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 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 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

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 humorUtilizing 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