Psychological Aging Part 2 Cognitive Disorders

1. Psychological Aging Part 2Cognitive Disorders HPR 452

2. 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

3. Delirium Characteristics • See Pg 86 – 5 characteristics • Manifestations • Memory impairment • Language disturbances • Learning difficulties • Involuntary movements • Abnormal mood shifts • Poor reasoning abilities and judgment

4. Causes • Medication • Trauma • Infection • Malnutrition • Metabolic Imbalances • Cerebrovascular Disorders • Alcohol Intoxication • Social Stressors • Depression • Prolonged Immobilization • Sensory Deprivation

5. 3 Types of Delirium • Hyperactive delirium • Increased motor activity • Hypoactive delirium • Decreased motor activity – More common form in elderly • 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

6. 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

7. 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

8. Anxiety • Depression • Suspiciousness • Spatial disorientation • Poor judgment and insight • Disinhibited behavior (i.e. crude jokes, neglecting personal hygiene

9. 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)

10. 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

11. 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

12. 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

13. 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 humor Utilizing these activities and domains may delay deterioration and increase Quality of Life • Concept of cognitive reserves

14. 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