Chapter 14 -- Late Life and Neurocognitive Disorders

I. Aging and Psychological Disorders

A.13.3% of U.S. Population is 65 and older, approximately 40 million people
B. Sensory perceptions decline (sight, sound, smell, taste, touch, balance)
C. Sustained attention and memory declines
D. Alzheimer's Disease - 5 million now and 13.4 million by 2050 according to Centers for Disease Control and Prevention; 5% age 65; 30% over age 85
E. Anxiety - 7% age 65 and older, less than young ages
F. Depression - 3% in community; 13.5% of those requiring home healthcare; 11.5% of hospitalized
G. Pain - 50% experience pain that limits functioning; Disabling back pain 6%, non-disabling back pain 23% among 75-year-olds

II. Neurocognitive Disorders

A. Mild cognitive decline from previous level
1. Concerns of patient, close other, or clinician
2. Neuropsychological performance between the 3rd and 16th percentiles
3. Does not interfere with independence
B. Major cognitive declines from previous levels
1. Concerns of patient, close other, or clinician
2. Neuropsychological performance below the 3rd percentile
3. Interferes with independence

III. Alzheimer's Disorder

A. Neurofibrillary tangles (twisted protein filaments composed of the protein tau in neurons in the hippocampus)
B. Senile plaques (small, round beta-amyloid protein in the frontal lobe)
C. Low glucose metabolism in cerebral cortex
D. One ApoE-4 allele for a gene on chromosome 19 increases risk to 20%, two alleles have greater risk, earlier onset (79% heritable)
E. Symptoms include memory loss, disorientation, and flat affect

F. Stages of Alzheimer's Disease
1. Mild forgetfulness of names and where one has placed things
2. Getting lost when going to familiar places, poor reading comprehension, anxiety
3. Forgetting personal history, confusion, flattened affect and withdrawal
4. Cannot recall address and family members, disoriented, trouble dressing
5. Dependent on others for survival, unaware of surroundings, can distinguish familiar people
6. Loss of verbal abilities, unable to walk, need help with eating and toileting, death within 12 years
G. Prevention
1. Regular physical exercise
2. Frequent cognitive activity
3. Mediterranean diet (fruits, vegetables, fish, nuts, olive oil)
4. Avoid depression
5. Avoid tobacco use

IV. Neurocognitive Disorders Caused by other Conditions

A.Substance-use persisting dementia
B. AIDS-related dementia
C. Frontotemporal lobar degeneration
1. Degeneration of the frontal and temporal lobes
2. Impulsive social acts, difficulty planning
D. Parkinson's disease
1. Degeneration of the basal ganglia
2. Slow and shakey motor movements
E. Huntington's disease
1. Degenerative neurological disorder involving chromosome 4
2. Involuntary motor movements and impulsive social acts
F. Vascular dementia
1. Cardiovascular disease limits flow of blood to brain
2. Memory impairment and patchy deterioration of cognitive functions

V. Treatment of Neurocognitive Disorders

A. Medical
1. Aricept and Exelon (cholinesterase inhibiting medications that interfere with the breakdown of acetylcholine)
2. Antidepressants help reduce cognitive symptoms
B. Psychological
1. Reinforcement for independent behavior
2. Physical exercise
3. Memory aids (lists and calendars)
4. Respite and family support

VI. Delirium

A. Disturbance in attention and awareness
B. Disturbance in orientation, language, memory, and planning
C. Rapid onset within hours or days
D. Symptoms are due to a medical condition
E. Fluctuation in symptoms
F. Treatment with antipsychotic medications
G. Prevention with sleep, hydration, exercise, glasses, and hearing aids