Discuss depression, dementia, and Alzheimer Disease and their impact on the cognitive functioning in late adulthood.

Question: Discuss depression, dementia, and Alzheimer Disease and their impact on the cognitive functioning in late adulthood.

Answer:
Depression
• The “common cold” of mental disorders.
• The individual is deeply unhappy, demoralized, self-derogatory, does not feel well, loses stamina easily, has a poor appetite and unmotivated.
• Causes: biological, psychological, social, experiential.
• 80 % of older adults receive no treatment at all.
• Treatment: Combinations of medications and psychotherapy.
• Improvements in 4 out of 5 elderly adults.
• Suicidal tendencies: 25 %.
• Lonely males are most likely to commit suicide.

Dementia

• A global term for any neurological disorder.
• A deterioration of mental functioning.
• 20 % of individuals over the age of 80 have dementia.

Alzheimer’s Disease

• The most common form of dementia.
• A progressive, irreversible disorder.
• Deterioration of memory, reasoning, language, and physical functioning.
• Prevalence: 4 million people over the age of 65.
• Will triple in the next 50 years due to increase in old age.
• Early-onset (younger than 65 years).
• Late-onset (after 65 years of age).
• Early onset is rare (10 percent of all cases).

Causes of Alzheimer's Disease

• A deficiency in the brain messenger chemical acetylcholine.
• Increasing number of tangles or tied bundles of protein.
• Plaques (deposits that accumulate in the brain’s blood vessels).
• An abnormal gene.

Stages of Alzheimer’s Disease

• Early stage: memory loss, decline in intellectual functioning.
• Later stage: hospitalization in a vegetative stage.
• Live 8 years after symptoms first appear.
• Care of patients and the burden on caregivers.
• Depression in 50 % of family caregivers.
• Respite care can relieve the caregiver.

Treatment

• Early Detection and treatment can delay the cognitive decline.
• Aricept: the main drug for the treatment.
• Spaced retrieval technique
• Computerized speech rehabilitation programs
• Diet: more fruits, vegetables, less red meat.
• Cholesterol lowering drugs

Multi-Infarct Dementia

• Progressive loss of intellectual functioning.
• Caused by repeated temporary obstruction of blood flow in cerebral arteries.
• A series of mini strokes.
• Symptoms: confusion, slurring of speech, other impairments.
• Treatment: exercise, diet, drugs.
• More common among men with high blood pressure.
• Individuals can recover from multi-infarct dementia.

Answer 2:
As answer 1 explained, people with depression are deeply unhappy, demoralized, bored, loses stamina easily and unmotivated. These all contribute to the inactivity in cognitive functioning as depressed people refuse not only to engage in physical activity, but are also in a state of emptiness cognitively, thus suppressing cognitive functioning. In late adulthood, research shows that men are more likely to experience depression than women because they usually experience more dramatic role shift as they retire. This a very interesting piece of fact for me because my dad, who is always very tough is depressed for the first time in his life as he turned 60, whereas my mom is not depressed, but is only dealing with PTSD. Knowing this helps not only me but my dad in understanding his mood swing, which actually help with his mood as well.


Further thoughts:
As a psychologist, what would you propose to resolve the social issue?
Please elaborate on the dramatic role shifts in males and how you would counsel your male late adulthood client if he came to you for therapy?

Answer 3:
Many people can't afford therapy. It is very expensive and many people don't have the financial support to be able to pay for it.

Some may have an aversion to therapy. The ol, 'I made it this far without it, why do I need it now.' Perhaps misunderstandings of its benefits. Often this is the age of those who grew up with the concept of the "loonie bin." (a home for people with serious emotional needs)

Some psychologists aren't very 'user friendly' to senior clients. Perhaps the client has tried therapy and wasn't warmly received.

How to solve? Perhaps there could be therapists who were known and welcomed to see aged clients. Perhaps a special focus.

Answer 4: Medical expenses to psychologists are pretty expensive. Maybe government subsidy could help? Personally, I also feel that when people see psychologists, they see themselves as having "problems" which is also an issue...many people, especially chinese people, I guess...would rather solve their own issues without outsider assistance...What do you think, fellow Hong Kong students?

Answer 5:

Yes I think seeking therapists help is becoming a new field in HK, and starting to gain acceptance, however for the aging population, I would think this would be even more of a stretch. A very large barrier. I know young working professionals who have sought help from the gov't services and so it seems they don't always see the same doctor and the waiting list is so long. It seems that there isn't enough therapists to go around. However, is affordable. Some more doctors in the government system could be very helpful, but there would need to be some advertising or promotions on 'getting help is ok.'

Answer 6:
Researchers (Hultsch et al, 1999) find that older adults, who engage in cognitive activities, especially challenging ones, have higher cognitive functioning than those who don’t use their cognitive skills. In late adulthood, individuals are easily depressed due to cumulative loss (death of a spouse and friends), declining health and loss of control. They will feel listless and unmotivated. Their cognitive functioning deteriorates as they prefer to stay away from any kind of activities.


Dementia is a set of disorders that occur mostly in old age. It usually accounts for cognitive defects in late adulthood. Individuals with dementia suffer serious memory loss and mental functioning deterioration, impairing daily activities and behaviors.


The leading cause of dementia in the United States is Alzheimer's disease. It happens when neurons in the sub-cortical regions deteriorate, leaving symptoms of tremors, shuffling gait, loss of facial expression, rigidity of limbs, poor balance and stooped posture. Recent memory deteriorates first, then older memories. Patients are eventually incapable of communicating or recognizing family and friends.

I also came across an interesting reading on the new development of detection of Alzheimer's from New York Times. Enjoy!

Gina Kolata (June 23, 2010). The vanishing Mind: Promise Seen for Detection of Alzheimer's. New York Times.

http://www.nytimes.com/2010/06/24/health/research/24scans.html?src=me&ref=homepage

Answer 7: I will first pay close attention to listen to their concerns of adapting to the new life style, and their understanding of their mood swings. Then I will share with them some research statistics to show how common it is for anyone to experience difficulties when facing role shift in lives. It would be also helpful to let them know why his wife does not experience as dramatic the mood swing as he does. Not only is every individual different, even though they are a couple, their life role shifts have different time line.

My friend, male, 30s, experiences some frustration as to why he doesn't feel the need to take it easy in career and start a family as his female friends in the same age have done. I explain to him that female has a different time line due to the mere fact that we will have an interruption in our career when we are having children. This life-event interruption prompts us to think more about our role and make adjustment psychologically. Yet our husbands, even though they also experience significant role shift to become a father, but the fact that there is not interruption in their career, and that the child-rearing responsibility is not as burdensome for male than female even in today's society makes them less likely to experience the role shift as dramatically as in female.

Thus male's role shift becomes more dramatic as they retire, usually in their older age, thus experience more stress than the well-trained female in shifting role since the first time they become mother.


Answer 8: To add to those excellent examples above, some do not believe in the therapeutic process. Hollywood often portrays therapy in a negative light or therapist as incompetent, and many people who are only exposed to the process through the TV or movies believe that is what therapy is like. Additionally, many cultures feel it is inappropriate to discuss family matters outside of the family unit and therefore do not allow family members to seek therapeutic services.

I have done advocacy work at the California state capital on behalf of the field of psychology. I believe it is our duty to fight for the rights to mental health services for our patients. If we don't, who will? It was an exciting experience and I encourage all of you to get involved to make a difference and positive social changes.

Has anyone known anyone or watched someone who has suffered from Dementia or Alzheimer's? It can be really sad and painful to watch those who love fade away.

It is often believed that only those who can contribute are the ones we place value and worth too. However the needs of those struggling with mental health issues are also important. Mental health does carry a stigma and it is such a great need.

Answer 9:
I have a paternal aunt with severe Alzheimer's and my great aunts twin sister has an even more severe case of Alzheimer's. Yes, it is very difficult. I just went to visit her a few days ago and it was obvious my aunt's cognitive function is rapidly declining. Most often it is the family who suffers more emotionally as the patient is unaware of his/her surroundings or situation.