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Summary ALL LECTURES 2020 VU Neuropsychology of Aging + some notes from readings
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A summary of all lectures for the VU psychology course ''Neuropsychology of Aging'' some notes from optional readings
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Neuropsychology of Aging 202012 Lectures
1. Why aging? Theories and Methods
2. Normal aging: memory
3. Normal aging: executive functions and processing speed
4. Normal aging: language, visual spatial functions, brain aging
5. Abnormal aging: subjective cognitive decline, mild cognitive impairment
6. Alzheimer disease 1
7. Alzheimer disease 2
8. Vascular dementia
9. Frontotemporal dementia
10. Dementia with Lewy bodies
11. Diagnosis and assessment
12. Prevention of dementia
Lecture One
Why Aging? Theories and Methods
Myths about Aging
- old people are typically less happy and content than young people
- most older people will develop dementia at some point
- with aging all cognitive functions will deteriorate
Aging is relevant to study for scientific reasons:
1. present complete view of development:
- developmental psychology: focus on children or young adults
- ignored continuation development in adulthood
- popular assumption in developmental psychology: gradual, predictable decline in
psychological functions with aging, 2-stage model
-- In the two stage model, it says there's a period of growth, physical and psychological
functions develop up to maturity, and a gradual and predictable period of decline called
senescing. For biological functions, this is mostly correct, but psychologically is it outdated.
Some things continue to improve with age.
2. Life span perspective: changes between birth and death regarded as development, changes
are not necessarily predictable. Changes in functional capacity are part of the life span,
maturation continues to death, change does not equal deterioration of functions
It is also relevant for a practical reason:
1. Strong increase in number of elderly worldwide
- increase in disease associated with aging
- increase demands for treatment and care
- prevention of age-related disorders
,Chronological age = number of years since birth
Biological age = age relative to the years one can expect to live (or relative to physical appearance
and bodily functions e.g. blood pressure)
Functional age = competence to carry out specific tasks relative to their chronological age
Psychological age = how well they adapt to changing conditions, flexibility, attempt new activities
Social age = views held by most people in society about how a person of a certain age should behave
Young old = 65-74, old-old = 75-84, oldest-old 85+
Persons over 65 are not a homogeneous group as there are intra and inter-individual differences
People are aging not just in wealthy countries, but worldwide. In the coming years, the population
over 60 will outnumber all other age groups in developed regions.
The consequences:
- dependency ratio: number of people who can care for the dependent ages, the very young
and also the very old (under 15 and over 65 / number of people 15-64)
- higher dependency rate: more dependents relative to the productives, more economic
pressure on the productives, dependency rate in developed countries will rise
- old age support ratio: 15-64 people / 65+ people
- in 2013 there were just 4 working persons for each older person and it will decline in the
future
- Health and healthcare costs: health expenditures grow rapidly due to aging as elderly need
specialized services, and major causes of disability and health problems for the elderly are
non-communicable diseases like cancer, diabetes, the four giant geriatrics: immobility,
instability, incontinence, intellectual impairment such as dementia. (number of people with
dementia will be 66 million in 2030 and 115 million in 2050)
Dementia is one of the world's most expensive diseases:
- increasing incidence
- large proportion of people with dementia who need support and care
- large proportion of people with dementia in high income countries live in nursing homes, so
full time care
- no effective medical treatment (psychology can make valuable contributions to care and
diagnosis)
Theories of Aging
Biological aging
- aging of the brain, almost always detrimental
- programmed theories, aging is genetically programmed (e.g. time clock theory, immune
system theory, says that bodily functions can only work for so long until stopping)
- stochastic theories, aging is the result of damage to the body during life, stress
,Psychological aging
One example is Selective Optimization with compensation (SOC). During development people gain
and lose capabilities, in older adults the losses outnumber the gains
- high levels of wellbeing in aging would require compensating new strategies where losses occur,
adapting to continue good levels of functioning and good quality of life, selecting domains where
high levels of functioning can be maintained that maximise quality of life
Similarly is the Ecological Model of Aging which involves interaction between person and
environment and adapting to the environment. To enjoy a positive outcome (such as QoL) adaption
requires that a person’s level of competence matches demands from environment
- lower levels of competence require lover levels of environmental demands
Socioemotional selectivity theory says with aging, motivation shifts from pursuit of knowledge to
pursuit of emotional satisfaction
- cognitive resources like attention and memory are used to enhance mood and QoL as opposed to
acquiring knowledge
In NL, the people 65-75 rate themselves as the most happy, 88% content with like, 90% rate
themselves as a happy person. Over 75s this is still over 80%
There is less depression in older age than there are with middle aged people, peak mid 40s
Higher subjective wellbeing in older age. There's a u bend, again middle aged people worst and
highest are the elderly.
The subjective experience of health and ability are more positive than the objective, however. There
is a satisfaction paradox: stability despite loss. Elderly people's vision went down over time and they
rated their eyesight the same, even though it was objectively worse. They also did this with mobility.
These were elderly without serious diseases.
Cognitive aging
There is an assumption of universal decline, inevitable cognitive decline based on the two stage
senescence model of gradual decline, but this is outdated.
Miles (1933) found cognitive ability declined after 30 and continuously declined, but this depends
how you look at intelligence. Fluid intelligence decreases but crystallized increases. There is large
cognitive plasticity (adapting to conditions) and cognitive reserve.
The life span perspective thus states that age related changes are a stage in life rather than a disease.
- Aging will not always lead to cognitive decline.
Schaie (2013): 4 patterns of cogntitive aging:
1. successful - maintaining function or modest decline
2. normal - overall modest decline on most cognitive abilities but not all
3. mild cognitive impairment (MCI) - decline greater than normal, >1SD or clinical dementia
rating of .5)
4. Dementia - marked decline in cognitive functioning, interfering with daily functioning
Successful aging: 10% of older adults.
Negash: assessed attention, EF, language, memory, visuospatial ability. Older participants could not
, be more than 1 SD below the norms of YOUNG adults, 6% were successful. Successful agers had
lower mortality than those with normal age related decline. They were very healthy. It seems that
they had few other conditions, so were also physically very well, and the effect of age without any
other confounding illness or medication, had little or no effect on cognition.
Successful cognitive agers often ''super normals'' - without meds or illnesses that could affect
cognition, so decline is not inevitable.
70% of older adults will have typical aging, where changes in cognitive functions, but still healthy.
Changes are usually in info processing, memory, EF, name retrieval
We know it's healthy using robust norming: follow people over time, and if someone is diagnosed
with dementia, remove all their info from the baseline. The remaining sample is then unlikely to have
early stage dementia
The critical variable in aging research is almost always chronological age. But what is the effect on
behaviour or cognition? Seems easy, but has its limitations. We can't manipulate it as it's an
organismic variable. We only have a few possibilities:
1. cross-sectional: compare different people who are similar. But they were born in different eras, so
findings can be confounded by the cohort effect (generations have common experiences growing up
that influence performance and development)
2. longitudinal: compare the same person when they're at different ages, but findings may not
generalize to other cohorts and there are retest effects, selective dropout
Readings Lecture One
Aging Older Adulthood: Chapter 1
- the scientific study of aging is recent
- there are more elderly people today than before, and development continues through old
age
- age can be defined chronologically, socially, functionally, biologically and psychologically
- with age, the gap between chronological age and subjective feelings of age widens and
people feel younger
- 65 is now the age we consider old but this may change in the future
- the fastest growing subgroup of old is the oldest-old
Successful Aging, Negash
- this study aimed to look at models of defining successful aging
- 3 models were developed, each with tests in 4 domains: memory, attention/EF, language and
visuospatial skill
- model 1: top 10% successful agers, bottom 90% typical agers
- model 2: top 50% successful agers
- model 3: above 1SD successful agers
- Model 1 showed 65% lower mortality in successful agers compared to typical agers
- Model 1 was most strongly associated with longevity and cognitive decline, so is useful for
investigating predictors of successful aging
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