Summary Neuropsychology of Ageing/Neuropsychologie van de Veroudering (VU)
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Course
Neuropsychologie van de Veroudering (P_BNPSOUD)
Institution
Vrije Universiteit Amsterdam (VU)
Book
Neuropsychology of Cognitive Decline
Summary of the lectures of the course Neuropsychology of Ageing/Neuropsychologie van de Veroudering (VU). Also summary of all of the required chapters from Tuokko & Smart (2018) and (if present) added articles.
Neuropsychology of Aging full lecture notes (English)
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Neuropsychologie van de Veroudering (P_BNPSOUD)
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Neuropsychology of Ageing
INDEX
1. Why ageing? Theories and methods 2
2. Normal ageing: Memory 6
3. Normal ageing: Executive functions and processing speed 9
4. Normal ageing: Language, visual spatial functions, normal brain ageing 13
Overview normal cognitive ageing 18
5. Mild Cognitive Impairment & Subjective Cognitive Decline 18
6. Alzheimer disease 1 23
7. Alzheimer disease 2 28
8. Vascular dementia 31
9. Frontotemporal dementia 36
10. Dementia with Lewy bodies 40
11. Diagnosis and assessment 43
12. Prevention of dementia 45
This summary includes (almost) everything from the lectures, chapters from the book and articles.
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, 2
Why ageing? Theories and methods
Erber, Ch. 1, 2
Negash et al., 2011
Wettstein et al., 2016
- Myths about ageing are that old people are less happy/content, everyone will develop dementia and
that with ageing all cognitive functions will deteriorate
- Relevance of studying ageing
o Scientific reason: presenting a complete view of development
§ Developmental psychology focuses on children/young adults. Popular assumption in
developmental psych: gradual, predictable decline psychological functions with ageing in a 2
stage model:
• Stage 1: physical and psychological functions develop (growth) up to a point (maturity)
• Stage 2: gradual and predictable decline (senescing).
• Appears that for biological functions this is mostly correct, but not for psychological
functions!
§ Life span perspective: changes between birth and death regarded as development
• Changes in functional capacity are part of the life span
• Maturation continues until death
• Relevant for studying psychological ageing
• Changes are not predictable, not necessarily deterioration of functions!
• Erikson’s 8 stages
o Personal reasons: give us insights into what we experience when we get older, what is
normal/abnormal
o Practical reasons
§ Strong increase in # of older persons worldwide
• Increase in disease associated with ageing
• Increase demands for treatment and care
• Prevention of age-related disorders
- The concept “age”
o Chronological age – the number of years since birth
§ Most common measure in studies of ageing, this is what we refer to in the lectures as well
§ Older adulthood typically starts at 65. (young-old: 65-74, old-old: 75-84, oldest-old: >85).
o Biological age – age relative to the years one can expect to live (or relative to physical appearance
and bodily functions, e.g. blood pressure)
o Functional age – person’s competence in carrying out specific tasks relative to persons of the same
chronological age
o Psychological age – how well can a person adapt to changing conditions, flexibility, attempt new
activities
o Social age – views held by most people in society about what a person of a particular chronological
age should do and behave
o Subjective age – the fact that the chronological age people select to mark the onset of middle and
older adulthood seems to be colored by their own age or stage of adulthood
o There is individual variability in ageing!! E.g. persons > 65 are no homogeneous group (inter-
individual and intra-individual differences)
o Ageism – a set of ideas and beliefs that are associated with discriminatory attitudes directed
toward older adults (negative beliefs or stereotypes about older adults as a group)
, 3
Population ageing
- From 1950s until now, life expectancy at birth has on average increased from +-
50 years to +- 75 years old, while total fertility rate has decreased from 5 to 3
children per woman.
- Figure on the right shows the percentages of the population per 5-year age
category
o Blue square is ageing baby boomers
o Can see that, as we move from 1970 (top figure) to 2050 (bottom figure),
65+ will take up a larger percentage of the population.
§ 2013: population over 60 outnumbered population aged 0-19 years
(falling tobacco use & cardiovascular disease mortality)
§ 2024: population over 60 expected to outnumber al other age groups in
more developed regions
- Consequences of population ageing
o Dependency ratio – ratio population in most dependent age and the
population in main working ages:
!"#$%& ()*+,&%! "!,%& -./ 0%&12!1 34%, 5. 6%3&1 3!, 27%&
!"#$%& 28 0%&12!1 -.95: 6%3&1
§ Increasing dependency rate
• More “dependents” relative to the group in the productive ages
• More economic pressure on the productive group
• Dependency rate in more developed countries will increase, mainly due to increase in
the number of older people
o Old age support ratio – number persons available in main
working ages to support each older person:
!"#$%& 28 0%&12!1 -.95: 6%3&1
!"#$%& 28 0%&12!1 5./
§ Decreasing!
§ 2013: just 4 persons of working age for each older person
in more developed regions
§ Ratio expected to decline further
o Health and health care costs
§ Health expenditures grow rapidly due to ageing
• Older persons usually require more health care in general and more specialized services
for more complex pathologies
§ Major causes of disability and health problems in old age are non-communicable disease,
including heart disease, cancer, diabetes, “the four giants of geriatrics” (immobility, instability,
incontinence and intellectual impairment)
§ Intellectual impairment/dementia
• Number of people with dementia: increasing and expected to increase more
• One of the world’s most expensive diseases. If dementia were a company t would be the
biggest by annual revenue, if it were a country it would be the 18th largest economy in
the world. What makes the disease so costly?
o Increasing incidence
o Large % of people with dementia who need support and care
o Large % of people with dementia in high income countries live in nursing homes
o No effective medical treatment. Psychology can make valuable contributions to care
and diagnosis
Theories of ageing
- Biological ageing theories, incl. ageing of the brain: changes almost always detrimental
o Programmed theories – ageing is genetically programmed
, 4
§ Time clock theory – cells can divide only a limited number of times
§ Immune system – the immune system is programmed to work efficiently for a certain amount
of time
§ Evolution – animals programmed to produce offspring. Once tasks have been accomplished,
animals become more susceptible to diseases
o Stochastic theories– ageing is result of damage to the body during life
§ Errors at cellular levels result in production of faulty molecules
§ Wear and tear theory – damage to the body will build up of time
§ Stress theory – body sustains damage from prolonged exposure to stress
§ Build-up of damaging substances in the body
- Psychological ageing theories
o Selective Optimization with Compensation (SOC)
§ During development people gain and lose capabilities
§ Older adults: losses > gains
§ High levels of well-being with ageing would require:
• Adapt to continue good level of functioning and QoL
• Select domains where high level of functioning can be maintained or that can maximize
QoL (optimization)
• Compensate with new strategies where losses occur (e.g. memory, mobility)
o Ecological model of ageing
§ Person x Environment interaction à level of adaptation
• To enjoy positive outcome adaptation requires that person’s level of competence
matches demands from the environment
• Lower levels of competence requires a lower level environmental demands
o Socioemotional selectivity theory
§ With ageing motivation shifts from pursuit of knowledge to pursuit of emotional satisfaction
§ Cognitive resources used to enhance mood and QoL rather than acquiring new knowledge
o Concept of “Successful ageing”
§ NL: 65-76 age group is most happy and content, less depression
(see graph; N = 972464) and higher subjective wellbeing in older
age. Over 75s, large majority also rated themselves as
content/happy
§ Wettstein et al. (2016). Subjective experience of health and ability
are more positive than objective health and ability (= satisfaction
paradox: stability despite loss. On the one hand, there is
measurable deterioration, whereas subjectively there is no/very
kilittle) deterioration
• E.g. objectively, mobility will decrease, however, subjectively, older people will not rate
it as that it has decreased so much
- Cognitive ageing
o Assumption of universal decline – assumption that ageing will inevitably lead to cognitive decline.
§ Two stage/senescence model, gradual age-related decline. Miles (1933): cognitive ability in
1600 persons aged 6-95.
• Developmental perspective and life-span perspective as mentioned before.
o Developmental: gradual age-related decline
o Life-span: age-related changes are a stage in life rather than a disease.
§ “classic aging pattern” – fluid vs crystallized intelligence. Fluid decreases with
aging, crystallized does not.
§ Cognitive plasticity and cognitive reserve (same pattern)
o Schaie (2013) 4 patterns of cognitive ageing
§ Successful ageing – maintain cognitive function or very modest decline
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