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SUMMARY Neuropsychology of Ageing (lectures)
Summary of Neuropsychology of Ageing based on the lectures and the lecture slides.
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Neuropsychology of ageingIntroduction; why ageing?
There are several ageing stereotypes; old people are less happy and content than young people, most
older people will develop dementia, with ageing all cognitive functions will deteriorate. However, is
this true? Ageing is relevant to study for several reasons:
- Scientific reasons
o Present a more complete view of development
Developmental psychology focusses on children or young adults, but the
continuation of development into adulthood is ignored. The two-stage model
is a popular assumption in developmental psychology: physical and
psychological functions develop up to a certain point, which is followed by a
gradual, predictable decline.
o Life span perspective
Changes between birth and death are regarded as development. Changes in
functional capacity are part of the life span, but a change does not necessarily
mean the deterioration of functions.
Erikson’s stage model is the psychodynamic lifespan approach: “human
development is domination by dramatic shift in emphasis”, meaning,
different crises to be resolved at different points in life. E.g., generativity vs
stagnation crisis, integrity vs despair crisis.
Shaie & Willis stage theory of cognition: stages reflect different uses of
cognition, rather than stage in acquisition of new information (Piaget).
Achieving stage, responsible stage, reintegration stage, reorganizational
stage, legacy-creating stage.
- Societal reasons
o Strong increase in number of older persons worldwide
The group of people of over 60 will become the largest age group. In 2024,
the population of 60+ is expected to outnumber all other age groups in more
developed regions.
There is an increase in disease associated with ageing, which leads to an
increased demand for treatment and care, as well as the question of how to
prevent age-related disorders.
Consequences of population ageing:
- Old age support ratio (working people (15-64) / old people): the number of persons
available in main working ages to support each older person. In 2013, there were just 4
persons of working age for each older person in more developed regions, and this ratio is
expected to decline further.
- Dependency ratio (not working age / working age): ratio between the population in most
dependent ages and the population in the main working ages. A higher dependency rate means
there are more ‘dependents’ relative to the group in the productive ages. Dependency ratios in
the more developed countries will rise, mainly due to an increase in the number of older
people. One way to counter this, is to raise the retirement age. The increase differs for
different countries, but world-wide there are more older people.
- Health and healthcare costs: health expenditures grow rapidly due to ageing. Older persons
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
diseases, including:
o Heart disease
o Cancer
o Diabetes
o Four giants of geriatrics: immobility, instability, incontinence, intellectual
impairment
, Dementia is one of the worlds most expensive diseases. There is an increasing incidence,
meaning more people are getting it. A large proportion of people with dementia need
support and care, and a large proportion of people with dementia in high income countries
live in nursing homes. There is no effective medical treatment.
However, the stereotype that most people will develop dementia is not true. It is about cognitive
decline, and ageing will not lead to universal cognitive decline. According to Schaie (2016), there are
four patterns to cognitive ageing:
- Successful ageing: maintain cognitive function or very modest decline, compared to
adulthood
- Normal ageing: overall modest decline of most cognitive abilities, but not all abilities
- Mild cognitive impairment (MCI): decline greater than normal (criteria proposed > 1 SD or
Clinical Dementia Rating of 0.5)
- Dementia: marked decline in cognitive functioning, interfering with daily functioning
Successful ageing has a special interest in research, because how to they do this? It is estimated that
around 10% of older adults have successful cognitive ageing. A study by Negash et. al, from 2011
assessed functions of attention/executive function, language, memory, and visual spatial ability. The
strictest criterion in the study was that older participants whose test score was no more than 1SD
below the norms of young adults, were considered successful agers. The study also showed that
successful agers had lower mortality than typical agers, they lived longer. Successful agers are often
older persons without conditions or medications that could affect cognition (e.g., diabetes,
cardiovascular disease, etc). When the effect of age (passage of time) was isolated, thus without
confounders of illness and medication, it was shown that age itself has little effect on cognition.
Successful agers have shown us that decline in not inevitable.
Around 70% of older adults fall into the category of typical/normal ageing. They show changes in
cognitive functioning, but it is still considered as healthy ageing. An approach in studies to show it is
healthy ageing is called robust norming: remove persons from norm sample who developed dementia
at some point after baseline, then the remaining sample is unlikely to be in early-stage dementia.
The statement that old people are less happy and content than young people is not true. Of all age
groups in the Netherlands, the 65-75 age group is most happy and content with their life. There is a
higher subjective well-being in older age. A self-reported well being study from 2010 showed a ‘U-
bend’, meaning that younger people were relatively happy, but this declines into adulthood, with the
lowest point being around middle age, followed by an increase in subjective well-being into old age.
There is also less depression in older age.
This seems to go hand in hand with well-being, with the middle-aged people showing highest
probabilities of depression and this probability decreases into old age. Furthermore, over 55s are the
wealthiest age group. In old age, there seems to be a paradox concerning ageing and well-being:
Subjective experience of health and ability was more positive than the objective measure. Participants
were subjectively more positive than the objective measure. This phenomenon is called the
satisfaction paradox. It can be explained by a few theories:
- Age-cohort effects: older people may report higher levels of life satisfaction because of the
lower expectations of a particular generation
- Socio-emotional selectivity theory: individuals experience more life satisfaction as age
increases because, with passing time and shrinking horizons, they spend more time in
activities that contribute to their well-being instead of pursuing goals that are expected to pay
off in the future
- Decline goal achievement gap: as time goes by, ageing persons realize that their expectations
were probably set too high in their younger years and learn to accept the reality of their lives
- Selective Optimization with Compensation (SOC): during development, people gain and lose
capabilities. In older adults, the losses start to outnumber the gains. High levels of well-being
with ageing would require:
, o Adapt to continue good level of functioning and good quality of life
o Select domains where high level of functioning can be maintained or that can
maximize quality of life
o Compensate with new strategies where losses occur (e.g., memory, mobility)
Theoretical approaches to cognitive ageing:
- Contextual approaches: age differences in cognitive functioning influenced by context,
attitudes, interests
- Biological approaches: effects of ageing on different brain areas are reflected in different
cognitive effects (e.g., frontal ageing hypothesis)
- Information-processing approach: different components of cognition affected differently by
ageing (e.g., slowing information processing speed)
- Integrative approaches: effects of ageing influenced by biological, psychological, and social
factors – biopsychosocial model
In ageing research, the research design is important. Of course, age is a critical variable in ageing
research. Typically, the chronological age is used, which is the number of years since birth. Age is an
‘organismic’ variable, it cannot be manipulated. There are two wats to study the effect of age:
1. Cross sectional approach: comparing different persons, who differ in age but are otherwise
as similar as possible. The focus is on age differences, not changes with age. The age effect is
derived from differences between persons who were born in different years/decades. The
problem is that the age effect could be confounded by the cohort effect. Cohort members have
common experiences as they grew up, which could influence their development and
consequently, their test performance in adulthood. Another limitation of this approach is the
standardization of the sample. What is the sample (young, old), what is the sample standard?
2. Longitudinal approach: comparing the same person at different points in time when they are
different ages. The focus is on the changes between T1 and T2, these changes reflect the
effect of ageing. This type of design uses the same people, the things that’s different, is their
age. In this case, there is no cohort effect, since the participants are from the same cohort. The
problems lie in other limitations:
a. Time consuming and expensive
b. Findings may not generalize to other cohorts
c. Retest/practice effect: the function that is being studied may benefit from repeated
testing, which may mask the ageing related decline, therefore underestimating the
ageing effect.
d. Selective drop-out: participants who do not return for a next assessment. People who
scored lower on T1 may not return for T2, whereas people who scored higher on T1
will return for T2, which gives a skewed effect of age. Participants staying in
longitudinal studies tend to have better health and cognitive functioning than those
dropping out, but this leads to a certain group not being part of the research
population
Typically, the effects of ageing are smaller in longitudinal designs than in cross sectional designs.
Associations between functions in cross-sectional designs may be absent in longitudinal designs.
A 2001, cross-sectional study by Jernigan et al. compared structural brain changes in 78 healthy adults
(30-90) years old. They, along with other studies, found that the volume of the brain in older people is
smaller than the younger group:
- 14% volume loss in the cerebral cortex
- 35% volume loss in the hippocampus -> loss accelerated with ageing
- 26% cerebral white matter
- Frontal lobes more volume loss relative to other cerebral lobes
- Largest volume reductions in the frontal and temporal areas
- Little volume loss in the primary visual cortex
- Least changes around the central sulcus and calcarine sulcus
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