Methodological Issues

Age effects - the consequence of being a given chronological age

Cohort effects - the consequences of having been born in a given year and having grown up during a particular time period

Time-of-measurement effect - confounds that arise because events at a particular point in time can have a specific effect on a variable being studies over time

Cross-sectional versus longitudinal studies

Dementia The development of multiple cognitive deficits

manifested by both: memory impairment one or more of the following:

aphasia (language disturbance apraxia (impaired ability to carry out motor activities despite

intact motor function) agnosia (failure to recognize or identify objects despite intact

sensory function) disturbance in executive functioning (i.e., planning, organizing,

sequencing, abstracting)

Alzheimer’s Disease Brain tissue irreversibly deteriorates, and death usually

occurs 10-12 yrs after onset Accounts for 50% of dementia in elderly. Diagnosis made

by exclusion which alive. Physiological effect - atrophy of cerebral cortex,

hippocampus, and other brain areas Plaques - small, round areas comprising the remnants of lost

neurons and -amyloid, a waxy protein deposit - scattered throughout the cortex

Neurofibrillary tangles - abnormal protein filaments which accumulate within the cell bodies of the neurons

Normal MRI

MRI of an Alzheimer’s Patient

Senile Plaques

Delirium

Disturbance of consciousness with reduced ability to focus, sustain, or shift attention

A change in cognition (such as memory deficit) or the development of a perceptual disturbance that is not better accounted for by a preexisting, established, or evolving dementia

The disturbance develops over a short period of time (usually hours or days) and tends to fluctuate during the course of the day.

Dementia versus Delirium

The clinical “feel” of talking with a person with delirium israther like talking to someone who is acutely intoxicated orin an acute psychotic episode. Whereas the demented patientmay not remember the name of the place where she or he is,the delirious patient may believe it is a different sort of placealtogether, perhaps mistaking a psychiatric ward for a usedcar lot…Hallucinations, especially visual hallucinations, arecommon in delirium, but are rarely seen in demented patientsuntil the very late stages of the disease. Knight (1996)

Nursing Homes

The decision to institutionalize comes as a last choice

For a large number of families, moving the parent to a nursing home lead to improved family ties and closeness

Langer and Rodin - nursing home research which indicates that conscious thinking as well as perceived control are essential in maintaining emotional and physical well-being in nursing homes