SUMMARY Neuropsychology of Ageing (P_BNPSOUD): bachelor psychology year 3
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Course
Neuropsychologie van de Veroudering (P_BNPSOUD)
Institution
Vrije Universiteit Amsterdam (VU)
Book
Handbook on the Neuropsychology of Aging and Dementia
This document contains a summary of all the lectures of the course Neuropsychology of Ageing given at VU Amsterdam. It contains lecture notes as well as a list of abbreviations and my notes from corresponding literature
Summary Neuropsychology of ageing and dementia (book chapters + articles) RUG
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Neuropsychologie van de Veroudering (P_BNPSOUD)
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Dear student, This document contains all my lecture notes +
corresponding literature information from the course Neuropsychology
of Ageing given at VU Amsterdam in the study year 2022-2023.
Important to know is that I have not attended the following two lectures;
- Lecture 2: Normal cognitive ageing and Brain ageing
- Lecture 8: Dementia care in nursing homes
I have written the slides down and added information from the
corresponding literature from most lectures (not lectures 1, 3 & 12, but
just so you know these two could contain a bit less information than the
others.
INDEX
List of abbreviations:
Lecture 1: Introduction. Why ageing?
Lecture 2: Normal cognitive ageing and brain ageing
Lecture 3: Subjective cognitive decline and mild cognitive impairment
Lecture 4: Alzheimer’s disease
Lecture 5: Vascular dementia
Lecture 6: Dementia with Lewy Bodies
Lecture 7: Sleep and Pain in Dementia
Lecture 8: Dementia care in nursing homes
Lecture 9: Frontotemporal dementia
Lecture 10: Cultural Diversity in Neuropsychology of Ageing
Lecture 11: Assessment
Lecture 12: Prevention
Good luck with studying !
1
,ACTh: Acetylcholine PD: Parkinson’s Disease
ACC: Anterior cingulate cortex PDD: Parkinson’s Disease Dementia (PDD)
AD: Alzheimer’s Disease PFC: Prefrontal cortex
ADL: Activities of daily living RBD: REM sleep behavioural disorder
Aβ: Amyloid Beta RC: Reliable Change
aMCI: Amnestic MCI REM: Rapid-eye-movement
APOE: Apolipoprotein E (gene) SCD: Subjective Cognitive Decline
BENCI: Battery for Neuropsychological SCN: Suprachiasmatic nucleus
Evaluation of Children SD: Standard deviation / single domain /
BPSD: Behavioural and psychological Semantic Dementia
symptoms of dementia SIVD: Subcortical ischemic vascular
CDT: Clock drawing test dementia
CEFR: Common European Framework of SOC: Selective optimization with
Reference compensation
CIND: Cognitive impairment no dementia TOT: Tip of the tongue state
CR: Cognitive reserve VaD/VD: Vascular dementia
CVD: Cerebrovascular disease / disorder VaMCI: Vascular MCI
DAT: Dementia of Alzheimer’s Type VH: Visual Hallucinations
DICE: Describe, investigate, create, evaluate VCI: Vascular cognitive impairment
DLB: Dementia with Lewy Bodies / Lewy VCIND: VCI no dementia
Body Dementia VCID: Vascular cognitive impairment
DSM-V(5): The fifth edition of the Diagnostic dementia
and Statistical Manual of Mental Disorders WM: Working memory
EF: Executive functions WMA: White matter abnormalities
F.E.: For example
FDG: Fluorodeoxyglucose
FTD: Frontotemporal dementia
FTLD: Frontotemporal lobar degeneration
HC: Health control
HRT: Hormonal replacement therapy
IADL: Instrumental activities of daily living
LB: Lewy bodies
LEQ: Lifetime of experiences questionnaire
LN: Lewy neurites
MCI: Mild cognitive impairment
MD: Multiple domains
MMSE: Mini mental state exam
MRI: Magnetic Resonance Imaging
naMCI: non-amnestic MCI
NC: No significant pathology. Cognitively
normal
NPS: Noncognitive neuropsychiatric
symptoms
PPA: Primary Progressive Aphasia
- lvPPA: logopenic variant PPA
- naPPA: nonfluent/agrammatic
variant PPA
- svPPA: semantic variant PPA
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,Lecture 1: Introduction. Why ageing?
There are a couple of reasons why ageing is important to study:
Scientific reasons
➔ Present a complete view of development
o Developmental psychology: focus on children or young adults
o Ignored continuation development in adulthood
o Popular assumption in developmental psychology: two-stage model
▪ Physical and psychological functions develop up to a point, followed by a
gradual, predictable decline
➔ Life span perspective: changes between birth and death regarded as development
o Changes in functional capacity are part of the lifespan
o Changes not necessarily deterioration of functions
o Erikson’s stage model – psychodynamic lifespan approach → ‘human
development is dominated by dramatic shifts in emphasis’
▪ Different crises to be resolved at different points in life. E.g. generativity vs
stagnation crisis, integrity vs despair crisis
o Schaie & Willis stage theory of cognition
▪ Stages reflect different uses of cognition, rather than stage in the
acquisition of new information (Piaget)
▪ Achieving stage, responsible stage, reintegration stage, reorganizational
stage, legacy-creating stage
Societal reasons
➔ Strong increase in number of older persons worldwide:
o Increase in diseases associated with ageing
▪ Because life expectancy is higher, diseases (that come with ageing) also
increase
o Increase demands for treatment and care
o Prevention of age-related disorders.
The population pyramids have changed a lot over the century. The baby boom that happened
during the 50’s, now are people that are ageing. Because a large group is becoming older, more
age-related diseases happen. People over 60s will become the largest age group. In 2013 the
population over 60 outnumbered those aged 0 to 19. In 2024 the
population over 60 is expected to outnumber all other age groups in
more developed regions.
→ consequences:
• old age support ratio
o Number of persons available in main working ages to
support each older person: number of persons aged 15-
64 / number of persons aged 65 or over.
o In 2013, 4 persons of working age were significant for
each older person in more developed regions
o The ratio is expected to decline further.
• Health and healthcare costs
o Health expenditures grow rapidly due to ageing
- Older persons require more healthcare in general and more specialized
services for more complex pathologies
o Fewer younger people can take care of older people (financially)
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, o Major causes of disability and health problems in old age are non-communicable
diseases, including:
- The 4 giants of geriatrics (study of the elderly)
▪ Immobility
▪ Instability
▪ Incontinence
▪ Intellectual impairment (dementia)
[ factors shown to contribute to cognitive reserve or to be related to cognitive decline in clinical
studies include education; occupational complexity; physical health; diet ]
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
• No effective medical treatment
➔ Estimated annual worldwide cost to society of dementia: $604 billion in 2010 and is
expected to be doubled by 2030.
Most older people will develop dementia:
According to Schaie (2013) there are four patterns of cognitive ageing.
1. Successful ageing = maintaining cognitive function a or very modest decline
- Prevalence of successful cognitive ageing
o Estimated ± 10% of older adults
o Based on one study: functions assessed were
attention/executive function, language,
memory, and visual-spatial ability. Results
should not be more than 1 SD below the norms
of young adults. The successful agers had
lower mortality than typical agers
o Cognition is comparable with those of younger
adults
- Often older persons without conditions or medication that could affect
cognition (e.g. diabetes, CVD)
o Isolate effect of age (passage of time) only, without confounders of
illness and medication
o Age has little effect on cognition
2. Normal ageing = overall modest decline of most cognitive abilities (but not all abilities)
- Around 70% of older adults
- Changes in cognitive functioning, but still healthy ageing
o E.g. speed of information processing, memory, executive functioning,
name retrieval
- How do we know it is healthy ageing?
o Robust norming: remove persons from the norm sample who
developed dementia (at some point) after baseline
▪ Remaining sample is unlikely to be in early-stage dementia
3. Mild cognitive impairment (MCI) = decline greater than normal but not dementia yet
- The original criteria for MCI are as follows
o Presence of a memory complaint
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, o Normal activities of daily living
o Normal general cognitive function
o Abnormal memory for age
o Not demented
4. Dementia = marked decline in cognitive functioning, interfering with daily functioning.
The cognitive decline that typically accompanies normal cognitive ageing involves decreased
efficiency in information processing in several areas, including
- Speed of processing
- Reaction time
- Working memory capacity
- Short-term memory
- Executive control
- Verbal fluency
Ageing and well-being
Older adults retain relatively good memory for ‘gist’ or familiar stimuli, while source memory and
recollection of contextual details decline.
Of all age groups in the Netherlands, the 65-75 age group is the most happy and content
- 88% content with their life, 89.4% rated themselves as a happy person
- Over 75s: 84% content, 86% happy
Some studies found that the age group over 55 is the
wealthiest. They find that there is less depression in older
age. Also, subjective experiences of the elderly show
more positive results of wellbeing than younger groups.
Satisfaction paradox
➔ Age-cohort effects
o Older people may report higher levels of
life satisfaction because of the lower
expectations of a particular generation
➔ Socio-emotional selectivity theory
o Individuals experience more life satisfaction as age increases because, with
passing time and shrinking time 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.
➔ Declining goal-achievement gap
o As time goes by, ageing persons realise 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)
o During development people gain and lose capabilities
o In older adults the losses start to outnumber the gains
o High levels of well-being with ageing would require:
▪ Adapt to continue a good level of functioning and good quality of life
▪ Select domains where high-level functioning can be maintained or that
can maximize the quality of life
▪ Compensate with new strategies where losses occur (e.g. memory,
mobility)
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,Research design
➔ Critical variable in ageing research
o Typically chronological age: the number of years since birth
o What is the effect of age on behaviour or cognitive function?
➔ Age is an ‘organismic’ variable, and cannot be manipulated
➔ Only ways to study the effects of age:
1. Comparing different persons, who differ in age, but are otherwise as similar as
possible → cross-sectional
2. Comparing the same person at different points in time, when they are at different
ages. → longitudinal
❖ Cross-sectional designs
o Age differences, not changes with ageing
o Age effect derived from differences between persons who were born in different
years/decades
▪ What is the problem?
• Age effect could be confounded by cohort effect
• Cohort: generation of persons born at about the same time
o Cohort members have common experiences as they grow
up, which could influence their development and,
consequently, their test performance in adulthood
❖ Longitudinal designs
o Looking at changes as a result of age
o Age related-change
o Changes between T1 and T2 (or T3, T4 etc.) reflect effect of age – effect of
ageing
o Participants from the same cohort – no cohort effect
▪ What is the problem?
• Time-consuming and expensive
• Findings may not generalize to other cohorts
• Retest effects
• Selective dropout/attrition
▪ Retest effects
• Function studied may benefit from repeated testing → because it
measures cognitive function better when done multiple times
• May mask ageing-related decline, underestimate effect
o Measures cognitive function more vulnerable than
measures biological functions
o Shorter intervals greater risk
▪ Selective drop-out – participants do not return for 2nd, 3rd, etc.
assessment
• This drop-out causes participants that have better health to stay
longer in these studies → These drop-outs are done because low-
scores might cause participants to lose interest. High scores
might have better health, so this would be a problem, because
you might underestimate declines
If you would choose which research design is a better choice some things should be taken into
account.
➔ Effects ageing are typically smaller in longitudinal designs than cross-sectional designs
➔ Associations between function in cross-sectional designs may be absent in longitudinal
designs.
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, o E.g. negative association rate of learning and forgetting at the between-
participant (group) level need not exist at within-person (individual) level
o Aggregation bias
In graphs, the means of different age groups will be
differently correlated than when you calculate every
data apart from each other.
Brain changes in normal ageing
Structural changes include volume loss between ages 30 and 90:
▪ 14% of cerebral cortex
▪ 35% hippocampus
o Loss in hippocampus volume is accelerated with ageing
▪ 26% cerebral white matter
Also, frontal lobes have more volume loss relative to other cerebral lobes. Different studies found
that the largest volume reductions are in the frontal and temporal areas.
Can brain changes account for cognitive changes?
Association decline in cognitive function and brain changes with ageing?
- Reduced volume and activation hippocampus correlated with deterioration of episodic
memory
- problem with cross-sectional studies
hippocampus → persons whose memory performance declined – reduction in activation –
smaller hippocampus volume at follow-up
parahippocampal gyri → persons whose memory performance declined – increase in activation
in these areas
the consequences of reduced processing include decreased working memory capacity because
less information can be processed within a given time and impaired higher-order cognitive
functions such as abstraction or elaboration, because the relevant information is no longer
available in working memory or storage.
APOE 4 → biomarker for Alzheimer’s disease
To distinguish brain changes from normal ageing and early pathological brain changes
- overlap in areas affected
- changes reflection of abnormal ageing in persons in very early stage of dementia
(incipient dementia)
Neuropathology in cognitively healthy older adults
- Post-mortem examination of brains of healthy older adults → Some people that don’t
show any decline and die, sometimes show a lot of aggregation or plaques during the
autopsy (>50%). A possible explanation for this is that they have so much spare
capacity; reserve in the brain (COGNITIVE RESERVE)
o range of abnormalities associated with dementia observed
o including amyloid plaques, neurofibrillary tangles, minor vascular infarcts, Lewy
bodies.
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