NEUROPSYCHOLOGY OF AGEING AND DEMENTIA
LEARNING OBJECTIVES
After successfully completing the course, students are able to:
● Identify and present psychological, cognitive and biological changes that
accompany normal ageing;
● Present and compare biological and psychological theories of normal ageing;
● Identify, compare and differentiate common types of dementia,including
Alzheimer’s disease, vascular dementia, frontotemporal dementia, Parkinson’s
disease dementia, dementia with Lewy bodies and Huntington’s disease dementia;
● Identify and compare conditions that are relevant in the differential diagnosis of
dementia, i.e., mild cognitive impairment and delirium;
● Discern the impact of dementia on caregivers.
,AGEING | PART I
LIFE COURSE TRAJECTORIES OF BODY FUNCTIONS
A: “Normal” development and decline.
B: Exposure in early life may leave imprints on structures or function of body systems.
C: Exposure acting in mid or in later life accelerating age-related decline.
1950 vs. 2014:
● Number of > 70 year olds further increased
● Babyboom generation
● Fewer births
2014 vs. 2060:
● More and more people reach a higher age
● Fewer births
Comparing developed and less
developed regions.
,DEFINITIONS OF AGE
Chronological age: measured in units of time (months or years) that elapsed since birth.
○ Young-Old: Ages 65-74
○ Old-Old: Ages 75-84
○ Oldest Old: Ages 85+
Biological age: where people stand relative to the number of years they will live
(estimation in terms of the body’s organ system and physical appearance).
● Speculative.
Functional age: person’s competence in carrying out specific tasks.
● In comparison with chronological age peers.
○ The Third Age: between retirement from work force and start of
age-imposed limitations.
○ The Fourth age: cognitive and physical impairments interfering with
everyday functioning.
The Third and Fourth age can overlap when you have cognitive and physical impairments
while you're still in the work force.
Psychological age: refers to how well a person adapts to changing conditions; the more
flexible you are to change, the younger you are.
Social age: views held by most members of a society about what individuals in a particular
chronological age group should do and how they should behave.
PERSPECTIVES ON AGING PROCESS
Normative aging: what is considered a usual, normal, or average outcome.
Succesful aging: what is considered ideal rather than average - the intersection of three
principal components:
● Low probability of disease and disease-related disability
● High cognitive and physical capacity
● Active engagement with life, primarily regarding interpersonal relations and
productive activity
Positive aging: the ability to find happiness and well-being even in the face of physical
and / or psychological challenges.
● Quality of life: focusing on what you can do, instead of what you can’t do.
,TWO THEORETICAL MODELS OF AGEING
THE SELECTIVE OPTIMIZATION WITH COMPENSATION MODEL OF AGEING
Individuals engage in adaptation throughout their lives.
They are capable of learning and changing and calling upon extra (reserve) capacity that
they might not need to use under ordinary circumstances.
● Selection: a strategy of concentrating efforts on domains in which effective
functioning is most likely to remain high.
● Optimization: a strategy of focusing on behaviors that maximize not only the
quantity but also the quality of life.
● Compensation: refers to substituting new strategies when losses occur.
THE ECOLOGICAL MODEL OF AGEING
The interaction between a person's competence and environment results in some level of
adaptation - measured in a person’s emotional well-being.
● Zone of maximum performance potential:
○ A perfect mixture between competence and the environmental pressures
and challenges - the environment is not asking too little or much from us.
● Marginally adaptive behavior:
○ There is a slight misbalance.
● Maladaptive behavior:
○ When you have high competence and low environmental pressures and
challenges (being ‘bored’ ), or the other way around.
Competence: physical, sensory,
cognitive and social capabilities.
A person with high competence
will adapt positively to a wider
range of environmental press than
a person with low competence.
,BIOLOGY OF AGEING
Why does aging occur?
What determines how long people live?
Biological changes: “physical changes (both structural and functional) that develop with
the passage of time and eventually end with death”.
● Gradual and cumulative;
● Peak in early adulthood;
● Decline after early adulthood.
○ Rate of decline differs strongly between individuals.
Not the majority, but even so most older adults are neither helpless nor dependent.
Are biological changes a consequence of the aging process rather than the disease?
● Aging in the absence of any disease is rare.
● The likelihood of many diseases increases with age.
Aging affects the consequences of disease when it occurs.
● The aging process and disease process interact.
Morbidity: illness and disease.
Mortality: death.
Two terms are related:
● Illness and disease can result in death.
● Death is often preceded by illness and disease.
● Morbidity does not necessarily result in mortality.
Life span: the maximum longevity, or extreme upper limit of time, that members of a
species can live (max ≈ 120 years in humans).
● Has stayed the same over time.
Life expectancy: the average number of years that individuals in a particular birth cohort
can be expected to live.
● Has increased over time.
● Affected by factors such as level of nutrition, sanitary conditions, and medical care.
● More and more people will approach the maximum life span –
compression of mortality.
, THEORIES OF BIOLOGY OF AGEING
Some theories: biological aging occurs within the organism regardless of outside forces.
Primary aging:
● Unavoidable (inevitable) biological process that affects all members of a species
(universal).
● Is set in motion early in life and progresses gradually over time.
○ Individual differences in progression rate.
● Is intrinsic: is determined by factors within the organism.
Other theories: biological aging is influenced by our environment and daily habits and the
way we cope with life’s challenges (radiation, stress).
Secondary aging:
● Experienced by most, but not necessarily all members of a species.
● Neither inevitable nor universal.
● Resulting from hostile environmental influences:
○ Disease
○ Disuse (e.g. lack of exercise)
○ Abuse (e.g. smoking)
LEARNING OBJECTIVES
After successfully completing the course, students are able to:
● Identify and present psychological, cognitive and biological changes that
accompany normal ageing;
● Present and compare biological and psychological theories of normal ageing;
● Identify, compare and differentiate common types of dementia,including
Alzheimer’s disease, vascular dementia, frontotemporal dementia, Parkinson’s
disease dementia, dementia with Lewy bodies and Huntington’s disease dementia;
● Identify and compare conditions that are relevant in the differential diagnosis of
dementia, i.e., mild cognitive impairment and delirium;
● Discern the impact of dementia on caregivers.
,AGEING | PART I
LIFE COURSE TRAJECTORIES OF BODY FUNCTIONS
A: “Normal” development and decline.
B: Exposure in early life may leave imprints on structures or function of body systems.
C: Exposure acting in mid or in later life accelerating age-related decline.
1950 vs. 2014:
● Number of > 70 year olds further increased
● Babyboom generation
● Fewer births
2014 vs. 2060:
● More and more people reach a higher age
● Fewer births
Comparing developed and less
developed regions.
,DEFINITIONS OF AGE
Chronological age: measured in units of time (months or years) that elapsed since birth.
○ Young-Old: Ages 65-74
○ Old-Old: Ages 75-84
○ Oldest Old: Ages 85+
Biological age: where people stand relative to the number of years they will live
(estimation in terms of the body’s organ system and physical appearance).
● Speculative.
Functional age: person’s competence in carrying out specific tasks.
● In comparison with chronological age peers.
○ The Third Age: between retirement from work force and start of
age-imposed limitations.
○ The Fourth age: cognitive and physical impairments interfering with
everyday functioning.
The Third and Fourth age can overlap when you have cognitive and physical impairments
while you're still in the work force.
Psychological age: refers to how well a person adapts to changing conditions; the more
flexible you are to change, the younger you are.
Social age: views held by most members of a society about what individuals in a particular
chronological age group should do and how they should behave.
PERSPECTIVES ON AGING PROCESS
Normative aging: what is considered a usual, normal, or average outcome.
Succesful aging: what is considered ideal rather than average - the intersection of three
principal components:
● Low probability of disease and disease-related disability
● High cognitive and physical capacity
● Active engagement with life, primarily regarding interpersonal relations and
productive activity
Positive aging: the ability to find happiness and well-being even in the face of physical
and / or psychological challenges.
● Quality of life: focusing on what you can do, instead of what you can’t do.
,TWO THEORETICAL MODELS OF AGEING
THE SELECTIVE OPTIMIZATION WITH COMPENSATION MODEL OF AGEING
Individuals engage in adaptation throughout their lives.
They are capable of learning and changing and calling upon extra (reserve) capacity that
they might not need to use under ordinary circumstances.
● Selection: a strategy of concentrating efforts on domains in which effective
functioning is most likely to remain high.
● Optimization: a strategy of focusing on behaviors that maximize not only the
quantity but also the quality of life.
● Compensation: refers to substituting new strategies when losses occur.
THE ECOLOGICAL MODEL OF AGEING
The interaction between a person's competence and environment results in some level of
adaptation - measured in a person’s emotional well-being.
● Zone of maximum performance potential:
○ A perfect mixture between competence and the environmental pressures
and challenges - the environment is not asking too little or much from us.
● Marginally adaptive behavior:
○ There is a slight misbalance.
● Maladaptive behavior:
○ When you have high competence and low environmental pressures and
challenges (being ‘bored’ ), or the other way around.
Competence: physical, sensory,
cognitive and social capabilities.
A person with high competence
will adapt positively to a wider
range of environmental press than
a person with low competence.
,BIOLOGY OF AGEING
Why does aging occur?
What determines how long people live?
Biological changes: “physical changes (both structural and functional) that develop with
the passage of time and eventually end with death”.
● Gradual and cumulative;
● Peak in early adulthood;
● Decline after early adulthood.
○ Rate of decline differs strongly between individuals.
Not the majority, but even so most older adults are neither helpless nor dependent.
Are biological changes a consequence of the aging process rather than the disease?
● Aging in the absence of any disease is rare.
● The likelihood of many diseases increases with age.
Aging affects the consequences of disease when it occurs.
● The aging process and disease process interact.
Morbidity: illness and disease.
Mortality: death.
Two terms are related:
● Illness and disease can result in death.
● Death is often preceded by illness and disease.
● Morbidity does not necessarily result in mortality.
Life span: the maximum longevity, or extreme upper limit of time, that members of a
species can live (max ≈ 120 years in humans).
● Has stayed the same over time.
Life expectancy: the average number of years that individuals in a particular birth cohort
can be expected to live.
● Has increased over time.
● Affected by factors such as level of nutrition, sanitary conditions, and medical care.
● More and more people will approach the maximum life span –
compression of mortality.
, THEORIES OF BIOLOGY OF AGEING
Some theories: biological aging occurs within the organism regardless of outside forces.
Primary aging:
● Unavoidable (inevitable) biological process that affects all members of a species
(universal).
● Is set in motion early in life and progresses gradually over time.
○ Individual differences in progression rate.
● Is intrinsic: is determined by factors within the organism.
Other theories: biological aging is influenced by our environment and daily habits and the
way we cope with life’s challenges (radiation, stress).
Secondary aging:
● Experienced by most, but not necessarily all members of a species.
● Neither inevitable nor universal.
● Resulting from hostile environmental influences:
○ Disease
○ Disuse (e.g. lack of exercise)
○ Abuse (e.g. smoking)
