1
Neuropsychology of Ageing and Dementia –
Literature
Inhoud
Lecture 1 .................................................................................................................................2
Chapter 1: Introduction: Older People under the Magnifying Glass .........................................2
Chapter 2: Bio- and Health Gerontology: How Ageing Changes Our Bodies ............................4
Lecture 2 .................................................................................................................................7
Chapter 3: Gerontopsychology: Ageing is All in Your Head .....................................................7
Chapter 2: Consideration of Cognitive Reserve ................................................................... 15
Lecture 3 ............................................................................................................................... 22
Chapter 28: Differentiating Mild Cognitive Impairment and Cognitive Changes of Normal Aging
......................................................................................................................................... 22
Chapter 29: Assessment of Alzheimer’s Disease ................................................................. 28
Lecture 4 ............................................................................................................................... 32
Chapter 30: Vascular Cognitive Impairment ........................................................................ 32
Chapter 31: Primary Progressive Aphasia ............................................................................ 35
Chapter 33: Assessment of Behavioral Variant Frontotemporal Dementia ............................ 39
Lecture 5 ............................................................................................................................... 50
The Neuropsychology of Huntington’s Disease .................................................................... 50
Chapter 34: Movement Disorders with Dementia in Older Adults ......................................... 52
Lecture 6 ............................................................................................................................... 67
Caregiver Burden: A Clinical Review ................................................................................... 67
Delirium in Elderly People .................................................................................................. 70
Lecture 7 ............................................................................................................................... 74
Chapter 116: Dementia: Screening, Evaluation, Diagnosis and Management ....................... 74
The Behavioral and Psychological Symptoms of Dementia in Down Syndrome Scale (BPSD-DS
II): Optimization and Further Validation ............................................................................... 77
Dementia in people with severe or profound intellectual (and multiple) disabilities: Focus
group research into relevance, symptoms and training needs .............................................. 79
,2
Lecture 1
Chapter 1: Introduction: Older People under the Magnifying Glass
Introduction: Europe’s Greying Population
Europe is witnessing a demographic shift, becoming the world’s oldest continent. By the early 21st
century, every sixth European was 65 years or older, and by 2050, this ratio is expected to increase to
one in four. This ageing trend impacts daily life, such as an increase in the number of older people in
cafes, the need for more senior-friendly products, and improved accessibility in public transport.
Societal systems like pensions and long-term care will require financial restructuring. These changes
raise critical questions about the future of Europe and the best strategies to address demographic
shifts. Gerontology, the multidisciplinary study of ageing, offers insights and solutions to these
challenges.
1.1 What is Gerontology?
Gerontology examines the biological, social, and psychological aspects of ageing, integrating insights
from fields like sociology, psychology, biology, and economics. The term stems from Greek: geron (old
man) and gerh (growing up, maturing, or ageing). Although the formal study emerged with Russian
microbiologist Ilya Metchnikov in the 19th century, ageing has been a topic of interest since antiquity.
For instance, Roman philosopher Cicero wrote De Senectute in the 1st century BC, challenging
negative stereotypes of old age, such as weakness and loss of purpose. Gerontology thus
encompasses both the state of being old and the dynamic process of growing older.
1.2 What is Old Age?
Old age is commonly associated with physical changes like wrinkles, greying hair, and health
problems. However, it is equally a social construct, shaped by societal norms and policies, such as
mandatory retirement, which often marks age 65 as a societal threshold for old age. Historically, this
age aligned with the onset of health decline and workforce withdrawal. However, recent trends show
earlier retirements and improved health into advanced ages, making 65 an unreliable marker for old
age.
Gerontology has responded by differentiating between two life phases in old age:
• The Third Age (Young-Old): A phase marked by good health, independence, and freedom
from work and child-rearing responsibilities.
• The Fourth Age (Old-Old): Characterized by accelerated physical and mental decline, where
losses outweigh gains.
These frameworks underscore the diversity of ageing experiences, which vary based on context,
health, and societal expectations. This book adopts multiple definitions of old age depending on the
topic discussed.
1.3 How Grey is Europe?
Europe serves as a prime case study for population ageing. It is the oldest continent globally, with
striking internal variations. As of 2009, Europe had a median age of 40 years, 12 years above the
global average. Sixteen percent of Europeans were aged 65 or older, compared to just 3% in Africa.
By 2050, 27% of Europeans are projected to be 65 or older, doubling the share seen in 1950. While
population ageing is a universal trend, Europe leads the way, with regional differences shaping the
pace and scale of change.
Regional Ageing Trends
• Historical Gradient: In the 1950s, Northern and Western Europe were older than Southern
and Eastern Europe.
,3
• Current Shifts: Ageing has accelerated in Southern Europe, narrowing the gap with the North
and West. By 2050, Southern and Western Europe are projected to host the oldest
populations, while Northern and Eastern Europe will remain relatively younger.
• Variations Within Countries: Factors like urbanization, gender, migration, and cultural
practices create disparities. Rural populations tend to age faster, and women outnumber men
in higher age groups.
1.4 What Are Older Europeans Like?
Older Europeans are a diverse group, shaped by national and individual differences. These variations
manifest across several dimensions:
Gender Differences
• Women outlive men, leading to a female majority among the oldest Europeans.
• The gender imbalance is particularly pronounced in Eastern Europe, where two-thirds of older
individuals are women, due to higher male mortality and war-related deaths.
Social Networks
• Social connections enhance well-being and provide support, but their nature varies:
o Northern Europe: Looser kinship ties, greater reliance on friends and associations,
and high participation in voluntary organizations.
o Southern and Eastern Europe: Strong family ties, with older adults embedded in
multigenerational households.
Socio-Economic Status
• Wealth: Higher in Western and Continental Europe (e.g., France, Switzerland) than in Eastern
Europe (e.g., Poland).
• Education: Higher levels in Northern and Continental Europe than in Southern and Eastern
Europe.
• Occupational Prestige: Reflects regional disparities, with Northern Europe ranking highest.
Health
• Nordic countries report better health outcomes, influenced by lifestyle and robust healthcare
systems.
• Eastern Europe struggles with higher obesity rates, smoking prevalence, and limited
healthcare resources.
• Women generally have longer life expectancies, but men report better self-perceived health.
1.4.1 Country-Profile: Old Age in Italy
Italy exemplifies advanced ageing:
• With 6% of its population aged 80 or older, it ranks as one of Europe’s oldest nations.
• Older Italians are family-oriented, with low participation in public activities but strong roles
within households.
• Caregiving largely relies on family members, supported by migrant workers (badanti), raising
ethical concerns about labour conditions.
1.4.2 Country-Profile: Old Age in Sweden
Sweden offers a model for active ageing:
• With 70% of individuals aged 55–64 in the workforce, Sweden leads Europe in older adult
employment.
• Older Swedes enjoy long, healthy lives and high engagement in volunteering and caregiving.
• Government policies, such as the right to work until age 67, promote independence and social
inclusion.
, 4
1.4.3 Country-Profile: Old Age in Slovakia
Slovakia, one of Europe’s youngest countries, highlights the challenges of ageing:
• Lower life expectancies and earlier health decline result in limited public and volunteer
engagement among older adults.
• Despite these challenges, older Slovakians report strong social integration and low poverty
rates.
• Policies are gradually evolving to address the ageing population’s needs.
Chapter 2: Bio- and Health Gerontology: How Ageing Changes Our
Bodies
2.1 Summary and Learning Goals
Bio- and health gerontology study the physical aspects of ageing and the care systems supporting
older individuals. While biogerontology focuses on biological processes at the molecular and systemic
levels, health gerontology addresses health conditions, the ability to perform daily activities, and
healthcare use in older populations. Key issues include the prevalence of diseases such as
cardiovascular conditions, cancer, diabetes, and dementia. Most European nations are equipped with
comprehensive healthcare and long-term care systems, providing critical support to families caring for
frail older adults.
Learning Goals:
• Define health using two different definitions.
• Identify three strategies to encourage healthy ageing.
• Name the four most common diseases affecting older Europeans.
• Provide an overview of formal and informal care arrangements for frail older adults.
2.2 What Are Bio- and Health Gerontology?
Ageing is a complex process influenced by biological, psychological, social, environmental, and
spiritual factors. Bio- and health gerontology examine the physical components of this process and
their interactions.
Biogerontology
Biogerontology is the study of ageing at the molecular and cellular levels. Researchers explore
processes such as caloric restriction and its effects on longevity, cellular homeostasis, and the role of
free radicals in ageing. Aubrey de Grey, a prominent biogerontologist, controversially views ageing as
a disease that could eventually be treated like other medical conditions. De Grey speculates that
humans may soon live far longer lives, potentially reaching 1,000 years. Critics, however, argue that
much of the research is based on animal studies and has yet to be conclusively applied to humans.
Health Gerontology
Health gerontology investigates how ageing affects health and daily functioning. It addresses
inequalities in health outcomes based on factors like income and education. Interventions occur on
two levels:
1. Individual-Level Interventions: Focus on promoting healthy lifestyles and preventing
disease.
2. Population-Level Interventions: Address structural issues like poverty, housing, and
healthcare system organization.
This sub-discipline emphasizes the importance of extending healthy life expectancy and enabling
older individuals to remain active and independent.
Neuropsychology of Ageing and Dementia –
Literature
Inhoud
Lecture 1 .................................................................................................................................2
Chapter 1: Introduction: Older People under the Magnifying Glass .........................................2
Chapter 2: Bio- and Health Gerontology: How Ageing Changes Our Bodies ............................4
Lecture 2 .................................................................................................................................7
Chapter 3: Gerontopsychology: Ageing is All in Your Head .....................................................7
Chapter 2: Consideration of Cognitive Reserve ................................................................... 15
Lecture 3 ............................................................................................................................... 22
Chapter 28: Differentiating Mild Cognitive Impairment and Cognitive Changes of Normal Aging
......................................................................................................................................... 22
Chapter 29: Assessment of Alzheimer’s Disease ................................................................. 28
Lecture 4 ............................................................................................................................... 32
Chapter 30: Vascular Cognitive Impairment ........................................................................ 32
Chapter 31: Primary Progressive Aphasia ............................................................................ 35
Chapter 33: Assessment of Behavioral Variant Frontotemporal Dementia ............................ 39
Lecture 5 ............................................................................................................................... 50
The Neuropsychology of Huntington’s Disease .................................................................... 50
Chapter 34: Movement Disorders with Dementia in Older Adults ......................................... 52
Lecture 6 ............................................................................................................................... 67
Caregiver Burden: A Clinical Review ................................................................................... 67
Delirium in Elderly People .................................................................................................. 70
Lecture 7 ............................................................................................................................... 74
Chapter 116: Dementia: Screening, Evaluation, Diagnosis and Management ....................... 74
The Behavioral and Psychological Symptoms of Dementia in Down Syndrome Scale (BPSD-DS
II): Optimization and Further Validation ............................................................................... 77
Dementia in people with severe or profound intellectual (and multiple) disabilities: Focus
group research into relevance, symptoms and training needs .............................................. 79
,2
Lecture 1
Chapter 1: Introduction: Older People under the Magnifying Glass
Introduction: Europe’s Greying Population
Europe is witnessing a demographic shift, becoming the world’s oldest continent. By the early 21st
century, every sixth European was 65 years or older, and by 2050, this ratio is expected to increase to
one in four. This ageing trend impacts daily life, such as an increase in the number of older people in
cafes, the need for more senior-friendly products, and improved accessibility in public transport.
Societal systems like pensions and long-term care will require financial restructuring. These changes
raise critical questions about the future of Europe and the best strategies to address demographic
shifts. Gerontology, the multidisciplinary study of ageing, offers insights and solutions to these
challenges.
1.1 What is Gerontology?
Gerontology examines the biological, social, and psychological aspects of ageing, integrating insights
from fields like sociology, psychology, biology, and economics. The term stems from Greek: geron (old
man) and gerh (growing up, maturing, or ageing). Although the formal study emerged with Russian
microbiologist Ilya Metchnikov in the 19th century, ageing has been a topic of interest since antiquity.
For instance, Roman philosopher Cicero wrote De Senectute in the 1st century BC, challenging
negative stereotypes of old age, such as weakness and loss of purpose. Gerontology thus
encompasses both the state of being old and the dynamic process of growing older.
1.2 What is Old Age?
Old age is commonly associated with physical changes like wrinkles, greying hair, and health
problems. However, it is equally a social construct, shaped by societal norms and policies, such as
mandatory retirement, which often marks age 65 as a societal threshold for old age. Historically, this
age aligned with the onset of health decline and workforce withdrawal. However, recent trends show
earlier retirements and improved health into advanced ages, making 65 an unreliable marker for old
age.
Gerontology has responded by differentiating between two life phases in old age:
• The Third Age (Young-Old): A phase marked by good health, independence, and freedom
from work and child-rearing responsibilities.
• The Fourth Age (Old-Old): Characterized by accelerated physical and mental decline, where
losses outweigh gains.
These frameworks underscore the diversity of ageing experiences, which vary based on context,
health, and societal expectations. This book adopts multiple definitions of old age depending on the
topic discussed.
1.3 How Grey is Europe?
Europe serves as a prime case study for population ageing. It is the oldest continent globally, with
striking internal variations. As of 2009, Europe had a median age of 40 years, 12 years above the
global average. Sixteen percent of Europeans were aged 65 or older, compared to just 3% in Africa.
By 2050, 27% of Europeans are projected to be 65 or older, doubling the share seen in 1950. While
population ageing is a universal trend, Europe leads the way, with regional differences shaping the
pace and scale of change.
Regional Ageing Trends
• Historical Gradient: In the 1950s, Northern and Western Europe were older than Southern
and Eastern Europe.
,3
• Current Shifts: Ageing has accelerated in Southern Europe, narrowing the gap with the North
and West. By 2050, Southern and Western Europe are projected to host the oldest
populations, while Northern and Eastern Europe will remain relatively younger.
• Variations Within Countries: Factors like urbanization, gender, migration, and cultural
practices create disparities. Rural populations tend to age faster, and women outnumber men
in higher age groups.
1.4 What Are Older Europeans Like?
Older Europeans are a diverse group, shaped by national and individual differences. These variations
manifest across several dimensions:
Gender Differences
• Women outlive men, leading to a female majority among the oldest Europeans.
• The gender imbalance is particularly pronounced in Eastern Europe, where two-thirds of older
individuals are women, due to higher male mortality and war-related deaths.
Social Networks
• Social connections enhance well-being and provide support, but their nature varies:
o Northern Europe: Looser kinship ties, greater reliance on friends and associations,
and high participation in voluntary organizations.
o Southern and Eastern Europe: Strong family ties, with older adults embedded in
multigenerational households.
Socio-Economic Status
• Wealth: Higher in Western and Continental Europe (e.g., France, Switzerland) than in Eastern
Europe (e.g., Poland).
• Education: Higher levels in Northern and Continental Europe than in Southern and Eastern
Europe.
• Occupational Prestige: Reflects regional disparities, with Northern Europe ranking highest.
Health
• Nordic countries report better health outcomes, influenced by lifestyle and robust healthcare
systems.
• Eastern Europe struggles with higher obesity rates, smoking prevalence, and limited
healthcare resources.
• Women generally have longer life expectancies, but men report better self-perceived health.
1.4.1 Country-Profile: Old Age in Italy
Italy exemplifies advanced ageing:
• With 6% of its population aged 80 or older, it ranks as one of Europe’s oldest nations.
• Older Italians are family-oriented, with low participation in public activities but strong roles
within households.
• Caregiving largely relies on family members, supported by migrant workers (badanti), raising
ethical concerns about labour conditions.
1.4.2 Country-Profile: Old Age in Sweden
Sweden offers a model for active ageing:
• With 70% of individuals aged 55–64 in the workforce, Sweden leads Europe in older adult
employment.
• Older Swedes enjoy long, healthy lives and high engagement in volunteering and caregiving.
• Government policies, such as the right to work until age 67, promote independence and social
inclusion.
, 4
1.4.3 Country-Profile: Old Age in Slovakia
Slovakia, one of Europe’s youngest countries, highlights the challenges of ageing:
• Lower life expectancies and earlier health decline result in limited public and volunteer
engagement among older adults.
• Despite these challenges, older Slovakians report strong social integration and low poverty
rates.
• Policies are gradually evolving to address the ageing population’s needs.
Chapter 2: Bio- and Health Gerontology: How Ageing Changes Our
Bodies
2.1 Summary and Learning Goals
Bio- and health gerontology study the physical aspects of ageing and the care systems supporting
older individuals. While biogerontology focuses on biological processes at the molecular and systemic
levels, health gerontology addresses health conditions, the ability to perform daily activities, and
healthcare use in older populations. Key issues include the prevalence of diseases such as
cardiovascular conditions, cancer, diabetes, and dementia. Most European nations are equipped with
comprehensive healthcare and long-term care systems, providing critical support to families caring for
frail older adults.
Learning Goals:
• Define health using two different definitions.
• Identify three strategies to encourage healthy ageing.
• Name the four most common diseases affecting older Europeans.
• Provide an overview of formal and informal care arrangements for frail older adults.
2.2 What Are Bio- and Health Gerontology?
Ageing is a complex process influenced by biological, psychological, social, environmental, and
spiritual factors. Bio- and health gerontology examine the physical components of this process and
their interactions.
Biogerontology
Biogerontology is the study of ageing at the molecular and cellular levels. Researchers explore
processes such as caloric restriction and its effects on longevity, cellular homeostasis, and the role of
free radicals in ageing. Aubrey de Grey, a prominent biogerontologist, controversially views ageing as
a disease that could eventually be treated like other medical conditions. De Grey speculates that
humans may soon live far longer lives, potentially reaching 1,000 years. Critics, however, argue that
much of the research is based on animal studies and has yet to be conclusively applied to humans.
Health Gerontology
Health gerontology investigates how ageing affects health and daily functioning. It addresses
inequalities in health outcomes based on factors like income and education. Interventions occur on
two levels:
1. Individual-Level Interventions: Focus on promoting healthy lifestyles and preventing
disease.
2. Population-Level Interventions: Address structural issues like poverty, housing, and
healthcare system organization.
This sub-discipline emphasizes the importance of extending healthy life expectancy and enabling
older individuals to remain active and independent.
