Download PERSONALITY AND AGING:

PERSONALITY AND AGING :
MORE GRUMPY? –NOT SO
Randy Summerville, PsyD
ARCC Neuropsychology
NEUROCOGNITIVE ASSESSMENT
The study of brain behaviors using
normative standards and
psychological/cognitive testing
procedures
Goal: Measure Functional level
It identifies what the patient needs.
Adaptive accommodations
Maximize their quality of life and/
appropriate support
PERSONALITY & AGING
per·son·al·i·ty
pərsəˈnalədē/
Noun: the combination of characteristics or qualities that form an
individual's distinctive character.
synonyms: character, nature, disposition, temperament, makeup, persona,
psyche
ag·ing
ˈājiNG/
the process of growing old.
PERSONALITY TYPES
DSM V criteria based
Narcissistic
Histrionic
Dependent
Antisocial
Schizoid
Myers-Briggs introspective based
 16 types 4 items per type
 Extra version vs introversion
 Sensing vs intution
 Thinking vs feeling
 Judging vs perceiving
A COMPLEMENTING COMBINATION
Neurology and Neuroimaging
•Display space occupying lesions
Neurocognitive testing
Produces a taxonomy of the brain behaviors and
can detect abnormalities that are not visible on
neuroimaging
•Compares them to age and education based
norms.
•Gives information about cognitive abilities (not
just memory)
CLINICAL EVALUATION
Neurocognitive Testing
 Short-term memory & verbal learning
 Working memory
 Logical memory
 Delayed recall
 Logical memory
 Confrontational naming
 Frontal lobes executive functioning
 Left frontal lobe skills of abstract categorization and
verbal reasoning
 Right frontal lobe skills of complex sequencing
 Procedural memory
FRONTAL LOBE FUNCTIONS
Executive Functions
Working memory
Sustained attention
Impulse control and response inhibition
Goal directed behavior
Verbal fluency
Left Frontal Lobe
 Abstract categorization
 Expressive language
 Verbal Reasoning
Right Frontal lobe
 Judgment
 Planning
 Complex sequencing
 Non-verbal reasoning
FRONTAL LOBE EXECUTIVE PROCESS
Regulation
Acts as Ego and superego self control
When disinhibited very much impulsive like the ID
GENERAL FALSE STEREOTYPES OF AGING
Alzheimer’s disease is to be expected with old age
Sickness and disability come with old age
Older people cannot learn
Old people are weak and helpless
Old people are boring and forgetful
Old people are unproductive
Old people are grouchy and cantankerous
STEREOTYPES
Grumpy old man
The old guy who loves to complain
about how things were better in his
day, and that kids these days show no
respect.
“damn young’uns, no respect, don’t
know how good they have it?. In my
day we had to walk 15 miles through
the snow to get to school, uphill both
ways! And we didn't complain, no sir,
we were happy, and we got a dime a
year to work 17 hours a day in the
mines, one cent an hour, but did we
complain? NO!”
Little old Italian/Greek
Mother/grandmother
The old lady who is boss, everyone in
the family listens her and obeys out of
a mix of fear and respect but she has
absolutely no idea what’s going on in
reality.
STEREOTYPES
Crazy Old Cat Lady
Dirty Old Man
Disinhibited and
often
inappropriate.
(deacon with right frontal
lobe infarction)
This person is invariably not
good with people, she usually
only has an affinity with one
specific type of animal. She
lives alone except for the large
number animals living with her.
She is often feared by the
community and seen as an
eccentric recluse.
What is acceptable and what is
not?
MOOD VS PERSONALITY VS COGNITIVE DECLINE
Case examples
Anxiously avoidant and helpless
(refusing support and care, lack of self care, deconditioning. )
Unresolved bereavement with memory loss
Sorrowful irritable stubbornly independent with estranged family and recovered
alcoholic.
NORMAL AGING
Slowed processing speed
 The ability to process new information
Decreased working memory
 The ability to process and manipulate new information
 Critical for encoding information
Sustain recall previously learned information
 Wisdom
 Book smarts
Decreased cognitive flexibility and logical
thinking
 Street smarts
ISSUES OF AGING
Losses
 Friends, retirement & financial
Bereavement
 Anger, denial, anger/guilt, depression &
acceptance
Physical decline
 Mobility, vision, hearing, arthritis, pain,
deconditioning,
& shortness of breath
WHEN DOES MEMORY LOSS BEGIN
Memory Loss affects nearly ¼ of those over age
65
At age 2 the brain is about 85% developed
Around age 16 the brain is fully developed
Around age 25 the brain begins to deteriorate.
Around age 85 the brain has deteriorated about 15%.
RESEARCH SAYS…
Stereotypical “grumpy older people” are clearly less
widespread than we like to assume.
EXISTENTIAL CRISIS
Meaning of relationships
Sense of giving back rather than taking
 What will I be remembered for?
Erickson 8th stage of maturity
 Ego Integrity vs. Despair
 Reflection on and acceptance of one's life and sense of oneself feeling
fulfilled with an established identity of one’s self. Anguish or depression if the
sense of wisdom has not bee achieved.
DEPRESSION IMITATES NEUROLOGICAL SYMPTOMS
Flattened Affect
Irritability
Disconnection of neurons from the
limbic system
Confusion
Common among individuals who
suffer
 Parkinson’s Disease
 Sub-cortical ischemic changes
 A good defense to intimidate the
other person
Anxiety
Disinhibition syndrome
DEPRESSION IMITATES NEUROLOGICAL SYMPTOMS
Vegetative symptoms
Lethargy and Apathy
A decline in executive functioning
 Impaired sustained attention
 Impaired goal-directed behavior
 Concentration
 Impaired working memory
 Planning
 Complex sequencing
 Initiation and switching of activities
 Multi-tasking
 Impaired task initiation
Worthlessness
Accurate appraisal of some cognitive
decline and feeling inadequate to
function and fear of confusion.
This is a combination of both organic
changes and a mood disorder.
HOW TO HELP TELL NORMAL AGING AND CHANGES IN
PERSONALITY FROM DEPRESSION AND NEUROLOGICAL
SYMPTOMS???
Diagnostic process
Medical history
Physical examination and laboratory tests
Personal interviews with patient and family members (social
history)
Memory screening
Neuroimaging
Based on progression of symptoms over time, a diagnosis is
made and care planning and treatment begin
NEUROPSYCHOLOGICAL EVALUATION
Diagnostic interview with the patient and loved
ones
Review history to assist in making the
differential diagnosis
Determine appropriate testing battery to
measure brain function
FEEDBACK FOR PATIENT AND FAMILY CARE PLANNING
Doctor and health care team provide recommendations, prescriptions and plan
Care planning
 Home modification and adaptation
Future planning
 Legal
 Financial
 Family intervention and care
Safety
 Driving
 Medication management
 Nutrition
 Assisted living care
THE BENEFITS OF BASELINE OR SCREENING
Neuropsychological screenings are recommended by the
American Academy of Neurology
 Abnormal screenings may help lead to early detection and
intervention
 Normal screen may provide reassurance for the “Worried Well”
 The Mini Mental Status Examination can both under- or overidentify frontal lobe and memory problems
Annual screening for symptomatic individuals over the
age of 65
EARLY DETECTION
Differential diagnosis
 Vascular Dementia vs. Alzheimer’s Disease and Pseudo-Dementia
Early intervention
 Medications
Planning
 Address safety issues
 Home living vs. long-term care
 Seek out resources
 Take legal action
Prevention
 Hazardous situations and needless distress
EXERCISE YOUR BODY
Bad memory is linked to heart disease and diabetes
Clogged arteries slow blood flow in the brain
Heart healthy foods are important for the brain as well as the heart
 Low fat
 glycemic index foods
 Low sodium
TREATMENT DEVELOPMENT AND TRAINING
Educate caregivers about an individual’s strengths
Provide feedback about effective and ineffective strategies
Identify cognitive weakness which create an increased frustration for the
individual and increased resistance for caregivers
Help caregivers with acceptance of the changes the loved one has undergone
COGNITIVE SKILLS
AND CASE
EXAMPLES
TRAILS B FRONTAL LOBE DISINHIBITION SYNDROME
CLOCK DRAWINGS
83YR OLD ALZHEIMER’S DEMENTIA WITH AGITATION AND FRONTAL LOBE DISINHIBITION
95YO MILDRED, NURSING HOME RESIDENT, DX 331.0 ALZHEIMER’S DEMENTIA REFERRED FOR MARKED
BEHAVIORAL CHANGES, ER, WAS WILDLY COMBATIVE
THANK YOU
FOR ADDITIONAL QUESTIONS
AND CONSULTATION PLEASE
CONTACT
(630) 424-8900.
ARCC NEUROPSYCHOLOGY
Randy Summerville, Psy.D.
Shani Bensman, Psy.D.
Greg Malo, Psy.D.
Alexis Silas, Psy.D.
Kristin Clifford, Psy.D.
Sue Robinson, LCSW
Madison Hurd, Psy.D., Post
Doctorate Fellow
Kristen Wright. PsyD, Post
Doctoral Fellow