W4 T3 P2

Anxiety Disorders in Older Adults

• Anxiety disorder is defined by excessive worry, hyper arousal, and counterproductive fear.
• The prevalence of all anxiety disorders is lower in older adults compared to younger adults.
• Anxiety symptoms often co-occur with depression in older adults, occurring in 30% to 70% of cases.
• Mixed anxiety and depressive disorder is diagnosed based on ICD-10 criteria.

Generalized Anxiety Disorder (GAD)

• GAD is frequently comorbid with depression in older adults.
• It has a median prevalence rate of about 2.2%, but this may be underestimated.
• SSRIs and CBT have been documented as effective treatments for anxiety disorders in later life.
• Benzodiazepines should be avoided due to the risk of dependence, falls, and cognitive impairment.

Phobias

• Phobias are the most common anxiety disorder in later life.
• Agoraphobia involves intense fear of open spaces, public transport, or leaving the house.
• It typically presents somatic anxiety symptoms like sweating, increased heart rate, and breathlessness.
• Agoraphobia is more common than specific or social phobias in older adults.
• Agoraphobia is less associated with a history of panic attacks compared to young adults.

Panic Disorder and OCD

• Panic disorder is rare in late life.
• Panic symptoms are often linked to cardiopulmonary diseases like COPD.
• New-onset OCD is rare in late life.
• OCD symptoms in older adults are similar to those in younger individuals.
• OCD in older adults is still understudied.

Post-Traumatic Stress Disorder (PTSD)

• PTSD prevalence decreases with age.
• PTSD may still develop in later life after trauma, stress, or chronic illness.
• Lower rates of PTSD in older adults may be due to increased recovery, under-reporting of symptoms, or a healthy survivor effect.

Psychotic Symptoms and Schizophrenia

• Up to 10% of 85-year-olds without dementia may exhibit psychotic symptoms.
• Approximately 23% of schizophrenia patients experience onset after their fifth decade.
• 15% to 20% will show a deteriorating clinical course.
• Negative symptoms are more prominent in earlier-onset schizophrenia.
• Positive symptoms, such as delusions and hallucinations, tend to decrease in severity.
• Paranoid ideation is a common clinical symptom in late-onset schizophrenia.
• Physical organic causes should always be considered and ruled out in cases of acute psychosis in old age.

Substance Use Disorders

• Smoking is a main topic within substance use disorders.
• Tobacco smoking prevalence varies among older persons based on gender, age, and cultural background.
• Smoking is linked to increased mortality and morbidity.
• Older adults respond well to counseling and medical advice for smoking cessation.
• Brief advice interventions have proven useful in helping to quit smoking.
• Illegal drug use is uncommon in old age.
• Abuse of prescription and over-the-counter medications, like benzodiazepines and opiates, is common.
• Inquiring about medication use is an important aspect of assessment to detect misuse.

Alcohol Misuse

• Research indicates that the prevalence of alcohol use disorders decreases with age.
• There may be an under report of of alcohol consumption in the general population.
• Alcohol abuse is more frequent in patients with comorbid pain and psychiatric diagnoses.
• Tolerance to alcohol decreases due to pharmacokinetic and pharmacodynamic changes.
• Alcohol abuse problem is expected to continue to grow as the baby boomer generation ages.
• Psychosocial treatment and psychoeducation can be effective for alcohol-related disorders.
• Integrated care services have reported better outcomes than specialized care settings for alcohol related disorders.

Dementia

• Dementia is a syndrome with chronic or progressive deterioration in cognitive functions, including memory, thinking, behavior, and daily activities.
• Dementia mainly affects older people and is not a normal part of aging.
• It’s estimated that 50 million people worldwide live with dementia, nearly 60% are in low- and middle-income countries.
• The number of people with dementia could increase to 82 million in 2030 and 152 million in 2050.

Alzheimer's Disease

• Alzheimer's disease is the most common type of dementia, accounting for up to two-thirds of cases.
• Risk factors include advanced age, Apolipoprotein e4 genotype, cardiovascular risk factors, and lower education.
• Major histological hallmarks are amyloid plaques and neurofibrillary tangles, consisting of tau protein.
• Plaques and tangles begin in the hippocampus and entorhinal cortex.
• The disease has an insidious onset and progresses slowly over the years.
• Diagnosis is mainly clinical, using cognitive screening tests such as MMSE and ACE.
• Medical professionals request blood tests to measure folate and vitamin B12 levels and brain imaging to confirm diagnosis.
• Early, common symptoms include short-term episodic memory loss and word-finding difficulties.
• BPSD (behavioral psychological symptoms of dementia), such as depression, psychosis, apathy, sleep disturbances, and agitation or aggression, are common in later stages.
• Treatments include acetylcholinesterase inhibitors (galantamine) and memantine to slow cognitive decline.
• Implementing psychosocial interventions for patients, cognitive stimulation, social participation, and caregiver psycho-education are important for treatment in Alzheimer's Disease.
• Further research is still required in finding disease modifying drugs.

Vascular Dementia

• Vascular dementia accounts for 10% to 15% of all dementias.
• Vascular dementia is associated with strokes.
• Large strokes lead to sudden worsening of cognition and stepwise progression.
• Microvascular disease often manifests with a subcortical dementia profile.
• Cardiovascular risk factors, such as smoking, hypertension, and diabetes, are common.
• Symptoms vary depending on the affected brain area.
• Neuropsychological testing results tend to be patchy.
• There is no clear indication of benefit with acetylcholinesterase inhibitors.

Fronto-Temporal Dementia (FTD)

• Fronto-temporal dementia represents dementia syndromes affecting the frontal and temporal lobes.
• Three common subtypes are the behavioural variant, semantic dementia, and progressive non-affluent aphasia.
• FTD accounts for 5% to 15% of all dementia diagnoses.
• Clinical features include earlier onset and a stronger familial loading.
• Behavioural changes includes disinhibition, apathy, social inappropriateness, and executive dysfunction dominate the early clinical course.
• Overlap with extrapyramidal disorders, such as Parkinsonism, may occur.
• Semantic dementia implies specific loss of word meaning and comprehension difficulties.
• Progressive non-affluent aphasia is marked by achromatic and telegraphic speech.
• Treatment options are limited for vascular dementia.

Lewy-Body Dementia

• Lewy-body dementia is the second most common form of dementia.
• The histological hallmark is Lewy bodies synuclein inclusions in the neocortex and brain stem.
• Clinical features include Parkinsonism (rigidity and bradykinesia), fluctuating consciousness, and visual hallucinations.
• Falls, autonomic instability, and REM behavior sleep disorders are typical clinical features.
• Lewy Body Dementia responds to acetylcholesterase inhibitors, showing a modest effect.
• Patients with LBD are highly sensitive to motor side effects of antipsychotics.

Dementia in Parkinson's Disease

• Dementia in Parkinson's disease shows Lewy bodies, diffused in cortical regions.
• Parkinson's dementia affects 30% to 50% of persons with Parkinson's disease.
• Clinical features include deficits in visual-spatial functioning, attention, and executive functioning and psychotic symptoms including visual hallucinations.
• Dementia in Parkinson's develops late in the illness after years of motor symptoms.
• Rivastigmine is recommended, particularly at initial stages for treatment.