The Age of Ageing: Dementia Diagnosis and Treating Dementias?
Advancing Age and Quality Aged Care
The general population is steadily becoming more likely to continue living beyond 65 years of age. In fact, the Australian Bureau of Statistics predicted one-third of the population will be aged 75-84 years by 2066. Such a fact inevitably begs the question: Are those extra years in old age enjoyable?
Ageing is another stage of human development that brings specific strengths and challenges. Amongst the challenges is sometimes the onset of dementia. Before delving into what dementia is and how it manifests, it is important to first have a clear and realistic understanding of ageing.
Aged Care in Australia and Quality of Life
Keeping a balanced, realistic, and accurate outlook on ageing is fundamental to fostering greater quality of life through a healthier, active, and sharper mind.
There is often an assumption that ageing prevents a good quality of life. This belief is not completely unfounded. There are expected declines in some specific areas of cognitive functioning, physical strength, and potential changes in personality.
Psychological research, however, has found evidence that inaccurate, negative, and implicit beliefs about ageing can significantly affect performance on different cognitive and motor tasks.
In 1996, Becca Levy found that priming a group of 60+ year-olds with negative stereotypes about ageing (e.g., decline, dependent, senile, confused, etc.) significantly hindered their performance on a visual and auditory memory task.
On the other hand, the group that was primed with positive stereotypes about ageing (e.g., wise, insightful, astute, guidance) performed significantly better. Such experiments have subsequently been repeated to measure performance in other areas, like with motor skills such as walking and writing, and even eye gait precision – only to produce similar results.
Little is said about the positive psychological effects of ageing. In contemporary psychological research, it is well known that most psychological disorders “lose momentum” later in life. This is partially because old age is highly associated with increased wisdom. This increased wisdom offers better coping mechanisms to deal with stress, depression, fear, disappointment, and uncomfortable emotions overall.
There is also an increase in well-being after 50 years of age. This culminates from one's ability to effectively entertain ourselves and engage in activities we truly enjoy. Such skill is thought to emerge from self-knowledge.
Self-knowledge is an ability that is positively correlated with age. It is also a precursor to stability, integrity, trust, and independent thinking. Friendships also mature, become more meaningful, honest, and centred around shared interests. Retirement from work also allows older adults to be more invested in their personal interests, and hobbies, and be more engaged with their loved ones.
Ageing and Cognitive Performance
While there are expected psychological changes associated with ageing, the majority of older adults will not experience dementia in their older age. Memory lapses, and decreases in stamina, focus, and sleep are all part of the normal process of ageing.
In dementia, however, the observed symptoms are severe, causing significant distress, and dysfunction, and represent a marked deviation from the normal process of ageing.
Dementia is an umbrella term given to a series of disorders that have an underlying neurological basis, and represent a deterioration in brain function, or cognitive function, compared to a previous level or performance. They are acquired at some point in life, as opposed to developed.
Different Dementia Types
Alzheimer’s Disease (AD)
Among various types of dementia, the most prevalent is Alzheimer's disease. This condition arises from the accumulation of harmful substances known as amyloid beta, resulting in deteriorating brain cells and the entanglement of cell filaments. It's worth noting that these biological changes alone might not lead to Alzheimer's; cognitive capabilities and other factors also play a role.
Symptoms of Alzheimer Disease
The main symptoms of Alzheimer disease are a decline in one’s ability to learn and difficulty remembering new information. Other problems, such as imprecise or empty speech, motor difficulties, inability to identify objects, and difficulties with decision making may also be present.
What is Vascular Dementia (VD)?
People often ask 'What is Vascular Dementia?' VD is considered the second most common form of dementia. VD is related to one or multiple strokes in the outer layers of the brain.
Symptoms for Vascular Dementia
Symptoms for Vascular Dementia are very similar to ones found in AD. However, VD tends to be associated with a sudden onset of such symptoms. Other symptoms, such as weakness, tingling in the extremities and gait disturbances, are often associated with VD but not AD.
Frontotemporal Dementia (FD)
Frontotemporal Dementia is considered the least common form of dementia. It is often associated with individuals who are 50 or over.
Frontotemporal Dementia involves atrophy or degeneration of neurons in the frontal and temporal lobes of the brain, areas which are primarily responsible for decision-making, inhibition, impulse control, planning, and social interactions. While its cause is hypothesised to be largely genetic, they are yet to be understood.
Symptoms of Frontotemporal Dementia
The main feature of symptoms of frontotemporal dementia is a marked change in personality as opposed to memory deficits (which may only be present much later on). Traits such as rudeness, disinhibition, sexually inappropriate comments, and poor interpersonal conduct are often present. The impact on personality and interpersonal relationships is high.
Lewy Body Dementia (LBD)
Lewy Body Dementia affects 10% of those diagnosed with dementia. The disorder is caused by the presence of abnormal cells (Lewy bodies) mostly in the lower but also upper layer of the brain. The cause of LBD is yet to be fully investigated; however, it is currently hypothesised to have a strong genetic influence.
Lewy Body Dementia Symptoms
Lewy Body Dementia symptoms include complex visual hallucinations, varied and unreliable alertness, Parkinson-like symptoms, and severe sensitivity to neuroleptics.
Early Dementia Signs
Early signs of dementia can vary depending on the specific type of dementia and the individual's unique experiences. However, some common early signs across various types of dementia include:
Misplacing Items: Frequently misplacing items and struggling to retrace steps to find them.
Mood Changes: Experiencing changes in mood, personality shifts, or displaying heightened irritability.
Memory Loss: Forgetfulness, particularly regarding recent events or conversations.
Difficulty with Routine Tasks: Struggling to perform familiar tasks such as cooking, managing finances, or following a familiar route.
Language Problems: Struggling to find the right words, repeating phrases, or having difficulty understanding conversations.
Confusion: Becoming disoriented in time or place, even in familiar surroundings.
Poor Judgment: Exhibiting poor decision-making skills or making questionable choices.
Withdrawal: Withdrawing from social activities, hobbies, or other engagements that were once enjoyed.
Difficulty with Problem-Solving: Struggling with tasks that involve planning or problem-solving.
Changes in Visual Perception: Having difficulty interpreting spatial relationships or identifying colours and contrasts.
It's important to note that experiencing one or more of these symptoms doesn't necessarily mean someone has dementia, as some level of cognitive decline can be a normal part of ageing. However, if these symptoms are significantly affecting daily life and functioning, it's advisable to seek a professional medical evaluation for proper screening, assessment, diagnosis and guidance.
Diagnosis of Dementia
It's important to note that experiencing one or more of these symptoms doesn't necessarily mean someone has dementia, as some level of cognitive decline can be a normal part of ageing. However, if these symptoms are affecting daily life and functioning, it's advisable to seek a professional medical evaluation for proper screening, assessment, diagnosis and guidance.
While dementias are debilitating conditions, there is strong evidence that early diagnosis and treatment have a significant and positive impact on quality of life.
It is important to get screened for dementia when possible, and if diagnosed, there are several effective psychological tools and therapeutic approaches available to help possibly delay, manage and understand the symptoms.
Living with dementia does not preclude anyone from having a meaningful life. Speak to your clinician today, and take a proactive and effective approach to guarantee a healthy and enjoyable post-retirement future.
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Levy, B. (1996). Improving memory in old age through implicit self-stereotyping. Journal of personality and social psychology, 71(6), 1092.
Levy, B. R. (2000). Handwriting as a reflection of aging self-stereotypes. Journal of Geriatric Psychiatry, 33,81-94.
Hausdorff, J. M., Levy, B. R., Wei, J. Y. (1999). The power of ageism on physical function of older persons: Reversibility of age-related gait changes. Journal of the American Geriatrics Society, 47,1346-1349.
Australian Bureau of Statistics. (2020, December). National, state and territory population. ABS. https://www.abs.gov.au/statistics/people/population/national-state-and-territory-population/dec-2020.
Australia, D. (2017). The Dementia Guide. Www.dementia.org.au. https://www.dementia.org.au/resources/the-dementia-guide
American Psychiatric Association. (2022). Neurocognitive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
Pachana, A. N., (2017). Ageing and psychological disorders. In E. Rieger (Eds.), Abnormal Psychology: Leading researcher perspectives, 4th Edition. McGraw-Hill Education Australia.
(c) 2023 Dean Harrison