Neuropsychology of ageing
Lecture 1: introduction: why ageing
Why is ageing relevant to study
Scientific reasons:
1. to present a more complete view of development
- Developmental psychology: focus on children or young adults, ignores continuation of
development in adulthood
- Two stage model: popular assumption in developmental psychology: physical and
psychological functions develop up to a point, followed by gradual and predictable
decline. Outdated model is too simplified
2. Life span perspective: changes between birth and death regarded as development
- Changes in functional capacity are part of the life span
- Changes are not necessarily deterioration of functions so no gradual decline
- Erikson’s stage model (identity crises): psychometric lifespan approach: different crises
to be resolved at different points in life
o Eg: identity vs confusion crisis in puberty, integrity vs despair crisis >65
- Schaie and Willis stage theory of cognition: stages reflect different uses of cognition
rather than stage in acquisition of new information (piaget). Is about the use of cognition
o Eg: achieving stage in early adulthood, reintegration stage, reorganizational stage,
legacy-creating stage
- Selection, optimization and compensation theory (SOC, Baltes): during development
people gain and lose capabilities, at old age losses start to outnumber the gains, and
ageing is seen as a dynamic process of adaption: selection of relevant activities to
maintain optimal functioning and to compensate for limitations
Compensation for limitations
Other theoretical approaches to cognitive ageing
- Information-processing approach: different components of cognition affected differently
by ageing, eg slowing information processing speed (Salthouse) meer in volgende
lecture, hierover is consensus: je wordt langzamer als je ouder wordt
- Biological approaches: effects ageing on different bain areas reflected in different
cognitive effects, eg frontal ageing hypothesis frontal lobe is belangrijk
- Integrative approaches: effects of ageing influenced by biological, psychological and
social factors: biopsychosocial model (Engel), eg scaffolding theory (STAC)
combinatie van bovenstaande approaches
o STAC model: scaffolding as normal response of brain to neural challenges in order
to maintain level of cognitive functioning
o STAC-r: adds influence of life course risk factors and protective factors
Belangrijkste: nuance van het idee dat ontwikkeling niet verdergaat als je 25jr bent
3. Societal reasons: strong increase in number of older persons worldwide is niet alleen een
rijke landen fenomeen:
- Because of: better healthcare, hygiene, nutrition, life styles, reduction of cardiovascular
mortality and smoking
,- Leads to: increase in diseases associated with ageing, increased demand for treatment
and care, prevention of age-related disorders more important
Consequences of population ageing
Over 60s will become the largest age group
2024: population over 60 expected to outnumber all other age groups in more developed
regions, by 2080 worldwide
Old age support ratio expected to decline further (was in 2013 4 persons of working age for
each older person in developed regions)
= number of people aged 15-64 / number of people aged >65
Dependency ratio: ratio between the population in most dependent ages and the population
in the main working ages
= number of children <15 + number of people >65 / number of people 15-64
- Higher dependency rate: more dependents relative to the group in the productive ages.
Dependency rate will increase in more developed countries, mainly because of increase
in older people
Health and healthcare costs
- Health expenditure grow rapidly due to ageing: older persons require more health care
in general and more specialized services for more complex pathologies
- Major causes of disability and health problems in old age are non-communicable
diseases (dus niet inflecties enzo) including: heart disease, cancer, diabetes, the four
giants of geriatrics (immobility, instability, incontinence, intellectual impairment) in dit
course focus on intellectual impairment/dementia/MCI
- Intellectual impairment/dementia. Prevalence: total number of people with dementia
projected to increase to 65.7 million in 2030 and 115.4 million in 2050 (WHO)
o Dementia is one of the world’s most expensive diseases: increasing prevalence,
large proportion of people with dementia who need support and care, in high
income countries live in nursing homes, no effective medical treatment for
dementia despite decades of research
Cognitive ageing
Ageing will not lead to universal cognitive decline
- Successful ageing: maintain cognitive function or very modest decline
10% of older adults, lower mortality than typical agers (live longer)
Often older persons without conditions or medications that effect cognition -> isolate
effect of age only without confounders of illness and medication -> age alone has little
effect on cognition, decline is not inevitable
Seem to be unaffected by age, lot of interest in this group
Oudere studie: strikte criteria om iemand als succesfully aged te labelen (moeten
hetzelfde scoren als mensen onder 30)
Leven ook langer, dus fysiek en cognitief beter (dit is ideal, want geen kosten voor de
zorg)
- Normal ageing: overall modest decline of most cognitive abilities (but not all abilities)
Around 70% of older adults
Changes in cognitive functioning, but still healthy ageing
, Onderscheid healthy ageing en vroege dementie: kan door robuste normering, veel
mensen over langere tijd volgen. Mensen van de sample verwijderen als ze ooit ergens
dementie krijgen.
- Mild cognitive impairment (MCI): decline greater than normal
o Criteria proposed >1DS or clinical dementia rating of 0.5
Around 30% of older adults
Changes in dementia incidence: 13% decrease in all-cause dementia per decade since
1998, based on large scale population studies (mainly in high income countries)
Global burden of disease study: incidence dementia decreased in 71 of 204 countries
between 1990 and 2019, significant decrease in 18 countries
- Dementia: marked decline in cognitive functioning, interfering with daily functioning
Ageing and wellbeing
Of all groups in the Netherlands, the 65-75 age group is the happiest and most content
>75: 84% content, 86% happy
Less depression in older ages
Over 55 wealthiest age group
Subjective experience of heath and ability more positive than objective health and ability
Higher subjective wellbeing in older age: The U-Bend self-reported well being
Satisfaction paradox: stability despite loss
- Age-cohort effects: older people may report higher levels of life satisfaction because of
the lower expectations of their generation
- Socio-emotional selectivity theory: individuals experience more life satisfaction as age
increases because they spend more time on activities that contribute to their well-being
instead of pursuing goals that are expected to pay off in the future
- Declining goal-achievement gap: as time goes by, aging persons realize that their
expectations were probably set too high in their younger years and learn to accept the
reality of their lives
Aging increases heterogeneity
In biological variables, cognitive variables, social variables and personality (self esteem and
depression)
Normal ageing increases cognitive heterogeneity
Heterogeneity in biological age among persons of the same chronological age
Chronological age: number of years since birth, if your biological age is higher than your
chronological age you have increased risk of disease or mortality
Oudere mensen over het algemeen meer blij, maar ook hier geldt binnen die groep meer
heterogeneity, dus ook veel mensen die niet zo blij rapporteren
Methods in ageing research
Age is critical variable in ageing research: typically, chronological age
What is the effect of age on behavior or cognitive function
Age is an organismic variable = cannot be manipulated -> only ways to study effect of age:
- Comparing different persons who differ in age but otherwise as similar as possible
- Comparing the same person at different points in time when they are at different ages
, 1. Cross-sectional design
- Age differences, not changes with ageing
- Age effect derived from differences between persons who were born in different years
- Problem: age effect could be confounded by cohort effect/bias: cohort members have
common experiences as they grow up, which could influence their development and
consequently their test performance in adulthood bijvoorbeeld weinig verwachtingen
van het leven en dus hogere waardering tov een groep die later is geboren/opgegeroeid
en wel hogere verwachtingen heeft
2. Longitudinal designs (beter)
- Changes between T1 and T2 reflect effect of ageing
- No cohort effects but other problems: time consuming and expensive, findings may not
generalize to their cohorts, retest and practice effects, selective dropout and attrition
- Retest effects: function studied may benefit from repeated testing which may mask the
ageing related decline -> underestimation of the effect
- Selective dropout: when participants do not return for follow-up assessments, is not a
problem when it is random but is a problem when it is selective. Systematic relationship
between attrition and performance; participants staying in longitudinal studies tend to
have better health and cognitive functioning than those dropping out
Both designs
- Recruitment bias: those with poorer health or wealth less likely to participate in research
-> no representative sample of the population
- Misclassification bias: persons in early stage of neurodegenerative disease misclassified
as healthy -> effect of ageing may be overestimated
Lecture 2: normal cognitive ageing and brain ageing
Memory
Deterioration of memory is associated with ageing
Different effects of different types and stages of memory, ‘ageing affects memory’ is
oversimplified
In general:
- More automatic processing: age-effect is smaller
Short term, semantic, implicit, procedural
- More controlled processing: age-effect is larger
Working, episodic, prospective, source memory
Meta-analysis verbal memory
- For short term memory: minor effects of age
Maintenance of the material
Eg: digit span forward, age difference = 0.53 (items more are recalled by younger group)
- Working memory: age effect
Processing component added to maintenance of the material
Eg: computation span or reading span task, age difference = 1.54
Episodic memory
Controlled versus automatic
Incidental versus intentional learning
Lecture 1: introduction: why ageing
Why is ageing relevant to study
Scientific reasons:
1. to present a more complete view of development
- Developmental psychology: focus on children or young adults, ignores continuation of
development in adulthood
- Two stage model: popular assumption in developmental psychology: physical and
psychological functions develop up to a point, followed by gradual and predictable
decline. Outdated model is too simplified
2. Life span perspective: changes between birth and death regarded as development
- Changes in functional capacity are part of the life span
- Changes are not necessarily deterioration of functions so no gradual decline
- Erikson’s stage model (identity crises): psychometric lifespan approach: different crises
to be resolved at different points in life
o Eg: identity vs confusion crisis in puberty, integrity vs despair crisis >65
- Schaie and Willis stage theory of cognition: stages reflect different uses of cognition
rather than stage in acquisition of new information (piaget). Is about the use of cognition
o Eg: achieving stage in early adulthood, reintegration stage, reorganizational stage,
legacy-creating stage
- Selection, optimization and compensation theory (SOC, Baltes): during development
people gain and lose capabilities, at old age losses start to outnumber the gains, and
ageing is seen as a dynamic process of adaption: selection of relevant activities to
maintain optimal functioning and to compensate for limitations
Compensation for limitations
Other theoretical approaches to cognitive ageing
- Information-processing approach: different components of cognition affected differently
by ageing, eg slowing information processing speed (Salthouse) meer in volgende
lecture, hierover is consensus: je wordt langzamer als je ouder wordt
- Biological approaches: effects ageing on different bain areas reflected in different
cognitive effects, eg frontal ageing hypothesis frontal lobe is belangrijk
- Integrative approaches: effects of ageing influenced by biological, psychological and
social factors: biopsychosocial model (Engel), eg scaffolding theory (STAC)
combinatie van bovenstaande approaches
o STAC model: scaffolding as normal response of brain to neural challenges in order
to maintain level of cognitive functioning
o STAC-r: adds influence of life course risk factors and protective factors
Belangrijkste: nuance van het idee dat ontwikkeling niet verdergaat als je 25jr bent
3. Societal reasons: strong increase in number of older persons worldwide is niet alleen een
rijke landen fenomeen:
- Because of: better healthcare, hygiene, nutrition, life styles, reduction of cardiovascular
mortality and smoking
,- Leads to: increase in diseases associated with ageing, increased demand for treatment
and care, prevention of age-related disorders more important
Consequences of population ageing
Over 60s will become the largest age group
2024: population over 60 expected to outnumber all other age groups in more developed
regions, by 2080 worldwide
Old age support ratio expected to decline further (was in 2013 4 persons of working age for
each older person in developed regions)
= number of people aged 15-64 / number of people aged >65
Dependency ratio: ratio between the population in most dependent ages and the population
in the main working ages
= number of children <15 + number of people >65 / number of people 15-64
- Higher dependency rate: more dependents relative to the group in the productive ages.
Dependency rate will increase in more developed countries, mainly because of increase
in older people
Health and healthcare costs
- Health expenditure grow rapidly due to ageing: older persons require more health care
in general and more specialized services for more complex pathologies
- Major causes of disability and health problems in old age are non-communicable
diseases (dus niet inflecties enzo) including: heart disease, cancer, diabetes, the four
giants of geriatrics (immobility, instability, incontinence, intellectual impairment) in dit
course focus on intellectual impairment/dementia/MCI
- Intellectual impairment/dementia. Prevalence: total number of people with dementia
projected to increase to 65.7 million in 2030 and 115.4 million in 2050 (WHO)
o Dementia is one of the world’s most expensive diseases: increasing prevalence,
large proportion of people with dementia who need support and care, in high
income countries live in nursing homes, no effective medical treatment for
dementia despite decades of research
Cognitive ageing
Ageing will not lead to universal cognitive decline
- Successful ageing: maintain cognitive function or very modest decline
10% of older adults, lower mortality than typical agers (live longer)
Often older persons without conditions or medications that effect cognition -> isolate
effect of age only without confounders of illness and medication -> age alone has little
effect on cognition, decline is not inevitable
Seem to be unaffected by age, lot of interest in this group
Oudere studie: strikte criteria om iemand als succesfully aged te labelen (moeten
hetzelfde scoren als mensen onder 30)
Leven ook langer, dus fysiek en cognitief beter (dit is ideal, want geen kosten voor de
zorg)
- Normal ageing: overall modest decline of most cognitive abilities (but not all abilities)
Around 70% of older adults
Changes in cognitive functioning, but still healthy ageing
, Onderscheid healthy ageing en vroege dementie: kan door robuste normering, veel
mensen over langere tijd volgen. Mensen van de sample verwijderen als ze ooit ergens
dementie krijgen.
- Mild cognitive impairment (MCI): decline greater than normal
o Criteria proposed >1DS or clinical dementia rating of 0.5
Around 30% of older adults
Changes in dementia incidence: 13% decrease in all-cause dementia per decade since
1998, based on large scale population studies (mainly in high income countries)
Global burden of disease study: incidence dementia decreased in 71 of 204 countries
between 1990 and 2019, significant decrease in 18 countries
- Dementia: marked decline in cognitive functioning, interfering with daily functioning
Ageing and wellbeing
Of all groups in the Netherlands, the 65-75 age group is the happiest and most content
>75: 84% content, 86% happy
Less depression in older ages
Over 55 wealthiest age group
Subjective experience of heath and ability more positive than objective health and ability
Higher subjective wellbeing in older age: The U-Bend self-reported well being
Satisfaction paradox: stability despite loss
- Age-cohort effects: older people may report higher levels of life satisfaction because of
the lower expectations of their generation
- Socio-emotional selectivity theory: individuals experience more life satisfaction as age
increases because they spend more time on activities that contribute to their well-being
instead of pursuing goals that are expected to pay off in the future
- Declining goal-achievement gap: as time goes by, aging persons realize that their
expectations were probably set too high in their younger years and learn to accept the
reality of their lives
Aging increases heterogeneity
In biological variables, cognitive variables, social variables and personality (self esteem and
depression)
Normal ageing increases cognitive heterogeneity
Heterogeneity in biological age among persons of the same chronological age
Chronological age: number of years since birth, if your biological age is higher than your
chronological age you have increased risk of disease or mortality
Oudere mensen over het algemeen meer blij, maar ook hier geldt binnen die groep meer
heterogeneity, dus ook veel mensen die niet zo blij rapporteren
Methods in ageing research
Age is critical variable in ageing research: typically, chronological age
What is the effect of age on behavior or cognitive function
Age is an organismic variable = cannot be manipulated -> only ways to study effect of age:
- Comparing different persons who differ in age but otherwise as similar as possible
- Comparing the same person at different points in time when they are at different ages
, 1. Cross-sectional design
- Age differences, not changes with ageing
- Age effect derived from differences between persons who were born in different years
- Problem: age effect could be confounded by cohort effect/bias: cohort members have
common experiences as they grow up, which could influence their development and
consequently their test performance in adulthood bijvoorbeeld weinig verwachtingen
van het leven en dus hogere waardering tov een groep die later is geboren/opgegeroeid
en wel hogere verwachtingen heeft
2. Longitudinal designs (beter)
- Changes between T1 and T2 reflect effect of ageing
- No cohort effects but other problems: time consuming and expensive, findings may not
generalize to their cohorts, retest and practice effects, selective dropout and attrition
- Retest effects: function studied may benefit from repeated testing which may mask the
ageing related decline -> underestimation of the effect
- Selective dropout: when participants do not return for follow-up assessments, is not a
problem when it is random but is a problem when it is selective. Systematic relationship
between attrition and performance; participants staying in longitudinal studies tend to
have better health and cognitive functioning than those dropping out
Both designs
- Recruitment bias: those with poorer health or wealth less likely to participate in research
-> no representative sample of the population
- Misclassification bias: persons in early stage of neurodegenerative disease misclassified
as healthy -> effect of ageing may be overestimated
Lecture 2: normal cognitive ageing and brain ageing
Memory
Deterioration of memory is associated with ageing
Different effects of different types and stages of memory, ‘ageing affects memory’ is
oversimplified
In general:
- More automatic processing: age-effect is smaller
Short term, semantic, implicit, procedural
- More controlled processing: age-effect is larger
Working, episodic, prospective, source memory
Meta-analysis verbal memory
- For short term memory: minor effects of age
Maintenance of the material
Eg: digit span forward, age difference = 0.53 (items more are recalled by younger group)
- Working memory: age effect
Processing component added to maintenance of the material
Eg: computation span or reading span task, age difference = 1.54
Episodic memory
Controlled versus automatic
Incidental versus intentional learning
