This paper presents a literature review of two significant mental health disorders affecting the elderly population: Alzheimer's-type dementia and eating disorders. Drawing on the DSM-IV-TR classification framework, the paper examines the cognitive impairments associated with Alzheimer's disease — including memory loss, language deficits, and behavioral symptoms — alongside current diagnostic tools and treatment options. It also explores the underexamined prevalence of eating disorders such as anorexia nervosa and bulimia nervosa among older adults, analyzing how physical, psychological, and social factors contribute to disordered eating in later life. The paper concludes that dementia and eating disorders in the elderly may be self-perpetuating, and that overlapping symptoms with depression make accurate diagnosis especially challenging.
In considering the general health of the population, a larger elderly population does not necessarily mean that most older adults live with or suffer from severe disabilities. Age-related disorders occur at different points in different people's lives. People are living longer and healthier, with the elderly population achieving this in the higher age range of a 5–10 year population cohort. However, there are key exceptions regarding disorders and mental health conditions in the older population, illustrated by conditions such as dementia, Alzheimer's disease, and the wider spectrum of related disorders. Understanding mental disorders in older people is currently an important area of inquiry. This paper presents a thorough review of literature to examine two disorders affecting the elderly population.
The focus is on understanding Delirium, Dementia, Amnestic and Other Cognitive Disorders, and eating disorders — categories from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) — as they present in older people. Cognition encompasses orientation, language, judgment, memory, performance of actions, problem-solving, and the conduct of interpersonal relationships (Benjamin & Virginia, 2008). Cognitive disorders are those that disrupt one or more of these aspects and are often complicated by behavioral symptoms. Delirium, Dementia, and Amnestic Disorders are characterized by complex interfaces among psychiatry, medicine, and neurology.
According to the DSM-IV-TR, these three groups — dementia, delirium, and amnestic disorders — share a common core symptom: impairment of cognition. Delirium is short-term confusion indicated by changes in cognition, caused by general medical conditions such as infection, multiple causes such as kidney failure and head trauma, substance-induced states, or unspecified causes (Benjamin & Virginia, 2008). Dementia is indicated by severe impairment in judgment, memory, cognition, and orientation. There are six categories of dementia, including Alzheimer's-type dementia — which occurs mainly in persons over 65 years and is indicated by delusions, disorientation, and depression — as well as vascular dementia caused by thrombosis or hemorrhage, dementia due to medical conditions such as head trauma or Pick's disease, substance-induced dementia, dementia of multiple etiologies, and dementia not otherwise specified (Benjamin & Virginia, 2008). Amnestic disorder is indicated by forgetfulness and memory impairment, caused by a medical condition such as hypoxia or by medication or toxin exposure. Of particular interest is the presentation of Alzheimer's-type dementia in the elderly, since dementia shares symptoms with other DSM-IV-TR disorders — including impaired judgment, memory, cognition, and speech orientation.
While many studies investigate cognitive disorders in elderly populations, few investigate the trend of eating disorders in this group, as eating disorders have historically been considered conditions of adolescents and middle-aged people. Eating disorders are examined here because they are on the rise among the elderly population (Business Wire, 2013). Eating disorders are indicated by two primary conditions — Bulimia Nervosa and Anorexia Nervosa — both characterized by a preoccupation with body image. The literature indicates that eating disorders in the elderly present with symptoms similar to those seen in younger sufferers, with a comparably strong emphasis on body image. This paper investigates eating disorders as a mental health issue affecting the elderly through factors such as difficulty eating, dementia or forgetting to eat, cancer or illness-related inability to cook and shop, poverty, elder abuse, and isolation.
More than 70 diseases and conditions can cause dementia. Though rare, temporal dementia can be caused by substance abuse, urinary tract infection, or vitamin deficiency. Alzheimer's disease is the most common type of dementia, present in 70% of dementia cases (Sullivan & Sullivan, 2010). Fraller (2013) notes that it has been more than 100 years since Alois Alzheimer published the case study of his patient Auguste, a 51-year-old woman who displayed symptoms of "irrationality, memory loss, disorientation to time and place, paranoia, hallucinations, and difficulties with language and cognition." These symptoms progressed to incontinence, being bedridden, and becoming nonverbal. Following the patient's death, an autopsy revealed "atrophy, tangled bundles of neurofibrils and accumulations of an unknown substance in a miliary pattern" (Fraller, 2013, p. 63). The combination of "memory loss, loss of executive function, behavioral symptoms, and patterns of histopathological lesions" is what has come to be called Alzheimer's Disease (AD) (Strassnig & Ganguli, 2005, cited in Fraller, 2013). There are three stages of Alzheimer's — mild or early, moderate, and late or severe — with advancement from one stage to the next indicated by a progression in the seriousness of symptoms.
Studies identify that Alzheimer's is not a normal aging disease, but one that often afflicts elderly persons aged 65 and older. According to Fairfield and Mammarella (2009), the results of individual longevity and population growth suggest that many elderly persons carry what has been proposed as the Alzheimer's accelerator gene, identified by Roses Allen. The study finds that persons with Alzheimer's-type dementia exhibit source-monitoring deficits. According to source-monitoring deficit theory, people use two classes of information to discriminate memory origins: qualitative characteristics such as contextual detail with associated cognitive operations, and conceptual information such as general knowledge. Persons with Alzheimer's disease have a diminished capacity to use either category to discriminate memory. To test this deficit in elderly Alzheimer's patients, the research examined cognitive operations between internally and externally generated events in both pathological and healthy aging persons. Fairfield and Mammarella (2009) found that older adults have greater difficulty than younger adults in discriminating between memories of performed and imagined actions, and that elderly patients with Alzheimer's-type dementia had marked difficulties in attributing the sources of imagined actions.
Carreiras, Baquero, and Rodriguez (2008) investigated syllable congruency frequency effects and syllable congruency effects in Alzheimer's patients, young adults, and elderly persons, yielding results consistent with those of Fairfield and Mammarella (2009). The results indicate that syllable congruency effects existed but differed across the three test groups (Carreiras, Baquero, & Rodriguez, 2008). The syllable congruency response in young adults was stronger than in elderly and Alzheimer's patients. Young adults responded more slowly to high-frequency syllables and more quickly to low-frequency syllables, while elderly and Alzheimer's patients responded slowly to low-frequency syllables and relatively faster to high-frequency syllables. This pattern is consistent with cognitive impairment affecting speech orientation.
These findings agree with a report in Nursing Home & Elder Business Week (2012), which identifies Alzheimer's disease as defined primarily by memory problems. That study examined 658 adults aged 65 and above who were free from dementia. Participants were given MRI scans and tests measuring language, memory, speed of information processing, and visual perception. By the study's end, 174 participants had silent strokes. Those with silent strokes scored slightly lower on memory tests than those without, as did persons with a smaller hippocampus — the brain's memory center. The study linked Alzheimer's memory problems with memory problems observed in persons with silent strokes and a small hippocampus.
This review further finds support for Alzheimer's as a disorder rooted in brain impairment through the work of Strassnig and Ganguli (2005, cited in Fraller, 2013). Fraller (2013) reports that the Alzheimer's Disease Neuroimaging Initiative (ADNI) is an "ongoing longitudinal international research collaboration funded by the National Institute of Aging (NIA), multiple pharmaceutical companies and private donations via the Foundation for the National Institutes of Health (NIH)" (p. 64). This project resulted in the development of "new biomarkers and brain imaging techniques" that enable visualization of AD pathology in living patients. These techniques, combined with patient history and cognitive testing, may improve "certainty of the diagnosis of AD and enable diagnosis of AD earlier in the disease process" (Fraller, 2013, p. 64). Over the past decade, research has also indicated potential cognitive benefits for patients with AD from vitamins E, B12, and B6, folic acid, omega-3 fatty acids in fish oil, and ibuprofen.
These studies underscore the importance of both assessment and management of Alzheimer's disease. In Fraller (2013), management strategies include vitamins E, B12, and B6, folic acid, omega-3 fatty acids in fish oil, and ibuprofen (p. 64), as well as light therapy and physical therapy to support speech and function. Approved pharmacological treatments include Donepezil, rivastigmine, galantamine, and tacrine for mild-to-moderate cognitive impairment in patients with AD. Donepezil has also received FDA approval for use in moderate-to-severe AD.
Beyond pharmacological management, ongoing assessment is required for patients with Alzheimer's. According to Uriri-Glover, McCarthy, and Cesarotti (2013), this involves standardized rating scales such as the Functional Assessment Staging Test (FAST), the Global Deterioration Scale, and the Clinician's Interview-Based Impression, which are used to determine functional decline in individuals with AD and other forms of dementia. Treatment also includes Ginkgo and ginseng — the most commonly used herbal supplements for memory enhancement and prevention of cognitive decline.
In the assessment of Alzheimer's disease, Dierckx et al. (2011) identify early identification as critically important. Early assessments using episodic memory tasks have predictive power for AD in its early stages, measuring deficits in the encoding and storage processes that characterize the disease. However, the study notes that results can present diagnostic challenges, since they may also reflect other memory-related conditions such as depression. Studies indicate that depression is associated with many late-life developments and disorders (Dierckx et al., 2011). To differentiate Alzheimer's disease from depression, the study used a ten-word list-learning task to evaluate the rate of forgetting and delayed recognition associated with memory loss and low cognitive ability in mild Alzheimer's-type dementia and depression. Results indicate that in both conditions, receiver operating characteristics for delayed recognition and forgetting were present, and that forgetting showed the highest diagnostic accuracy in distinguishing mild AD from depression (Dierckx et al., 2011). The close link between depression and elderly disorders is a recurrent theme in the literature, with depression appearing as a symptom of both Alzheimer's dementia and eating disorders.
Abbilello and Rosenfeld (2013) report on cognitive impairment in community and home settings, noting that delirium — a "temporary state of cognitive impairment" — "has been associated with increased morbidity and mortality in both the palliative care and geriatric population" (p. 104). Delirium is also cited as extending hospital stays, exacerbating medical conditions, and increasing poor patient outcomes, further burdening caregivers and the healthcare system. The authors also describe a small study examining whether the question "Do you think [this person] has been more confused lately?" could be used to assess delirium. Study findings suggest that cognitive impairment without dementia affects an extremely large number of individuals, although the study is reportedly inconclusive and more research is needed.
"Prevalence and risk factors of late-life eating disorders"
"Body image, multifactorial causes, and clinical presentations"
"Self-perpetuating link between dementia and disordered eating"
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