Psychiatry of old age
Overview Psychiatric illness particular to zhe elderly -Alzheimer＇s disease -Lewy body disease -Vascular dementia -frontal lobe dementia -Subcortical dementia Psychiatric illness similar to that seen in younger adults -Depression
Psychiatric illness similar to that seen in younger adults Depression • The most common condition • Somatic,symptoms,hypochondriasis,and rthoughts about death are more common in zhe elderly. • Maior depressive disorder in zhe elderly can be complicated by an underlying organic brain syndrome. • The development of a depressive illness can be zhe first sign of a dementia
Manargement of depression Aim :treat zhe depressive disorder and address zhe precipiating maintain factors • Drug treatment • Psychosocial therapy • Other treatment
Disorders particual to older people Chronic brain syndromes(dementias) Alzheimer’s Disease 1. Discribed by Alois Alzheimer in 1907 2.Conception：acquired、comprehensive、and progressive cognitive dysfunction（认知功能障碍). ➢1). Acquired（获得性）-智能正常Before AD：normal intelligence And no consciousness disorder（无意识障碍） ➢Comprehensive（全面性）- comprehensive recession of cognition（认知的综合衰退） ➢Progressive（进行性）-The course of AD is unreversibility （病程不可逆） ➢Dgenerative—neuronatrophy（神经元萎缩）、Cell derease （细胞减少）
2026/2/26 6 Alzheimer Disease (阿尔茨海默病) Alois Alzheimer，1907 First patient of AD Most famous patient
N A 3.4 million Afria 0.5 million N A 1.0 million W U 4.9 million India 1.8 million W P 1.5 million Latin A 1.8 million 2001 TOTAL: 24.3 million E U 2.8 million China 6.0 million * & Developing Western Pacific Region. From Ferri et al, Lancet 2005;366:2112–2117. 0 2 4 6 8 10 12 C hina* W Europe N A merica E Europe Lat in A merica India & S A sia W Pacif ic N A f rica & M iddle East A f rica Epidemiology of AD
5 N A 5.1 million Africa 0.9 million N A 1.9 million W U 6.9 million India 3.6 million W P 2.9 million L A 4.1 million 2020 TOTAL: 42.3 million E U 3.9 million Chnia 11.7 million * & Developing Western Pacific Region. From Ferri et al, Lancet 2005;366:2112–2117. 0 2 4 6 8 10 12 C hina* W Europe N A merica E Europe Lat in A merica India & S A sia W Pacif ic N A f rica & M iddle East A f rica Epidemiology of AD
6 N A 9.2 million Africa 1.6 million N A 4.7 million W U 9.9 million India 7.5 million W P 4.3 million L A 9.1 million 2040 TOTAL：81.1 million E U 6.0 million China 26.1 million 0 2 4 6 8 10 12 C hina* W Europe N A merica E Europe Lat in A merica India & S A sia W Pacif ic N A f rica & M iddle East A f rica 26.1 * & Developing Western Pacific Region. From Ferri et al, Lancet 2005;366:2112–2117. Epidemiology of AD
2026/2/26 10 Etiology and pathogenesis U ncertain.It m a y r e late t o g e netic a n d e n vironmental f a ctors. ➢ A m y l oid p r o t ein d e p osi ted a b n o rmal ly i n t h e b r a i n（脑内β样淀粉蛋白异常沉积） ➢ Dysfunction of Neurotransmitter（神经递质功能障碍）C o n t ain w i t h t h e a c t iv ity l o s e of AChE、 depress level of Ach ) ➢g enetic f actors ➢ APP、PS1、PS2 Gene mutation cause –Familial Dementia ➢ APOE4 ALLELIC GENE – Late onset AD ➢e nvironmental f actors ➢ V i r u s i n f e c t i o n 病毒感染 ➢ H e a v y m e t a l p o i s o n i n g 重金属中毒 ➢ A b n o r m a l l i p i d m e t a b ol i s m 脂质代谢异常