Psychische Erkrankungen im Alter – Warum wir eine neue Sicht brauchen

Zusammenfassung

Klinische Bilder bei älteren Patienten mit psychischen Erkrankungen sind häufig sehr komplex, einzelne Störungsbilder scheinen weniger abgegrenzt, was sich auch in epidemiologischen Studien bestätigt. In diesem Artikel wird die These einer Dedifferenzierung der Krankheitsbilder im Alter entwickelt. Als mögliche Ursache werden Defizite in den Exekutivfunktionen im Alter diskutiert.

Abstract

The clinical pictures of older patients with mental illnesses are often very complex, individual disorders appear less distinct, which is also confirmed in epidemiological studies. The article develops the hypothesis of a dedifferentiation of clinical pictures in old age. Deficits in executive functions in old age are discussed as a possible cause.

Schlüsselwörter

Gerontopsychiatrie - Krankheitsbilder - Dedifferenzierung - Exekutivfunktionen

Keywords

gerontopsychiatry - mental illness - dedifferentiation - executive functions

Publication History

Received: 25 July 2024

Accepted: 05 December 2024

Article published online:
07 January 2025

• Literatur

• 1 Abrams RC, Bromberg CE. Personality disorders in the elderly. Psychiat Ann 2007; 37: 123
• 2 Volkert J, Schulz H, Härter M. et al. The prevalence of mental disorders in older people in Western countries – a meta-analysis. Ageing Res Rev 2013; 12: 339-353
• 3 Linden M, Kurtz G, Baltes MM. et al. Depression bei Hochbetagten Ergebnisse der Berliner Altersstudie* Ergebnisse der Berliner Altersstudie. Nervenarzt 1998; 69: 27-37
• 4 Beekman AT, De Beurs E, Van Balkom AJ. et al. Anxiety and depression in later life: co-occurrence and communality of risk factors. Am J Psychiatry 2000; 157: 89-95
• 5 Andreas S, Schulz H, Volkert J. et al. Prevalence of mental disorders in elderly people: the European MentDis_ICF65 + study. Br J Psychiatry 2017; 210: 125-131
• 6 Braam AW, Copeland JR, Delespaul PA. et al. Depression, subthreshold depression and comorbid anxiety symptoms in older Europeans: Results from the EURODEP concerted action. J Aff Disord 2014; 155: 266-272
• 7 Peters M. Körperliche Krankheit bei älteren PatientInnen in der Psychosomatischen Klinik. Psychother, Psychosom, Med Psychol 2023; 73: 457-464
• 8 Bodkin JA, Pope HG, Detke MJ. et al. Is PTSD caused by traumatic stress?. J Anxiety Disord 2007; 21: 176-182
• 9 Lapp LK, Agbokou C, Ferreri F. PTSD in the elderly: the interaction between trauma and aging. Int Psychogeriat 2011; 23: 858-868
• 10 Peters M. Psychische Erkrankungen im Alter – Empirische Befunde zur Theorie sekundärer Strukturdefizite. Z Psychosom Med Psychother 2021; 67: 451-467
• 11 De Beni R, Palladino P. Decline in working memory updating through ageing: Intrusion error analyses. Memory 2004; 12: 75-89
• 12 Oberhauser L, Neubauer AB, Kessler E-M. Conflict avoidance in old age. GeroPsych 2018; 30: 61-70
• 13 Kessler EM. Psychotherapie mit sehr alten Menschen. Überlegungen aus Sicht der Lebensspannenpsychologie. Psychother Alter 2014; 11: 145-161
• 14 Lövdén M, Ghisletta P, Lindenberger U. Cognition in the Berlin Aging Study (BASE): the first 10 years. Aging Neuropsychol Cogn 2004; 11: 104-133
• 15 Park DC, Polk TA, Park R. et al. Aging reduces neural specialization in ventral visual cortex. Proceedings of the National Academy Sciences 2004; 101: 13091-13095
• 16 Dolcos F, Rice HJ, Cabeza R. Hemispheric asymmetry and aging: right hemisphere decline or asymmetry reduction. Neurosci Biobehav Rev 2002; 26: 819-825
• 17 Sauer-Zavala S, Gutner CA, Farchione TJ. et al. Current definitions of “transdiagnostic” in treatment development: A search for consensus. Behav Ther 2017; 48: 128-138
• 18 Snyder HR, Friedman NP, Hankin BL. Transdiagnostic mechanisms of psychopathology in youth: Executive functions, dependent stress, and rumination. Cognit Ther Res 2019; 43: 834-851
• 19 Malloy-Diniz LF, Miranda DM, Grassi-Oliveira R. Executive functions in psychiatric disorders. Front Psychol 2017; 8: 1461
• 20 Diamond A. Executive functions. Ann Rev Psychol 2013; 64: 135
• 21 Cristofori I, Cohen-Zimerman S, Grafman J. Executive functions. In: M D’Esposito, JH Grafman (Eds.) Handbook of clinical neurology. Elsevier; 2019. 163. 197-219
• 22 Hasher L, Stoltzfus ER, Zacks RT. et al. Age and inhibition. Journal of experimental psychology: Learning, Mem Cognit 1991; 17: 163
• 23 Palmer EC, David AS, Fleming STM. Effects of age on metacognitive efficiency. Conscious Cogn 2014; 28: 151-160
• 24 Von Hippel W, Vasey MW, Gonda T. et al. Executive function deficits, rumination and late-onset depressive symptoms in older adults. Cognit Ther Res 2008; 32: 474-487
• 25 Yochim BP, Mueller AE, Segal DL. Late life anxiety is associated with decreased memory and executive functioning in community dwelling older adults. J Anxiety Disord 2013; 27: 567-575
• 26 Fujii Y, Kitagawa N, Shimizu Y. et al. Severity of generalized social anxiety disorder correlates with low executive functioning. Neurosci Lett 2013; 543: 42-46
• 27 Zainal NH, Newman MG. Executive function and other cognitive deficits are distal risk factors of generalized anxiety disorder 9 years later. Psychol Med 2018; 48: 2045-2053
• 28 Polak AR, Witteveen AB, Reitsma JB. et al. The role of executive function in posttraumatic stress disorder: A systematic review. J Affect Disord 2012; 141: 11-21
• 29 Peters M, Schulz H. Theory-of-mind abilities in older patients with common mental disorders – a cross-sectional study. Aging & Ment Health 2022; 26: 1661-1668
• 30 Peters M, Schulz H. Zur klinischen Bedeutung reduzierter Exekutivfunktionen bei älteren Patient:innen mit psychischen Erkrankungen. Z Psychosom Med Psychother 2024; 69: 48-62
• 31 Behrendt I. Kognitive Hemmung – Experimente mit dem Directed-Forgetting-Paradigma. [Dissertation]. Göttingen: Georg-August Universität Göttingen; 2002
• 32 Lindenberger U, Li SC, Bäckman L. Delineating brain-behavior mappings across the lifespan: substantive and methodological advances in developmental neuroscience. Neurosci & Biobehav Rev 2006; 30: 713-717