686 CHAPTER 15
Like Mr. Rosen, Mrs. B. had a history of depression and was taking antidepres-
sant medication. However, the neuropsychologist who assessed Mrs. B.’s cognitive
functioning determined that the diffi culties she was having were not due to depres-
sion (LaRue & Watson, 1998).Anxiety Disorders
Like depression, anxiety disorders are less common among older adults than among
younger adults. The anxiety disorder most prevalent among older adults is gener-
alized anxiety disorder (Segal, 2003). About 5% of older adults have generalized
anxiety disorder, most often along with depression; in about half the cases, the anxi-
ety disorder was not present when the individual was younger (Flint, 2005). The
fears and worries that accompany generalized anxiety disorder can impair cognitive
functioning, in part because they give rise to preoccupations and decreased atten-
tion and concentration.Schizophrenia
Although not common, about 15% of people with schizophrenia have their fi rst
psychotic episode when older than 44 (Cohen et al., 2000). Schizophrenia can in-
volve both positive symptoms (delusions and hallucinations) and negative symp-
toms, such as speaking minimally (alogia) and an absence of initiative (avolition;
see Chapter 12); these symptoms can also arise with cognitive disorders.Medical Factors That Can Affect Cognition
The typical older adult has one or more medical conditions that can diminish cog-
nitive functioning. In this section we review medical problems that affect cognitive
functioning and that can cause cognitive disorders—delirium, amnestic disorder,
and dementia.Diseases and Illnesses
Various physical diseases and illnesses can affect cognition—directly or indirectly.
Some medical illnesses, such as encephalitis (a viral infection of the brain) and brain
tumors, directly affect the brain and, in doing so, affect cognition. The specifi c cog-
nitive defi cits that arise depend on the particular features of the illness, such as the
size and location of a brain tumor.
Some chronic diseases or illnesses indirectly affect cognition by creating pain,
which can disrupt attention, concentration, and other mental processes. For exam-
ple, arthritis can cause chronic pain, and the aftermath of surgery can cause acute
pain. In addition, pain can interfere with sleep, which further impairs mental pro-
cesses. The detrimental effects on cognition of some illnesses may be temporary, soCASE 15.1 • FROM THE OUTSIDE: Normal Aging or Something More?
Maurice Rosen was 69 when he made an appointment for a neurological evaluation. He had
recently noticed that his memory was slipping and he had problems with concentration that
were beginning to interfere with his work as a self-employed tax accountant. He complained
of slowness and losing his train of thought. Recent changes in the tax laws were hard for him
to learn, and his wife said he was becoming more withdrawn and reluctant to initiate activi-
ties. However, he was still able to take care of his personal fi nances and accompany his wife on
visits to friends. Although mildly depressed about his disabilities, he denied other symptoms
of depression, such as disturbed sleep or appetite, feelings of guilt, or suicidal ideation.
Mr. Rosen has a long history of treatment for episodes of depression, beginning in his
20s. He has taken a number of different antidepressants and once had a course of electro-
convulsive therapy. As recently as 6 months before this evaluation, he had been taking an
antidepressant.
(Spitzer et al., 2002, p. 70)