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   PERSONALITY CHANGES IN OLD AGE – A SHORT REVIEW

Dr. Mona Srivastava

Assistant Professor,Deptt.of Psychiatry,

Institute of Medical Sciences,B.H.U., Varanasi

 

Personality traits are consistent determinants of human behavior. Personality traits also determine health outcomes, some traits are protective and some act as risk factors for morbidity, disability and mortality (1, 2)

In a prospective study (3) extraversion was associated with decreased rate of disability. High levels of conscientiousness showed disability to be lower by 50%. Higher rates of neuroticism and lower levels of social engagements in old age are associated with an increased risk of cognitive decline, disability and death. (4)

Assessment of personality in elderly has its limitations because of lack of specific instruments and the time needed to conduct such studies. As a part of healthy ageing, studies have shown it to be genetically determined. Genes define temperament and influence change in personality across the life span. Ageing is also genetically determined. Age related decrease in extra version and conscientiousness and increase in harm avoidance are a part of adaptive process (6). Johnson et al (6) have shown that personality traits remained stable between assessments on multidimensional personality questionnaires five years apart. The prevalence of personality disorders in elderly is reported at 2.8% - 13% in the community, 5-33% in outpatients, 7-61% in inpatients (7) Cluster B personality has been shown to decrease with age.

The personality disorders will be discussed in context with medical illness:

1.         Personality change in context of dementia syndrome

Behavioral and psychological symptoms (BPSD) are present in all types of dementia, BPSD symptoms may be the index symptoms for clinical intake. Early in the disease fronto- temporal lobar degeneration (FTLD) may present mostly as behavioral problems. Passant et al have reported that dramatic personality change, speech disorder, affective symptoms were present in patients who had a post mortem diagnosis of FTLD. Distribution in terms of inappropriate eating increased addiction; obscene, reckless behaviors have been reported. The time duration between onset and full blown dementia is one to six years (8). Typical socio-pathic behavior changes may appear and police apprehension may be needed; Diehl et al (9). The area primarily involved is the right temporal lobe. Dementia of Alzheimer’s type may initially present as anosognosia which may lead to decrease in activities of daily living (ADL) but the patient may continue to have insight into their deficits and cognitive tests (8,9). Rankin et al (10) report that self awareness for the changed behavior was markedly decreased in FTLD than Alzheimer’s. Some authors like to prefer the term “anosodiaphoria” or unconcern about the personality change for this disorder.

Personality changes in mild cognitive impairment

Mild cognitive impairment or MCI is a recent emerging field. A large study using Neuropsychiatry inventory (NPI) examined MCI patients, and found behavioral problem in 59% patients, dysphoria, apathy, irritability and anxiety were a couple of behavioral changes observed; Feldman et al (11).

Personality change in the context of a medical illness

The personality can change because of organic changes pathological changes and stress of having to deal with the illness. Frailty, loss of function can lead to reactive personality changes. Life long personality traits can show adaptive behavioral patterns. Illness like cortical atrophy, pituitary disease, cerebellar diseases heart disease have been studied in detail by Liszewski et al., (12)

Diogenes syndrome- A medical curiosity

A curious disorder which manifests in old age is characterized by self neglect squalor, hoarding behavior, social withdrawal, lack of concern for the living environment. Usually the older adults manifesting these symptoms do not fulfill any criteria. Sometimes FTLD, dementia syndromes and psychotic disorders may be present. Most often this disorder is a variant of preexisting personality traits. This disorder has been described as a geriatric variant of personality disorder most closely related to by cluster A personality. Mortality and morbidity are high since it is associated with lack of insight (13).

Conclusion:

Psychological coping is as variable as biological ageing. Since the personality constructs are relatively stable and the review of literature reveals that significant alterations in personality should serve as red flags signaling the need for further examination especially the different forms of dementia.

References :

1.             Wilson RS, Krueger KR, gui et al. Neuroticism, extra version and mortality in a defined population of older persons. Psychosomatic Medicine (2005); 67: 84 1-45.

2.             Weiss A, Costa PT. Domain and facet personality prediction of all-cause mortality among medical patients aged 65 to 100. Psychosomatic Medicine (2005); 67 : 724-33.

3.             Krueger KR. Wilson RS Shah RC et al. Personality and incident disability in older persons. Age and ageing (2006); 35: 428-33.

4.             Wilson RS, Krueger KR, Arnold SE et al. Childhood adversity and Psychosocial adjustment in old age. American Journal of Geriatric Psychiatry (2006); 14: 307-3 15.

5.             Van Alpen SPJ, Englen GJJA. Reaction to personality disorder masquerading as dementia: a case of apparent Diogenes syndrome. International Journal of Geriatric Psychiatry (2005); 20: 189-190.

6.             Johnson V, mcguem, Krueger RE. Personality stability in late adulthood : a behavioral genetic analysis. Journal of Personality (2005); 73: 523-55.

7.             Van Alpen SPJ engelen GJJA. Kuin Y, Desksen JJL. The relevance of a geriatric sub-classification of personality disorders in the DSM-V. International Journal of Geriatric Psychiatry. (2006); 21: 205-209.

8.             Johnson JK. Diehl J, Mendez MF, et al. Frontotemporal lobar degeneration : demographic characteristics of 353 patients. Archives Neurology (2005) ; 62: 925-930.

9.             Diehl J, Ernest J, Krapp S et al. Misdemeanor in front temporal dementia. Neurology psychiatry (2006); 74: 203-210.

10.           Rankin KP, Baldwin E, Pace-Sawitskyc et al self awareness and personality change in dementia. Journal of Neurology, Neurosurgery and Psychiatry (2006); 76: 632-639.

11.           Feldman H, scheltens P, Scaspini F et al, Behavioural symptoms in mild cognitive impairment. Neurology (2004); 62: 1199-1201.

12.           Liszewski CM, O Hearn BA, Leroil et al. Cognitive impairment and psychiatric symptom in 133 patients with disease associated with carebellar degeneration. Journal of Neuropsychiatry and Clinical Neuroscience (2004); 16:109-112.

13.           Montero Odasso M, Schapira M, Duque G et al. Is collectionism a diagnostic clue for Diogenes Syndrome ? International Journal of Geriatric Psychiatry. (2005); 20 : 709-71.