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
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
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).
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.
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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.
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personality disorder masquerading as dementia: a case of apparent Diogenes
syndrome. International Journal of Geriatric Psychiatry (2005); 20: 189-190.
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behavioral genetic analysis. Journal of Personality (2005); 73: 523-55.
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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);
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 ?
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