11. Old Age Psychiatry Flashcards
What is the “ABCD” of Dementia?
A - Activities of Daily Living
B - Behavioural / Psychiatric Symptoms of Dementia
C - Cognitive Impairment
D - Decline (in Functioning)
What are the Cognitive Features of Dementia?
- Dymnesia (Memory Loss)
Plus one of: - Dysphasia (Communication) - Expressive / Receptive
- Dyspraxia (Inability to Carry out Motor Skills)
- Aysgnosia (Not Recognising Objects)
- Dysexecutive Functioning - Orientation / Visuospacial …
- Functional Decline - Activities of Daily Living
In Dementia, What to Mini-Mental State Examinations (MMSE) correlate with?
Ability to Perform Daily Activities
What are the Forms of Neuropsychiatric Disturbances, which can occur in Dementia?
- Psychosis
- Depression
- Altered Circadian Rhythms
- Agitation
- Anxiety
What are the Features of Dementia vs Delirium?
Dementia vs Delirium:
- Insidious Onset vs Abrupt Onset
- Slow, Progressive Decline vs Acute Illness
- Generally Irreversible vs Reversible
- Late Disorientation vs Early Disorientation
- Slight (day-to-day) Variation vs Variable (hour-to-hour)
- Less vs Prominent Physiological Changes
- Late Stage Clouding of vs Fluctuating Consciousness
- Normal Attention Span vs Short Attention Span
- (Day-Night) vs (Hour-Hour) Disturbed Circadian Cycle
- Late vs Early Psychomotor Changes
What are the Features of Dementia vs Depression?
Dementia vs Depression:
- Insidious Onset vs Abrupt Onset
- No Psychiatric History vs Psychiatric History
- Conceals Disability vs Highlights Disability
- “Near-Miss” Answers vs “Don’t Know” Answers
- Day to Day vs Diurnal Mood Fluctuation
- Stable Cognitive Loss vs Fluctuating Cognitive Loss
- Unconcerned by Losses vs Distressed by Losses
- Short Term Memory Loss vs Memory Loss
- Memory Loss Occurs First vs with Depressed Mood
- Associated with a Decline in Social Function vs Anxiety
What is the Aetiology if Dementia?
- Alzheimer’s Disease - 50%
- Vascular Dementia - 25%
- Mixes Alzheimer’s and Vascular Dementia - 15%
- Lewy Body Dementia - 5%
- Other Causes - 5%
What are the Features of a Clinical Assessment for someone with Dementia?
- History and Collateral History
- Risk Assessment - to them / driving / other people
- Cognitive Testing - MMSE
- Physical and Bloods
- Neuroimaging
- Follow-Up
What are the Features of Lewy Body Dementia?
- Deficits of Attention / Frontal Executive / Visuospatial
- Fluctuation / Visual Hallucinations / Parkinsonism
- REM Sleep Disorder / Anti-Psych Sensitivity
- Falls / Syncope / other Psychiatric Symptoms
Note - Amnesia is not Prominent
What are the Features of Frontotemporal Dementia?
- Behavioural Disorder - Personality Change
- Speech Disorder
- Neuropsychology - Frontal Dysexecutive Syndrome
- Neuroimaging - Abnormal Frontotemporal Lobes
- Neurological Signs commonly Absent Early
What are the Common Drug Treatments of Alzheimer’s Type Dementia?
- Mild-Moderate = Acetylcholinesterase Inhibitors (AchEI) - Donepezil / Rivastigmine
- Moderate-Severe = Memantine
Note - Slows Decline, does not stop Progression
What are the Other Psychotropics used for Dementia Treatment?
- Antipsychotics - Risperidone / Quetiapine / Amisulpride
- Antidepressants - Mirtazapine / Sertraline
- Anxiolytics - Loraepam
- Hypnotics - Zolpidem / Zopiclone / Clonazepam
- Anticonvulsants - Valproate / Carbamazepine
What is Capacity?
Abilities relevant to Competence:
- Understanding
- Manipulating
- Approaching the Situation and its Consequences
- Communicating Choices
Other than Dementia. What conditions commonly occur in the Elderly?
- Depressive Symptoms (15%) / Illness (3%)
- Anxiety Disorders
- Mania (Bipolar Disorder)
- (Late Onset) Schizophrenia (+/- like Psychosis)
- Alcohol Problems
- Suicidal Iseation
