Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

m4 psych > 15. Psychogeriatrics > Flashcards

15. Psychogeriatrics Flashcards

1
Q

Major Neurocognitive Disorder

A

Significant cognitive decline from a previous level of performance in 1 or more of the following domains:
- Attention
- Executive function
- Learning and memory
- Language
- Perceptual motor
- Social cognition

+ affect independence in performing daily activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

Which allele enhances risk of cognitive decline a/w depressive symptoms?

A

APOE-E4 allele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Mild Neurocognitive Disorder

A

Modest cognitive decline from a previous level of performance in 1 or more of the following domains:
- Attention
- Executive function
- Learning and memory
- Language
- Perceptual motor
- Social cognition

+ do NOT affect independence in performing daily activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which delusion is common in dementia patients?

A

Delusion of theft (accusing caregivers of stealing items)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which delusion is common in delirium patients?

A

Persecutory delusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Examples of cortical dementia

A
  • Alzheimer disease
  • Fronto-temporal lobe dementia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cognitive assessment for dementia

A

Mini mental state examination
Montreal cognitive assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Assessing Activities of Daily Living (ADLs)

A

Basic: DEATH
Dressing
Eating
Ambulating
Toileting
Hygiene

Advanced: SHAFT
Shopping
Housekeeping
Accounting
Food/meds prep
Transportation/Telephone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Irreversible causes of dementia

A

Alzheimer’s
Vascular dementia
Lewy body dementia
Fronto-temporal dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Reversible causes of dementia

A

Normal pressure hydrocephalus
Subdural hematoma (bridging veins)
Vitamin B12 deficiency
Neurosyphilis (venereal disease research laboratory)
Hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Risk factors associated with Alzheimer’s disease

A
  • Old age*** (most significant risk factor)
  • APOE E4 allele
  • Head injury
  • Down syndrome
  • Poor linguistic skills
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Protective factors against Alzheimer disease

A
  • High education level
  • High physical activity level
  • APOE E2 allele
  • Late retirement
  • Consumption of fish
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Onset of Alzheimer disease

A

Insidious, gradual decline, progressive onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does Down syndrome increase risk of Alzheimer’s dementia?

A

Amyloid precursor protein gene is found in chromosome 21
In trisomy 21, APP increases, forming amyloid plaques and increases risk of Alzheimer’s developing at an earlier age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clinical features in Alzheimer’s disease

A
  1. Clear evidence of memory decline
  2. Gradual decline in memory over time
  3. Psychotic symptoms (visual hallucination more common than auditory)
  4. Behavioural changes
  5. Personality changes
  6. Orientation (disorientation in time)
  7. Neurological features
    - reduction in REM sleep, frequent nocturnal waking periods and shortened sleep periods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management of Alzheimer’s disease

A
  • Mild AD: Consider cognitive stimulation programme
  • Moderate AD: Acetylcholinesterase inhibitors: donepezil (+VaD), galantamine, rivastigmine (+LBD)
  • Severe AD: Memantine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Side effects of acetylcholinesterase inhibitors

A

Diarrhoea
Urination
Miosis
Muscle cramps
Bradycardia*
Bronchospasm
Emesis
Lacrimation
Lethargy
Salivation
Seizures

*can remember MIND mnemonic
- Muscle cramps
- Insomnia
- Nausea
- Diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Side effects of memantine

A

CHECK mnemonic

Confusion
Headache
Equilibrium - Nausea
Constipation
Kidney function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Onset of vascular dementia

A

Unpredictable course, abrupt stepwise deterioration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Vascular dementia vs Alzheimer’s dementia

A

VaD
- abrupt stepwise deterioration
- executive function/apraxia is first to go
- memory loss later
- dysarthria
- presence of cerebrovascular event, HTN, atherosclerosis
- worse prognosis (3 years)

AD
- gradual, progressive decline
- memory loss/amnesia is first to go
- acalculi, apathy
- better prognosis (6 years)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Frontotemporal dementia features

A

Frontal changes
- Behavioural changes: Disinhibition
- Impulsivity
- Personality

Temporal changes
- Speech changes: speech production, word finding, object naming, grammar or word comprehension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Brain changes seen in Alzheimer’s dementia

A

Amyloid plaques
Neurofibrillary tangles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Brain changes seen in frontotemporal dementia

A

Frontotemporal atrophy
Gliosis of white matter in the frontal lobes
Intracellular inclusions
Swollen neurons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Lewy body dementia triad

A
  1. Cognitive impairment
  2. Parkinsonism features
  3. Visual hallucinations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Lewy body dementia vs Parkinsonism dementia
LBD: - dementia first then Parkinsonism features Parkinsonism dementia - Parkinsonism features then dementia
25
Triad of normal pressure hydrocephalus
1. Gait disturbance 2. Cognition impairment 3. Urinary incontinence
26
Late onset bipolar disorder is associated with
- less grandiosity - less violent or reckless behaviour - less likely a/w drug use - increase irritability and anger - increase obsessive thought
27
Worried-well syndrome
Anxious people worrying that they have dementia
28
Dementia in Creutzfeldt-Jakob disease
Dementia is rapidly progressive and will lead to death
29
Examples of behavioural and psychological symptoms of dementia
Agitation Aggression Apathy Delusions - delusion of theft - partition delusion Depression Disinhibition Sleep Disturbances Hallucinations (due to sensory impairment in elderly) Wandering
30
Phenomenon where symptoms worsen later in the day (late afternoon/early evening) due to changes in ambient light
Sundowning *occurs in 2/3 patients with dementia due to disturbed circadian rhythm
31
Approach to BPSD
1. Is it delirium? 2. Not delirium, is there a medical cause for BPSD? 3. Are there reversible causes for BPSD? 4. If all ix and solutions fail, are there meds available? 5. Caregiver care and onward placement
32
Non-pharmaco treatment of BPSD
Caregiver training Aromatherapy Exercise training Simulated presence therapy Music therapy Pet therapy Massage therapy
33
Pharmaco tx of BPSD
*not the mainstay of treatment *reserved for severe BPSD and when BPSD still persists despite correction of medical causes *used when non-pharmaco therapy has failed 1. Topiramate - S/E: renal stones 2. Cholinesterase inhibitors - Donepezil, rivastigmine 3. Antidepressants - SSRI: Citalopram, escitalopram (SSRI) Avoid - mood stabilisers (might reduce irritability) - anticholinergics (worsens cognition) - bzd (worsens cognition)
34
Use of antipsychotics?
Yes, use 2nd gen antipsychotics but comes with a lot of dangers *must weigh the pros and cons START LOW, GO SLOW
35
S/E of using antipsychotics in dementia patients
- Worsening metabolic syndrome (increases sugar, cholesterol) - EPSEs - Fall risk - Increased mortality (NMS)
36
Non-pharmacological treatment for dementia
- Reminiscence therapy - Reality orientation therapy - Validation therapy - Snoezelen (utilisation pf specially designed room with stimulating environment) - Aromatherapy
37
Risks in a dementia patient
Risk of self harm Risk of harm to others Risk of falls Risk of fires Risk associated with wandering Caregiver burnout -> abuse of elderly patient
38
Mini mental state examination results
Out of 30 points Cut off is 24/30 for a Singaporean who has O level education ❖ 20-24: mild dementia ❖ 10-19: moderate dementia ❖ Below 10: severe dementia
39
Frontal lobe assessment
1. Cognition estimation 2. Verbal fluency 3. Judgement 4. Abstract thinking 5. Luria hand test 6. Alternating sequence *NO score, just a global impression
40
Cognition estimation
- How high is the ceiling? (in meters) - How tall is an average Singaporean woman? (in meters) Pathology: Estimation of woman's height is taller than that of the ceiling
41
Verbal fluency
- How many animals can you name in 1 minute? - How many words starting with the letter F/A/S can you say in 1 minute? *At least 10 words to pass the assessment Pathology: Repeating of words
42
Judgement (probe further)
If there is a fire in this room, what would you do? - How will you run? - Where would you go? - Will you use the lift? If you find an envelope on the floor with an address and stamp on it, what would you do? - Expect patient to say "I will post it"
43
Abstract thinking
- Name similarities between a table and a chair - What is the meaning of "kill 2 birds with 1 stone"
44
Luria's hand test
Demonstrate once, but if patient is confused can show again Perform at least 5 times independently using left and right hand to pass the test Pathology: Perseveration, unable to do task
45
Alternating sequence
Draw a part of the sequence - Square and triangle linked by a line - Ask patient "Draw the sequence and continue drawing the sequence from the last object" *Do not just ask the patient to copy the sequence Pathology: Will keep on drawing the last object *perseveration
46
MMSE
1. Orientation (time) 2. Orientation (place) 3. Short term memory (registration) 4. Attention and calculation (acalculia) 5. Short term memory (recall) 6. Recognition (agnosia) 7. Language 8. Visual-spatial skill 9. Motor sequence (ideomotor apraxia) *testing parietal-temporal lobe
47
Orientation (time) - 5 points
"Without looking at your watch/the clock" 1. Time (AM/PM - must ask!) 2. Day of the week 3. Date of the month 4. Month 5. Year
48
Orientation (place) - 5 points
1. Ward # 2. Floor 3. Name of hospital 4. Nearest MRT 5. Name of country you are in
49
Short term memory (registration) - 3 points
"Let me say finish first then you repeat after me. (Say objects slowly) Ok very good. I will ask you a few minutes later, please remember these 3 items" Registration of 3 items: - Apple - Ball - Pillow (maximum repeat 2 times)
50
Attention and calculation (acalculi) - 5 points
Serial 7 or serial 3 - Start from 100, -7 and continue to minus 7 from your answer until I tell you to stop - Start from 20, -3 *do at least 5 times Months backwards - Can you say the months from December backwards? Spelling backwards - Can you spell 'world'? - Can you spell it backwards? (points scored irrespective of consecutive error)
51
Short term memory (recall) - 3 points
Can you recall of the 3 items that I told you previously? - Apple, ball, pillow - If patient makes up another item, that's confabulation
52
Recognition (agnosia) - 2 points
- Pen - Watch
53
Language - 3 points
Write a complete sentence (testing writing ability: agraphia) - must be grammatically correct - let patient write on paper - any sentence - "Write me a sentence about the weather today" Follow a written common (testing reading ability - alexia) - Write on paper and show patient "close your eyes" Repeat a sentence after me (rule out aphasia) - "No ifs ands or buts"
54
Visual-spatial skill (constructional praxis) - 1 point
Copy my drawing "double pentagon"
55
Motor sequence - 3 points
3 stages command "Only do this after I have finished my instructions - Take this piece of paper with your left hand - Fold it into half - Place it on your right thigh/desk"
56
Is MMSE the gold standard in establishing the diagnosis of dementia?
No, MMSE is a screening test and there is no gold standard to diagnose dementia
57
Predisposing factors for depression in the elderly
- Polypharmacy - Cerebrovascular event - Woman - Widowhood - Looking after a spouse with chronic illness
58
After the age of 65, the prevalence of dementia increased by how many times every 5 years?
2x
59
MOA of memantine
Reduce glutaminergic neurotransmission (glutaminergic and NMDA antagonist)
60
Features more common in late onset depressive disorder
More somatic symptoms More psychosis symptoms More cognition symptoms More anxiety symptoms More determined to die White matter changes Absence of family history of depressive disorder
61
Contraindications to acetylcholinesterase inhibitor
- Severe dementia or MMSE < 10/30 - Bradycardia or on beta blockers - GI bleed or peptic ulcer
62
Potential benefits of using acetylcholinesterase inhibitor
Improve cognition Improve BPSD a/w dementia Delay nursing home placement
63
Psuedodementia vs dementia
Pseudodementia - Onset of symptoms: mood issues occurs before cognitive impairment) - Poor motivation when attempting cognitive assessment (giving “idk” replies) - Patchy inconsistent memory loss (short term and long term) - Poor attention - Improve of cognitive symptoms improve with treatment for mood

m4 psych (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions