Clin - Geriatric Psych

Question 1

diagnostic criteria for cognitive impairment

Answer 1

1) evidence of modest cognitive decline from a previous level of performance in 1+ cognitive domains
- complex attention
- executive function
- learning and memory
- language
- perceptual motor
- social cognition

2) cognitive deficits do not interfere w/ capacity for independence in everyday activities

Question 2

what are some special considerations when treating geriatric patients

Answer 2

• multiple comorbidities
• unusual presentation of illness
• under-reporting

Question 3

risk factors for alzheimer’s dementia

Answer 3

• female
• fam hx
• head trauma
• down’s

Question 4

risk factors for vascular dementia

Answer 4

• male
• old age
• HTN
• other CV disease

Question 5

what is pick’s disease

Answer 5

rare type of age-related dementia that affects the frontal lobes of the brain and causes speech problems like aphasia, behavior difficulties and eventually death

Question 6

what is lewy body dementia

Answer 6

protein deposits, called Lewy bodies, develop in nerve cells in the brain regions involved in thinking, memory and movement

presents: memory loss with parkinson-like movement

Question 7

what are some reversible causes of dementia

Answer 7

• drug-induced
• thyroid disorder
• metabolic disorder
• hematomas
• hydrocephalus

Question 8

sx of dementia

Answer 8

• memory loss
• communication loss
• difficulty performing tasks, organization, and coordination
• getting lost
• personality changes
• inappropriate behavior
• psychotic sx
• agitation

Question 9

what labs and radiology should you get when evaluating dementia in an elderly patient

Answer 9

• endocrine panels
• B12
• folate
• CBC, CMP
• HbA1C
• CT, MRI, PET scan

Question 10

what should you avoid when treating elderly patients with dementia

Answer 10

anticholinergic meds

• benadryl
• hydroxyzine

Question 11

what can cause psychoses in the elderly

Answer 11

• inappropriate drug use/withdrawal
• infection
• urinary retention, constipation
• CV problems
• strokes
• seizures

Question 12

sx of psychosis due to major depressive disorder

Answer 12

• somatic troubles
• persecution
• guilt
• poor self-esteem

Question 13

risk factors for substance abuse in the elderly

Answer 13

• female
• marital status
• absence of hobbies/socialization
• health concerns

Question 14

consequences of substance abuse in the elderly

Answer 14

• cognition impairment
• depression
• sleep alteration
• balance and vestibular problems
• delirium

Question 15

treatment of substance abuse in the elderly

Answer 15

• cannot go “cold turkey” (could cause delirium tremens and death)
• benzos (valium/diazepam taper)

Question 16

how to diagnose depression in the elderly

Answer 16

• give pt geriatric depression scale, 1 point for each bolded answer
• score >5: suggestive of depression
• score >10: always indicative of depression
• score >15: warrants follow up comprehensive assessment

Question 17

what would make you think an elderly pt’s depression is actually due to a non-psychiatric cause

Answer 17

a recent and abrupt onset with absence of social factors

Question 18

what medication should you absolutely avoid in elderly pts

Answer 18

diphenhydramine

Question 19

compare depression and dementia in the elderly

Answer 19

depression: pts will often have insight, though little effort
dementia: little/no insight

Question 20

treatment for depression in the elderly

Answer 20

• meds
• psychotherapy
• CBT
• exercise, diet, lifestyle modification