[CLMD] Diagnosis of Psychiatric Conditions in Geriatric Patients [Hill] Flashcards
How do you characterize Mild Cognitive Impairment?
a Modest Cognitive Decline from a previous level of performance
Does NOT interfere with daily basics (Capacity for independence)
When treating a Geriatric pt what are some considerations you need to be cognisant of?
Multiple comorbidities
Varied Diseases (Degenerative dz, Cancer, etc)
Unusual presentations
Under REPORTING (depression etc)
Medication
When working on a geriatric pt, what rule should you follow for medication?
Start Low and go Slow! (Be Conservative)
When you are presented with a older pt who might have dementia – what specific entities should you consider?
Alzheimers (50-60%)
Vascular Dementia (15-30%)
Progessive Disorders [like Frontotemporal Dementia/Lewy Body Dementia]
Reversible Dementia causes
What sort of pt would raise the highest risk of being diagnosed with Alzheimers?
Female, with family history, head trauma, Down Syndrome
What sort of pt would raise the highest risk of the diagnosis of Vascular Dementia?
Male, advanced age, HTN, Cardiovascular dz
What sort of signs should you be on the look out for when you have a patient who has Frontotemporal Dementai (Progessive disorders)
Changes in Personality
Socially Inappropriate
Impulsive/emotionally distant
Occurs in slightly younger pts (40-60)
What sort of reversible causes of dementia are commonly seen?
Drug Induced
Thryoid dz
Metabolic Disorder (Diabetes)
Hematomas
Hydrocephalus (Normal Pressure Hydrocephalus)
If you have a patient that is elderly and has weight loss, anxiety, irritability, sadness, and dementia –> what sort of clinical diagnosis would you attribute?
Depression (Pseudomentia)
**Often depression can cause dementia in older patients.
What are some other symptoms of dementia?
Depression
Memory Loss
Communication problems
Difficulty with performing tasks and such
Problems with disorientation
Personality Changes
Inappropriate Behavior
Psychotic Sx (Hallucinations, delusions)
Agitation (violence)
When evaluating an elderly pt with dementia – what sort of things should you consider?
H&P
Progression of Dz
Comorbid conditions
Neurological exam
Mental Status exam
Functional Status (dressing, bathing etc)
Neuropsych testing
Labs
Radiology
What sort of labs are the best to order for an evaluation of a dementia pt?
CBC, CMP, Thyroid, B12, Folate, Hb1AC
When treating Dementia in the elderly how should you approach it?
Attempt to rule out other causes
treat comorbid conditions
SLOW PROGRESSION
Reduce Stress
Increase Physcial Acitivty
NO BENADRYL
What are two drugs that are given to pts with dementia to help slow the progression?
Donepezil (Aricept)
Memantine (Namenda)
(Helps with depression and agitation as well!)
What should you NEVER GIVE an elderly pt with dementia?
Benadryl
Hydroxyzine
What is the black box warning for using anti-psychotic medications in geriatric pts with dementia?
EX: Olanzapine, Aripiprazole, Risperidone, Quetiapine
Can increase Mortality
Delirum vs Dementia?
Delirium – Acute
Dementia – Chronic
What are some of the causes of Psychosis in the elderly?
MDD with Psychotic Features **2nd most common
Alzheimers type Dementia **most common
What is the difference between MDD with Psychotic Features and Alzheimers type Dementia?
Alzheimers type dementia will have more delusions, paranoid in nature
vs
MDD with Psychotic features have more SOMATIC TROUBLES, Persecution, guilt, and poor self-esteem
What are the Risk Factors for Substance abuse in the elderly?
Female
Marital Status (widowed, divorced etc)
Abscence of Hobbies
Health Concerns
higher abuse potential of Benzos and Opiates
What are some of problems with substance abuse and the elderly?
Congition impairment
Depression
Sleep Problems
Falls/Fractures (vestibular problems)
Delirium
Risk of other medical conditions
If you go Cold turkey on treating a substance abuse – what sort of problems may you encouter with an elderly pt?
Delirium Tremens and Death
(Ex: Benzos)
What are some of the signs and symptoms of depression in the elderly?
Anxiety
Fatigue and Hypersomnolence
Somatic Complaints
Cognitive impairment
Weight loss
Insomnia
Anhedonia
Agitation
How do you diagnose Major Depression in the elderly?
Anhedonia or Depressed Mood for 2 weeks
+
4 of the following:
Feelings of worthlessness
decreased ability to concentrate
fatigue
psychomotor agitation
insomnia
weight or appetite changes
recurrent thoughts of suicide
How can you tell a demented pt vs a depressed elderly pt?
Depressed –> have insight, little effort
Demented –> NO insight
