Dementia and Depression

Question 1

Why is depression different to sadness?

Answer 1

• Doesn’t enjoy enjoyable things (anhedonia) - Loss of functioning - Length of time - Lack of feeling/ to many negative feelings

Question 2

What are the symptoms of depression?

Answer 2

• > 2 weeks of core (2 of 3): - Low mood - Low energy/ motivation - Anhedonia Also: - Worthlessness - Recurrent suicidal thoughts - Reduced concentration - Insomnia/ hypersomnia - Appetite and weight loss

Question 3

What contributes to depression?

Answer 3

• Depressogenic stressors - Prolonged stressors - Low self worth and cognitive bias - Genetics/ Environment - Recuperative response/ overwhelm homeostasis - Poor sleep - Social withdrawal - Hoplessness -

Question 4

How do you assess depression?

Answer 4

• Psych history > Single episode/ recurrent > Predisposing, precipitating and perpetuating > Psych Co-morb, Mania, anxiety - MSE > Objective mood, self-care, psychotic symptoms > Protective factors - Risk > Thoughts, urges, actual SH (suicide or not) > Protective factors - Organic factors > Hypothyroid, Addison’s, cushings > Beta blockers, digoxin, anticonvulsants

Question 5

How do you treat depression?

Answer 5

• Mild > Psychoeducation, sleep hygience, self guided CBT, social interventions - Moderate > CBT > Medication (SSRI/ SNRI/ mirtazapine) - Severe > Switch/ combine medications > Inpatient treatment > ECT

Question 6

How does depression present in the elderly?

Answer 6

• High biological symptoms (insomnia, appetite loss) - Catatonia more likely - Can look like dementia

Question 7

How does the normal brain age?

Answer 7

• Global decrease in brain size - Neurone cell loss in cortex/ hippocampus/ cerebellum - Decreased synaptic connectivity - Deposits of tau and amyloid protein - Decline in IQ after 60 - Decline in working memory, problem solving and cognitive flexibility - Fear of death - bereavement - financial problems - Illness - Social isolation - Loss of independence

Question 8

What is dementia?

Answer 8

• Progressive global decline in higher cortical functions across various domains +/- deterioration in emotional regulation, behaviour - Increasing prevalence with age (95+ = 33% risk)

Question 9

What are the differentials for dementia?

Answer 9

• Dementia - Depression - Delirium - Reversible causes

Question 10

What is the most common type of dementia?

Answer 10

• Alzheimers - 2= vascular

Question 11

What is the onset of alzheimers?

Answer 11

• Insidious onset - Memory impairment first

Question 12

When is early onset Alzheimers?

Answer 12

• <65 y - Rapid progression

Question 13

What are the treatments of alzheimers?

Answer 13

• Acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) - NMDA antagonist (memantine) Not disease modifying but helpful with symptoms

Question 14

What is the pathophysiology of alzheimers?

Answer 14

• Tau tangles (clumping inside cells which then die) - Amyloid protein plaques- extracellular, kills cells, causes inflammation

Question 15

What is vascular dementia?

Answer 15

• Multi infarct dementia - step wise progression - TIA/ stroke/ vascular risk factors - No treatment (optimise vascular RF)

Question 16

What is lewy body dementia?

Answer 16

• Onset <1 y of Parkinson’s - Fluctatuing attention and awareness - Visual hallucinations - REM sleep behaviour disorder

Question 17

What is frontotemporal dementia?

Answer 17

• Pick bodies - 20% of early onset - Emotional blunting/ lability, disinhibition, apathy, restlessness, change in mood/ behaviour

Question 18

Other dementias?

Answer 18

• PARKINSONS - huntingtons - CJD - alcohol, HIV etc.

Question 19

What are things that present like dementia but are reversible?

Answer 19

• Normal pressure hydrocephalus (dementia, ataxia and urinary incontinence) - Hypothyroid - Vitamin B12 - Neurosyphillis - Pseudodementia

Question 20

How do you test for dementia?

Answer 20

• History incl. support network - Mental state exam - Cognitive exam (MMSE, RUDAS, ACEIII) - Physical exam - Bloods - EEG - Brain imaging

Question 21

What is delirium?

Answer 21

Acute episode of confusion (impairment of consciousness) which is fluctuating > Disturbance in consciousness > Reduced ability to direct, focus, sustain and shift attention > Disturbance in perception, thinking, memory, psychomotor behaviour, emotion and sleep-wake cycle

Question 22

What are the causes of delirium?

Answer 22

P ain In fection C onstipation H ydration M edications (esp. anticholinergics) E lectrolytes (Na/ Ca/ Glucose)

Question 23

How do you treat delirium?

Answer 23

Asessment of mental state Monitor and ensure safety Re orientation strategies

Question 24

What is the difference between delirium and dementia?

Answer 24