Dementia and Depression Flashcards
Why is depression different to sadness?
- Doesn’t enjoy enjoyable things (anhedonia) - Loss of functioning - Length of time - Lack of feeling/ to many negative feelings
What are the symptoms of depression?
- > 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
What contributes to depression?
- Depressogenic stressors - Prolonged stressors - Low self worth and cognitive bias - Genetics/ Environment - Recuperative response/ overwhelm homeostasis - Poor sleep - Social withdrawal - Hoplessness -
How do you assess depression?
- 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
How do you treat depression?
- Mild > Psychoeducation, sleep hygience, self guided CBT, social interventions - Moderate > CBT > Medication (SSRI/ SNRI/ mirtazapine) - Severe > Switch/ combine medications > Inpatient treatment > ECT
How does depression present in the elderly?
- High biological symptoms (insomnia, appetite loss) - Catatonia more likely - Can look like dementia
How does the normal brain age?
- 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
What is dementia?
- Progressive global decline in higher cortical functions across various domains +/- deterioration in emotional regulation, behaviour - Increasing prevalence with age (95+ = 33% risk)
What are the differentials for dementia?
- Dementia - Depression - Delirium - Reversible causes
What is the most common type of dementia?
- Alzheimers - 2= vascular
What is the onset of alzheimers?
- Insidious onset - Memory impairment first
When is early onset Alzheimers?
- <65 y - Rapid progression
What are the treatments of alzheimers?
- Acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) - NMDA antagonist (memantine) Not disease modifying but helpful with symptoms
What is the pathophysiology of alzheimers?
- Tau tangles (clumping inside cells which then die) - Amyloid protein plaques- extracellular, kills cells, causes inflammation
What is vascular dementia?
- Multi infarct dementia - step wise progression - TIA/ stroke/ vascular risk factors - No treatment (optimise vascular RF)
What is lewy body dementia?
- Onset <1 y of Parkinson’s - Fluctatuing attention and awareness - Visual hallucinations - REM sleep behaviour disorder
What is frontotemporal dementia?
- Pick bodies - 20% of early onset - Emotional blunting/ lability, disinhibition, apathy, restlessness, change in mood/ behaviour
Other dementias?
- PARKINSONS - huntingtons - CJD - alcohol, HIV etc.
What are things that present like dementia but are reversible?
- Normal pressure hydrocephalus (dementia, ataxia and urinary incontinence) - Hypothyroid - Vitamin B12 - Neurosyphillis - Pseudodementia
How do you test for dementia?
- History incl. support network - Mental state exam - Cognitive exam (MMSE, RUDAS, ACEIII) - Physical exam - Bloods - EEG - Brain imaging
What is delirium?
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
What are the causes of delirium?
P ain In fection C onstipation H ydration M edications (esp. anticholinergics) E lectrolytes (Na/ Ca/ Glucose)
How do you treat delirium?
Asessment of mental state Monitor and ensure safety Re orientation strategies
What is the difference between delirium and dementia?
