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DPD 2019 > Depression and dementia > Flashcards

Depression and dementia Flashcards

1
Q

Definition of depression

A

> 2 weeks of experiencing core symptoms

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2
Q

What are the core symptoms of depression

A

Low mood

Low energy/motivation (can lead to impaired functionality)

Anhedonia (lack of enjoyment)

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3
Q

other symptoms of depression

A

Feelings of worthlessness/inappropriate guilt

Recurrent thoughts of death, suicidal thoughts or actual suicide attempts

Reduced concentration, indecisiveness

Psychomotor agitation or retardation

Insomnia (esp. early morning waking) or hypersomnia

Significant appetite and or weight loss

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4
Q

Aetiology of depression

A

Depressogenic stressors could lead to:

  1. Prolonged stressed leading to a recuperative response due to genetics/environment) which might overwhelm homeostasis
  2. Low self-worth (cognitive bias

These two things can both lead to low mood/low energy/anhedonia (core symptoms)

Social withdrawal/isolation and poor sleep might contribute to low mood etc.

When the depression gets bad enough, hopelessness may emerge which is a risk for suicidality

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5
Q

Assessment of depression

A

Psych history (single episode or reecurrent/predisposing, precipitating and perpetuating factors/ previous anxiety, mania of other psych comorbidity)

MSE (obective mood, self care, psychotic symptoms)

Risk (thoughts, urges, actual SH/protective factors)

Exclude organic causes

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6
Q

What are the organic causes of depression

A

Hypothyroid, addisons, cushings, hypercalcaemia, folate decificiency…

ADD

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7
Q

Treatment of depression

A
  1. Mild
    Psychoeducation, sleep hygiene, self-guided CBT techniques, social intervention
  2. Moderte
    CBT
    Medication (SSI, SNRI, mirtazapine)
  3. Severe…..
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8
Q

Depression in the elderly difference from other people

A

Usually increase biological symptoms e.g. insomnia, appetite loss

Catatonia more likely

Can look like dementia (pseudodementia)

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9
Q

Normal ageing-changes in brain structure

A
  1. Global decrease in brain size
  2. Neuronal cell loss in cortex, hippocampus, cerebellum
  3. Decreased synaptic connectivity
  4. Deposits of tau and amyloid protein (yes, this is normal, just happens more in alzheimers!)
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10
Q

Normal ageing-changes in brain function

A

Decline in IQ after 60

Decline in working memory, problem-solving, cognitive flexibility

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11
Q

Normal ageing- psychosocial

A

Fear of death, bereavement, financial problems, illness, social isolation, loss of independence

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12
Q

Define dementia

A

Progressive decline in higher cortical functions across various domains:
-+//deterioration in emotional regulation, behavioural Sx

Increases prevalence with age

“Chronic brain failure”

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13
Q

Types of dementia

A

Alzheimers
Vascular dementia
Mix of the two above
Lewy body

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14
Q

What is the onset of alzheimers and what is the cardinal feature

A

Insidious onse, memory impairment

Medial temporal lobe (entorhinal cortex affected first)

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15
Q

Early onset alzheimers

A

<65 y/o

Rapid progression

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16
Q

Treatment for alzheimers

A

Not disease modifying

Acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine)

NMDA antagonists (memantine)

17
Q

…..

A

……

18
Q

……

A

…….

19
Q

What is vascular dementia

A

Multi-infarct dementia

Step-wise progression

TIA/stroke/vascular risk factors

20
Q

Treatment for vascular dementia

A

None

-Optimise vascular risk factors

21
Q

Lewy body dementia

A

Onset <1yr of parkinsons

Fluctuating attention and awareness

Visual hallucinations

Same cause as parkinsons

22
Q

Frontotempral dementia

A

Pick bodies

20% of early onset dementias

……

23
Q

What are the other dementia diseases

A

……..

24
Q

…..

A

…..

25
Q

…….

A

……

26
Q

What are reversible dementias

A

Normal pressure hydrocephalus

27
Q

What are the signs of normal pressure hydrocephalus

A

Dementia, ataxia and urinary….

28
Q

Assessment of dementia

A
  1. History incl support network
  2. MSE
  3. Cognitive testing (MMSE, RUDAS, ACEIII)
  4. Physical examination (signs of parkinsonism)
    5.
    6.
    7.
29
Q

What is delirium

A

Reduced ability to direct, focus, sustai and shift attention

Disturbance of consciousness (on a continuum from clouding to coma)

Disturbances of preception, thinking, memory, pwsychomotor behaviour, emotion and sleep-wake cycle

At any age, transient and fluctuaing

30
Q

Causes of delirium

A

PInCHME

Pain 
Infection 
Constipation 
Hydration (incl urinary retention) 
Medications (anticholinergics)
Electrolytes (Na, Ca and glucose)
31
Q

Management of delirium

A

…………….

DPD 2019 (30 decks)

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