Depression and dementia Flashcards
Definition of depression
> 2 weeks of experiencing core symptoms
What are the core symptoms of depression
Low mood
Low energy/motivation (can lead to impaired functionality)
Anhedonia (lack of enjoyment)
other symptoms of depression
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
Aetiology of depression
Depressogenic stressors could lead to:
- Prolonged stressed leading to a recuperative response due to genetics/environment) which might overwhelm homeostasis
- 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
Assessment of depression
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
What are the organic causes of depression
Hypothyroid, addisons, cushings, hypercalcaemia, folate decificiency…
ADD
Treatment of depression
- Mild
Psychoeducation, sleep hygiene, self-guided CBT techniques, social intervention - Moderte
CBT
Medication (SSI, SNRI, mirtazapine) - Severe…..
Depression in the elderly difference from other people
Usually increase biological symptoms e.g. insomnia, appetite loss
Catatonia more likely
Can look like dementia (pseudodementia)
Normal ageing-changes in brain structure
- Global decrease in brain size
- Neuronal cell loss in cortex, hippocampus, cerebellum
- Decreased synaptic connectivity
- Deposits of tau and amyloid protein (yes, this is normal, just happens more in alzheimers!)
Normal ageing-changes in brain function
Decline in IQ after 60
Decline in working memory, problem-solving, cognitive flexibility
Normal ageing- psychosocial
Fear of death, bereavement, financial problems, illness, social isolation, loss of independence
Define dementia
Progressive decline in higher cortical functions across various domains:
-+//deterioration in emotional regulation, behavioural Sx
Increases prevalence with age
“Chronic brain failure”
Types of dementia
Alzheimers
Vascular dementia
Mix of the two above
Lewy body
What is the onset of alzheimers and what is the cardinal feature
Insidious onse, memory impairment
Medial temporal lobe (entorhinal cortex affected first)
Early onset alzheimers
<65 y/o
Rapid progression
Treatment for alzheimers
Not disease modifying
Acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine)
NMDA antagonists (memantine)
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What is vascular dementia
Multi-infarct dementia
Step-wise progression
TIA/stroke/vascular risk factors
Treatment for vascular dementia
None
-Optimise vascular risk factors
Lewy body dementia
Onset <1yr of parkinsons
Fluctuating attention and awareness
Visual hallucinations
Same cause as parkinsons
Frontotempral dementia
Pick bodies
20% of early onset dementias
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What are the other dementia diseases
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What are reversible dementias
Normal pressure hydrocephalus
What are the signs of normal pressure hydrocephalus
Dementia, ataxia and urinary….
Assessment of dementia
- History incl support network
- MSE
- Cognitive testing (MMSE, RUDAS, ACEIII)
- Physical examination (signs of parkinsonism)
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What is delirium
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
Causes of delirium
PInCHME
Pain Infection Constipation Hydration (incl urinary retention) Medications (anticholinergics) Electrolytes (Na, Ca and glucose)
Management of delirium
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