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Psychiatry > Elderly > Flashcards

Elderly Flashcards

1
Q

Antipsychotics for behavioural disturbance in dementia associated with what?

A

Death

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2
Q

Sleep changes in the elderly

A

Decreased total sleep time
Increased sleep latency
Increased nocturnal wakenings
Decreased REM
Decreased amplitudes in the sleep-wake cycle
Decreased slow wave sleep

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3
Q

Best antipsychotic for delirium in elderly people when pharmacotherapy is indicated

A

Haloperidol has the best evidence

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4
Q

DSM-V criteria for frontotemporal dementia

A

A. Criteria for a NCD met
B. Insidious onset and gradual progression
C. 1 of the following

a. Behavioral Variant
i. Prominent decline in social cognition and/or executive abilities and 3+ of the following:
ii. Behavioral disinhibition
iii. Apathy or inertia
iv. Loss of sympathy or empathy
v. Perseverative, stereotyped, or compulsive/ritualistic behavior
vi. Hyperorality and dietary changes

b. Language variant
i. Prominent decline in language ability in form of speech production, word-finding, objectnaming, grammar, or word comprehension
ii. Relative sparing or learning, memory, and perceptual-motor function

D. Probable frontotemporal NCD if 1 of the following is present, otherwise it should be possible

a. Evidence of causative gene from family history or genetic testing
b. Evidence of disproportionate frontal/temporal involvement from neuroimaging

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5
Q

Old age insomnia - Sedative hypnotics in older adults?

A

Not first line, risk of accidents, hip fractures. CBT and brief behavioural interventions are first line

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6
Q

Genetic marker associated with late onset AD

A

APOE4

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7
Q

What happens to the seizure threshold with advancing age?

A

It gets higher

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8
Q

Investigation for an elderly person on high dose citalopram

A

ECG

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9
Q

What’s the cutoff on the GDRS?

A

6

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10
Q

Which is more sensitive, the MOCA or the MMSE?

A

MOCA

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11
Q

Best scale for depression in dementia

A

Cornell Scale for Depression in Dementia

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12
Q

Tool to assess pattern of agitation in dementia

A

Dementia observation scale DOS

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13
Q

Minor delay in word finding is normal with age T/F

A

T

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14
Q

Rate of conversion of mild NCD to major per year and rate of conversion to normal

A

5-10% to major 25-30% to normal

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15
Q

Rate of Alzheimer’s In population

A

5%

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16
Q

% of dementia that is vascular

A

15%

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17
Q

Depression and apathy are common in vascular dementia T/F

A

T

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18
Q

Family history is a RF for frontotemporal dementia T/F

A

T

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19
Q

Profound apathy- which dementia most likely?

A

FTD

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20
Q

Abnormal clock drawing shows exec dysfunction T/F

A

T

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21
Q

Late onset delusional disorder has a good prognosis T/F

A

F

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22
Q

Female sex has a better outcome in delusional disorder T/F

A

T

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23
Q

Elderly people have decreased adrenergic receptor sensitivity T/F

A

T

24
Q

Late life depression more common in women T/F

A

T

25
Q

Suicide rates in the elderly are nearly twice as high T/F

A

T

26
Q

Why do elderly people get orthostatic hypotension?

A

Because of a decrease in adrenergic receptor sensitivity

27
Q

What’s the most prevalent anxiety disorder in the elderly?

A

Specific phobia 3-5%

28
Q

Features of melancholic depression

A
  1. Early morning wakening
  2. Morning mood worse
  3. Psychomotor retardation
  4. Morning awake
  5. Excessive guilt
  6. Loss of emotional reactivity
  7. Anorexia
  8. Anhedonia
29
Q

Which is the condition most assiciated with psychotic symptoms in the elderly?

A

Dementia

30
Q

Late onset depression is associated with higher rates of relapse T/F

A

T

31
Q

EEG changes in delirium

A

Diffuse slowing. Generalised theta or delta slow wave activity, poor organisation of background rhythm, loss of reactivity to eye opening and closing

32
Q

Indications for CT head in dementia

A

Indications for CT head in dementia
o Age <60y
o Rapid decline in cognition (ie over 1-2m)
o Duration of dementia <2y
o Recent significant head trauma
o Unexplained neurological symptoms
o History of cancer (especially locations that frequently metastasize to brain)
o Use of anticoagulants or bleeding disorder
o Symptoms of NPH
o New localizing neurologic symptom
o Unusual or atypical cognitive Sx (ie progressive aphasia)
o Gait disturbance
o If presence of undiagnosed CVD would change treatment

33
Q

Genetic testing in dementia is recommended when in terms of age at onset?

A

<65y

34
Q

Treatment of choice for behavioural sx of LBD

A

Rivastigmine

35
Q

There is no increased rate of suicide in dementia T/F

A

T

36
Q

Prevalence of MCI over 65

A

10-20%

37
Q

Rate of conversion of MCI to dementia each year

A

10%

38
Q

Percentage of MCI that do not develop dementia

A

25%

39
Q

Cognitive impairment, fluctuations, frequent falls and visual hallucinations

A

LBD

40
Q

The nost frequently used tests of executive function in aging

A
  1. Trail making test
  2. Verbal fluency test
  3. VFT animals category
  4. Clock drawing test
  5. Digits forward or backward subtest of WAIS
  6. Stroop test
  7. Wisconsin card sorting test
41
Q

What is the strongest risk factor for Alzheimer’s dementia?

A

Age

42
Q

Prevalence of AD at 90 years of age

A

21%

43
Q

EEG pattern of periodic synchronous bi- or triphasic sharp wave complexes is highly suggestive of what?

A

CJD

44
Q

The MMSE is good for what in dementia?

A

It has high sensitivity and specificity for separating moderate dementia from normal cognition

45
Q

Which type of dementia does not respond to ACEi

A

FTD

46
Q

Neurofibrillary tangles only occur in Alzheimer’s dementia T/F

A

F also in Down syndrome, dementia pugilistica (punch drunk syndrome). Not in vascular dementia though

47
Q

The most characteristic focal finding on MRI in AD

A

Reduced hippocampal volume

48
Q

What’s the one year mortality after an episode of delirium?

A

As high as 50% K&S

49
Q

Anticholinergics can precipitate delirium T/F

A

T frequently

50
Q

Subcortical NCDs

A
  1. Parkinsons disease dementia
  2. HIV dementia
  3. Vascular lesions which are subcortical
51
Q

Delirium DSM V

A

DSM-5

A. Disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).

B. The disturbance develops over a short period of time (usually hours to a few days), represents an acute change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.

C. An additional disturbance in cognition (e.g.memory deficit, disorientation, language, visuospatial ability, or perception).

D. The disturbances in Criteria A and C are not better explained by a pre-existing, established or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal such as coma.

E. There is evidence from the history, physical examination or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e. due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies.

52
Q

Risk factors for post op delirium

A

● pre-existing dementia (strongest)

● severe medical illness. (2nd strongest)

● Advanced age

● Little contact with family

● male sex

● depression

● alcohol abuse

● Electrolyte abnormalities

● Medication use

● hearing/visual impairment

● Limited pre-morbid activities

● pre-existing challenges with ADLs

● fracture on admission

● General anesthesia is NOT a RF for post-operative delirium

53
Q

APOE4 increases risk of earky onset AD T/F

A

F, its late onset

54
Q

LBD criteria DSM V

A

DSM-5 Diagnostic Criteria for Major or Mild Neurocognitive Disorder with Lewy Bodies

The criteria are met for major or mild neurocognitive disorder AND

The disorder has an insidious onset and gradual progression AND

The disorder meets a combination of core diagnostic features and suggestive diagnostic features for either probable or possible neurocognitive disorder with Lewy bodies.

For probable major or mild neurocognitive disorder with Lewy bodies, the individual has two core features or one suggestive feature with one or more core features.

For possible major or mild neurocognitive disorder with Lewy bodies, the individual has only one core feature or one or more suggestive features.

Core diagnostic features of neurocognitive disorder with Lewy bodies include the following:

fluctuating cognition with pronounced variations in attention and alertness

recurrent visual hallucinations that are well-formed and detailed

spontaneous features of parkinsonism, with onset subsequent to the development of cognitive decline

suggestive diagnostic features:

meets criteria for rapid eye movement sleep behavior disorder

severe neuroleptic sensitivity

disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder

55
Q

AD has predominant PET changes in the temparo-parietal region T/F

A

T

56
Q

General anaesthesia is a risk factor for post op delirium T/F

A

F

Psychiatry (27 decks)

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