Elderly Psychiatry Flashcards
What are some pathological signs of dementia?
Widened sulci
Narrowed gyri
Cerebral atrophy (diffuse in AD, in frontal and temporal lobes if FTD)
AD: neurofibrillary tangles and amyloid plaques
How does memantine work?
Glutaminergic NMDA receptor antagonist
How do most AD drugs work?
AChE inhibitors
Memantine 2nd line
What are some examples of AD drugs that are AChE inhibitors?
Galantamine
Rivastigmine
Donepezil
What are the types of dementia, in order of how common they are?
Alzheimer’s
Vascular
Lewy Body
Frontotemporal
What causes vascular dementia?
Brain damage due to cerebrovascular Disease
Eg after multiple infarcts, single strategic infarct, small vessel disease
What are some risk factors for vascular dementia?
Diabetes Smoking Hyperlipidaemia Hx of stroke/ TIA Obesity Hypertension CHD
How do some symptoms of vascular dementia differ to AD?
More associated with seizures and focal neurological abnormalities eg visual disturbances/ EPSE/ Sensory our motor symptoms
Deteriorations tend to be stepwise in VD
How does Lewy Body dementia usually present?
Usual memory loss and cognitive decline as well as... Visual hallucinations Syncope episodes Parkinsonian symptoms Fluctuating awareness and attention
How does frontotemporal dementia present?
Behavioural changes eg loss of inhibition, lack of insight, inappropriate social behaviours, loss of empathy
Problems with speech and vocabulary
What are the 3 types of delirium?
Hypoactive (most common)
Hyperactive
Mixed
How can we diagnose delirium?
Using CAM
+ve if score >5 or equal to
How doe the decline in Alzheimer’s dementia differ to the decline in vascular dementia?
Alzheimer’s has a gradual progression (as more plaques build up in the brain)
Vascular dementia has a step wise decline correlating with additional vascular events
An onset of dementia before which age is classed as early onset dementia?
Less than 65
How does hypoactive delirium present?
Withdrawn
Loss of appetite
Less communication
Low mood
