Elderly Psychiatry, Dementia, and Delerium

Question 1

Define dementia

Answer 1

A syndrome characterised by chronic progressive cognitive impairment, significant enough to impact on a pts ADLs, existing for at least 6 months. No altered level of consciousness.

Question 2

What are some of the cognitive functions impaired in dementia?

Answer 2

Memory
Attention
Concentration
Language processing
Speech
Thinking
Judgement

Question 3

Define delirium

Answer 3

A syndrome characterised by acute cognitive impairment alongside fluctuating levels of consciousness and attention

Question 4

What % of people over 85 are affected by dementia?

Answer 4

25%

20% at 80, 15% at 75, 10% at 70, 5% at 65

Question 5

What is the average time from diagnosis of dementia to death?

Answer 5

10 years

Question 6

What are the main types of dementia?

Answer 6

Alzheimer’s Disease
Dementia with Lewy bodies
Vascular dementia
Frontotemporal Dementia
Alcoholic dementia

Question 7

Which medical conditions are associated with dementia?

Answer 7

Huntington’s
MS
HIV
Down’s syndrome

Question 8

Define Alzheimer’s disease

Answer 8

A form of dementia characterised by insidious onset of symptoms, associated with the formation of amyloid plaques, neurofibrillary tangles, and brain atrophy.

Question 9

What are the differentials for dementia wrt cognitive decline?

Answer 9

Depression
Delirium
Physical illness eg infection, pain, poor glycaemic control
****g

Question 10

What are some of the features of early stage dementia?

Answer 10

• Cognitive decline, usually (short term) memory related
• Subtle changes in mood +/or behaviour
• Impact on higher functioning ADLs
• Minimal impact on basic ADLs
• Often have insight

Question 11

What are some of the features of mid stage dementia?

Answer 11

• More pronounced cognitive difficulties
• More pronounced behavioural/mood changes
• Increase in assistance for basic tasks needed
• Insight loss - view deviates from reality

Question 12

What are some of the features of late stage dementia?

Answer 12

• Severe and pervasive memory features/cognitive symptoms
• Marked behavioural changes, both positive and negative
• Severe disability - assistance required almost constantly
• No insight

Question 13

What are positive behavioural features?

Answer 13

Behavioural changes where there is an added or different behaviour exhibited.

Question 14

What are negative behavioural changes?

Answer 14

Behavioural change where a previous behaviour is taken away, or the patient becomes withdrawn.

Question 15

Define frontotemporal dementia

Answer 15

Chronic progressive neurodegenerative syndrome characterised by change in personality and social conduct, with usually preserved memory and visuospatial skills. Due to frontotemporal lobe degeneration.

Question 16

Define vascular dementia

Answer 16

Syndrome of cognitive decline caused by multiple acute ischaemic events that progresses in a step-wise manner.

Question 17

Define Lewy body dementia

Answer 17

Syndrome of cognitive decline characterised by the presence of Lewy bodies in the brainstem and neocortical areas.

Question 18

What is considered when distinguishing between types of dementia?

Answer 18

Course
Onset
Initial symptoms
Mood and behavioural changes
Other symptoms
Neurological features
Structural brain imaging

Question 19

Can pts get mixed type of dementia? Eg?

Answer 19

Yes

Eg Alzheimer’s with vascular dementia

Question 20

What is an important part of the history to get in a pt with suspected dementia?

Answer 20

Collateral Hx (alongside pts own account)