Exam #1: Behavioral & Psychological Symptoms of Dementia Flashcards
What is the neuropsychiatric complication of dementia?
Psychological comorbidity of dementia
*****Dementing disorders put the brain at risk for psychiatric complications
What do you need to remember in the approach to a geriatric patient with new psychiatric symptoms?
Need to consider the entire patient & rule out an obvious physiological problem e.g. UTI
What is the first thing that needs to be determined with a new neuropsychiatric complaint?
Timeline
Outline the dementias mnemonic.
D= drugs E= emotional/ psychiatric M= metabolic derangement E= endocrine disease N= nutrition T= trauma I= ischemia, inflammation, infection A= anoxia, arrhythmia, anemia S= sensory, social, spiritual isolation
What is agitation?
Non-specific term for:
- Anxiety
- Irritability
- Restlessness
- Aggression
- Screaming
- Rummaging
- Sundowning
**It is important to get a sense of the severity
What are the non-pharmacologic interventions for agitation?
1) Avoid confrontation
2) Remove environmental triggers
3) Create quiet & calm environment
4) Structure daily routine
5) Address pain & discomfort
6) Consider aromatherapy
What are the pharmacologic interventions for agitation?
Buspar SSRI Anticonvulsants Benzodiazapees Antipsychotics Cholinesterase inhibitors
*****These are more directly intended for “anxiety”
What is sundowning?
Agitation that starts in the late afternoon or early evening
- May be related to circadian rhythms
What are the non-pharmacologic interventions for sundowning?
- Keep living area lit
- Have the person engaged with something enjoyable at time of symptom onset
What are the pharmacologic interventions for sundowning?
Benzodiasapenes
Antipsychotics
**Can be given pre-preemptively
What is Capgras Syndrome?
Misidentification syndrome; person sees the loved one & recognizes that the person looks like there loved on, but isn’t
What is Fregoli Syndrome?
Misidentification of strangers as familiar persons
What are the non-pharmacologic interventions for delusions?
- Reassurance
- Distraction
- Benign neglect
- Validation therapy
- Remove objects that are being misidentified
What are the pharmacologic interventions for delusions?
Atypical anti-psychiotics
What is the most common type of hallucination?
Visual
How can hallucinations be treated non-pharmacologically?
- Reassurance
- Distraction
- Benign neglect
- Validation therapy
How can disturbing hallucinations be treated pharmacologically?
Atypical anti-psychotics
How should you approach patients that are resistive to care?
- Limit goals
- Use a gentle slow approach
- Some patients will cooperate for a reward
**Can pretreat with benzodiazopenes if these don’t work
How can you approach disinhibition?
- Avoidance of situations
- Restrictive clothing
- “Information cards”
How can you pharmacologically approach disinhibition?
**SSRI + medroxyprogesterone acetate–>then add lupron if that combo doesn’t initially work after a while
- Anticonvulsants
- Beta Blocker
- SSRI
Why wait a couple of months before giving Lupron?
Will initially “empty” the brain of LH & FSH, leading to a surge of disinhibition
Is there a good pharmacologic intervention for wandering?
No
What is the best “treatment” for wandering?
Facilitate it in a safe way
What is apathy?
Lack of interest
**Can lead to decreased efforts at hygiene & other important activities that needs to be addressed
What cortical area is involved in apathy?
Cingulate gyrus
How is apathy treated pharmacologically?
Provigil & ritalin i.e. psychostimulants
