Geriatric Psychiatry Flashcards
What does the acronym ‘DEMENTIA’ stand for in relation to causes?
D: drug toxicity, E: ethanol, M: metabolic - hypothyroid, E: environmental - metal poisoning, N: nutritional - B12, thiamine deficiency, T: tumour and trauma, I: infectious - HIV, syphilis, viral, A: affective disorder - pseudodementia
List the types of dementia.
- Alzheimer’s disease
- Dementia with lewy bodies
- Vascular dementia
- Fronto-temporal dementia
- Others
Differentiate between cortical and subcortical dementia.
Cortical: Alzheimer’s disease, fronto-temporal dementia
Subcortical: Lewy body dementia, vascular dementia - more neurological signs
What are the 4 A’s of dementia symptoms?
- Amnesia
- Apathy
- Acalculia
- Alogia
What is the age of onset for fronto-temporal lobe dementia?
45-65 years old
What are the management options for fronto-temporal lobe dementia?
Management with SSRIs to manage impulsive behaviour
Describe the characteristics of Alzheimer’s Disease.
- Progressive degenerative disease
- Insidious onset, gradual progression
What are the risk factors for Alzheimer’s Disease?
- Age
- Sex (F>M)
- Genetics - APOE4 homozygosity predisposes, APOE2 is protective
List the protective factors against Alzheimer’s Disease.
- High level of physical activity ≥ 3 times a week
- Education: >15 years vs <12 years
- Cognitive engagement
- Fish intake > once a week
- Medications: NSAIDs, statins
What are the main pharmacological treatments for Alzheimer’s Disease?
- Acetylcholinesterase inhibitors (donepezil, rivastigmine)
- NMDA receptor channel blocker (Memantine)
What are the side effects of acetylcholinesterase inhibitors?
- Diarrhea
- Muscle cramp
- Bradycardia
- Bronchospasm
- May lower seizure threshold
What are the main features of Lewy Body Dementia?
- Accumulation of alpha synuclein inclusions
- Hallucinations and delusions
- Fluctuating cognition
- Changes in attention and visuospatial awareness
- Parkinsonian features
Identify the risk factors for vascular dementia.
- Hypertension
- Diabetes
- Depression
What are common features of vascular dementia?
- Stepwise deterioration
- Abrupt onset, fluctuating course
- Patchy memory impairment
- Labile emotions/depression
- Personality preserved
What are the common medical causes of dementia?
- Normal pressure hydrocephalus
- Alcoholic dementia
- HIV-associated dementia
- Creutzfeldt-Jakob Disease (CJD)
- Hypothyroidism
- Chronic subdural hematoma
- Neurosyphilis
What are the features suggesting a medical cause for dementia?
- Rapid onset/progression
- Younger age
- Recent/chronic illness before onset
- History of trauma/toxin exposure
- Predominant frontal lobe symptoms
- Onset of focal neurological symptoms
What are the features of Behavioral & Psychological Symptoms of Dementia (BPSD)?
- Agitation
- Aggression
- Disinhibition
- Delusions and hallucinations
- Wandering
- Depression
- Apathy
- Sleep disturbances
What is the CAMS criteria for diagnosing delirium?
- Acute onset & fluctuating course
- Inattention AND either disorganized thinking or altered level of consciousness
List the potential causes of delirium.
- CVA, CNS pathology
- Meningitis, encephalitis, UTI
- Trauma
- Vasculitis
- Electrolyte disturbances
- Endocrine issues
- Iatrogenic causes
- Neoplasms
- Seizures, withdrawal, drug/toxin induced, hypoxia, constipation
What is the management approach for delirium?
Find and treat the underlying cause; reserve psychotropic meds for distress due to agitation/psychotic symptoms
True or False: It is recommended to treat hypoactive delirium with psychotropic medications.
False
