Hallucinations in the elderly Flashcards
Which part of the brain typically sees atrophy in Alzheimer’s dementia?
The Hippocampus
What is covered in a MMSE?
- Appearance and behaviour
- Speech
- Mood
- Thoughts (content and form)
- Perception
- Cognition
- Insight
What is covered in a dementia risk assessment?
- Previous involvement with
- Family history
- ADLs
- Falls
- Accidents (driving etc)
- Smoking/alcohol
- Memory re important information (money, bank details)
What signs are seen in Alzheimer’s dementia?
- More common in women
- Hallucinations may occur in late stages
- Gradual decline in cognitive impairment
- Decrease in facial expression develops in late disease
- Physical deterioration usually at late stage
What signs are seen in Lewy body dementia?
- More common in men
- Visual hallucinations occur early
- Fluctuating cognitive impairment
- Face shows little emotion from early in disease process
- Early problems with balance
What are the core, suggestive, and supportive features of lewy body dementia?
Core:
- Fluctuating cognition
- Recurrent well-formed visual hallucinations
- Spontaneous features of Parkinsonism
Suggestive:
- REM sleep behavioural disorder (sleepwalking etc)
- Severe neuroleptic sensitivity
- Low dopamine transporter uptake in basal ganglia on SPECT/PET
Supportive:
- Falls
- Autonomic dysfunction
- Delusions
- Depression
How is lewy body dementia diagnosed?
- Based on the pattern of symptoms
- Only confirmed with a brain autopsy showing lewy bodies in neurons (protein buildup)
How is Lewy body dementia treated?
Motor:
- Drugs used for Parkinson’s such as levodopa
Cognitive:
- Drugs used for alzheimer’s such as donepezil
Rivastigmine can help with visual hallucinations
Clonazepam can help with REM sleep behaviour disorder
Other:
- Engage in stimulating acitivies as this will slow progress
- Refer for neurological assessment regarding falls
- Refer for physiotherapy and functional assessment
What is the starting treatment option for lewy body dementia/Parkinson’s demenia?
Rivastigmine patch, 4.6mg/24hours
Oral is usually given, but if a patient has swallowing difficulties or GI issues, a patch is preferred
This dose can be increased to 9.5mg/24 hours after 4 weeks
What is REM sleep behaviour disorder?
Rem sleep behaviour disorder:
- Exhibiting dream enacted behaviours
- Patient is not confused upon waking
- Treated with Clonazepam
- Seen more often in patients with other neurological disorders
Which anti-psychotics are used in patients with lewy body dementia?
- Patients with LBD or Parkinson’s dementia have an increased risk of neuroleptic sensitivity
- Low dose anti-psychotics can cause worsening of confusion and increased agitation and rigidity
Treatments:
- Low does Quetiapine OR Clozapine
- Quetiapine is preferred as more monitoring is required with Clozapine
