Old Age Pschyiatry Flashcards
Groups of cognitive features in dememntia
Memory (dysnesia)
functional decline
neuropsychiatric disturbance
for a diagnosis of dementia you need dysnesia plus one or more of
dysphasia - expressive or receptive
dyspraxia
dysgnosia
dysexecutive functioning
how can you measure functional decline in dementia?
ADLs
give examples of neuropsychiatric disturbances
psychosis depression altered circadian rhythms agitation anxiety
discuss dementia vs delirum
Delirium can be mistaken for, or can coexist with, dementia and should be addressed promptly. Delirium is often under-diagnosed in the clinical setting. It is essential that delirium is discounted as early as possible. The underlying physical disorder, together with the cognitive decline, may constitute a medical emergency.
Dementia Delirium
Insidious onset with unknown date Abrupt, precise onset, known date
Slow, gradual, progressive decline Acute illness, lasting days or weeks
Generally irreversible Usually reversible
Disorientation late in illness Disorientation early in illness
Slight day to day variation Variable hour by hour
Less prominent physiological changes Prominent physiological changes
Consciousness clouded only in late stage Fluctuating levels of consciousness
Normal attention span Short attention span
Disturbed sleep-wake cycle; day night Disturbed sleep-wake cycle; hour to hour variation
Psychomotor changes late in illness Marked early psychomotor changes
discuss dementia vs depression
It can be difficult to differentiate between dementia and depression. Depression can manifest as dementia, or the dementia syndrome of depression (depressive pseudodementia). Conversely, dementia can present with depressive symptoms in the early stages of the illness. Depression and dementia often coexist. Up to 50% of individuals diagnosed with dementia will have coexisting depressive symptoms at some stage of the illness.
Dementia Depression
Insidious onset Abrupt onset
No psychiatric history History of depression
Conceals disability Highlights disabilities
Near-miss answers “Don’t know” answers
Mood fluctuation day to day Diurnal variation in mood
Stable cognitive loss Fluctuating cognitive loss
Tries hard to perform but is unconcerned by losses Tries less hard to perform and gets distressed by losses
Short-term memory loss Short and long-term memory loss
Memory loss occurs first Depressed mood coincides with memory loss
Associated with a decline in social function Associated with anxiety
Describe the course of dementia (diagram)
see notes
Describe the course of dementia (words)
In the optimal case, the course of AD progression can be divided conveniently in to three stages, early, mild to moderate, and severe. In the early stages of the disease, the patient will generally remain symptom-free. As the illness progresses, the extent of cognitive impairment becomes such that patient and caregivers recognise that there is a problem. A progressive and insidious decline in cognition and functional ability marks the mild to moderate stage. Cognitive loss leads to functional decline and behavioral symptoms. The rate of decline varies from patient to patient. During the later severe stages of the illness functional ability is lost completely and institutionalisation is inevitable. Although AD is a progressive disease for which there is currently no cure, symptomatic treatments are becoming available that maintain or may improve the patient’s functional ability. Despite new symptomatic treatments having not been shown to affect the underlying disease process, the ability to maintain function or cognitive capabilities for longer should be viewed as a viable treatment objective. Expectations, however, should be realistic.
clinical assessment for dementia
history and collateral risk assessment cognitive testing physical and bloods neuroimaging follow up - PDS for up to 1 year
what would you see on a functional scan of alzheimer’s?
increased gyri and atrophy of temporal lobes
dementia as a clinical syndrome (ABCD)
ADLs
Behavioural and psychiatric symptoms of dementia (BPSD)
Cognitive impairment
Decline
Features of neuropsychiatric disorders
Psychosis Depression Altered circadian rhythm Agitation Anxiety
Describe dementia with lewy bodies
amnesia not prominent deficits of attention,frontal executive, visuospatial fluctation visual hallucination parkinsonism
What with a DATScan in DLB (dementia with lewy bodies) show?
reuptake of the dopamine transporter in the head of the caudate nucleus and putamen will be in the shape of a full stop. normal = comma
describe frontotemporal dementia
behavioural disorder - personality change
speech disorder - altered output, stereotypy, echoloa, perseveration, mutism
neuropsychology - frontal dysexecutive syndrome, memory, praxias, visuospatial function not severely impaired
neurological signs absent early, parkinsonism later
