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Mental Health > Old Age Psych > Flashcards

Old Age Psych Flashcards

1
Q

What are the 3 D’s in old age psych?

A

Delirium
Dementia
Depression

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2
Q

What scoring system is most commonly used to assess old age cognition?

A

Addenbrooke’s Cognitive Examination (ACE-III)

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3
Q

What score indicates a cognitive impairment in older patients?

A

<82/100

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4
Q

What are the 3 scoring systems that can be used to assess cognition?

A
  • ACE-III
  • Montreal Cognitive Assessment (MOCA)
  • Mini Mental State Examination (MMSE)
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5
Q

What tool is used to assess frontal lobe function in older age patients?

A

The Frontal Assessment Battery (FAB)

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6
Q

What are the categories assessed in the ACE-III and what are they scored out of?

A
  • Attention (18)
  • Memory (26)
  • Visuo-spatial (16)
  • Fluency (14)
  • Language (26)
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7
Q

What instruments can be used to assess the functional aspects of dementia patients?

A
  • ADL questionnaire
  • Functional activities questionnaire
  • Bristol Functional assessment
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8
Q

What instruments can be used to assess the psychological aspects of dementia patients?

A

Neuropsychiatric inventory (NPI)

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9
Q

What instruments can be used to assess the care giver strain aspects of dementia patients?

A

MBRC caregiver strain instrument

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10
Q

Which dementias can be managed somewhat with medication?

A

Lewy Body dementia

Alzheimer’s dementia

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11
Q

What are the 3 drug classes that can be used to help slow down the process of dementia?

A
  1. Cholinesterase inhibitors - donepezil, galantamine
  2. Butyrylcholinesterase and acetylcholinesterase inhibitors - Rivastigmine
  3. NMDA receptor blockers - memantine
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12
Q

What does BPSD stand for?

A

Behavioural and psychological symptoms of dementia

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13
Q

List some BPSD

A
  • Hallucinations
  • Delusions
  • Anxiety
  • Marked agitation
  • Aggression
  • Wandering
  • Hoarding
  • Sexual disinhibition
  • Apathy
  • Shouting
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14
Q

What investigations need to be carried out prior to starting a patient on a medication for dementia control?

A
  1. ECG - some medications can cause bradycardia, prolonged QTc and LBBB
  2. U&E - memantine can cause acute renal failure
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15
Q

What psychological managements are available to patients with dementia?

A
  1. CBT
  2. Cognitive stimulation therapy
  3. Reminiscence therapy
  4. Aromatherapy
  5. Sensory stimulation
  6. Music therapy
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16
Q

What is ‘Lasting Power of Attorney’?

A

Delegating the ability for others to manage your affairs if there is a lapse or loss of capacity due to ill health.
There is one for making decisions about health and one for decisions about property and finances

17
Q

How much does a LPA cost?

A

£130 court fees

18
Q

What is an ‘Advanced Care Plan’?

A

A formal document that outlines the patients wishes for their care whilst they still have capacity that can be followed when they lack capacity once the disease progresses

19
Q

What is DoLS?

A

Deprivation of Liberty Safeguard

20
Q

What do DoLS do?

A

They are provided under the MCA to protect anyone whose liberty is taken away in whatever form (usually in a nursing/care home or hospital). They ensure the patients best interest is the centre of decisions

21
Q

What are the known risk factors for developing Alzheimer’s Dementia?

A
  1. Age - increases with increasing age
  2. Being female
  3. Being African
  4. Depression in mid-later life
  5. Lifestyle factors e.g. smoking, drinking, education
  6. Head injuries
22
Q

What are the known risk factors for developing Vascular dementia?

A
  1. Age - increases with increasing age
  2. Being male
  3. Being of South Asian descent
  4. Depression in mid-later life
  5. Lifestyle factors e.g. smoking, drinking, education
  6. Head injuries
23
Q

What are the known risk factors for Lewy Body dementia?

A
  1. Age - increases with increasing age
  2. Being African or Caribbean
  3. Depression in mid-later life
  4. Lifestyle factors e.g. smoking, drinking, education
  5. Head injuries
24
Q

Describe the clinical presentation of Alzheimer’s Disease

A
  1. Cortical function involvement, 3A’s ; Aphasia (inability to communicate), Agnosia (inability to interpret sensations), Apraxia (inability to perform learned movements on command)
  2. Decreased motivation and drive - apathy and lack of spontaneity
  3. Slow rate of progression
25
Q

When is it classed as ‘Early onset’ Alzhemier’s?

A

When someone presents before the age of 65

26
Q

What percentage of people with Down’s Syndrome will develop Alzheimer’s dementia if they live to their 60s?

A

50%

27
Q

What are the 2 types of vascular dementia?

A
  1. Single infarct dementia - symptoms dependent on where this has occurred
  2. Multi-infarct dementia
28
Q

How does Vascular dementia clinically present if there is small vessel disease in the sub-cortex?

A
  1. Personality changes
  2. Slowness of thought
  3. Affective symptoms
  4. Executive skills - planning, organising, making decisions or solving problems becomes very difficult

There is a step-wise progression in VD

29
Q

How does Lewy Body Dementia (LBD) typically present clinically?

A
  1. Sleep disturbance - nightmares, aggressive movements, disruption of sleep cycle
  2. Autonomic dysregulation
  3. Variable cognition
  4. Psychotropic medication hypersensitivity
  5. Urinary incontinence
  6. Cognition - visio-spatial issues, language impairment, dyspraxia
30
Q

When comparing AD to LBD, what happens with; facial expression?

A

AD - decrease in facial expression comes at a later stage

LBD - little facial emotion from early disease

31
Q

When comparing AD to LBD, what happens with; cognitive impairment?

A

AD - progressive loss

LBD - fluctuating cognitive impairment

32
Q

When comparing AD to LBD, what happens with; Hallucinations?

A

AD - they may occur but in the later stages of disease

LBD - visual hallucinations occur early on

33
Q

When comparing AD to LBD, what happens with; physical status?

A

AD - deteriorates in the later stages

LBD - Balance problems early on

Mental Health (7 decks)

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