Old Age Psych Flashcards
What are the 3 D’s in old age psych?
Delirium
Dementia
Depression
What scoring system is most commonly used to assess old age cognition?
Addenbrooke’s Cognitive Examination (ACE-III)
What score indicates a cognitive impairment in older patients?
<82/100
What are the 3 scoring systems that can be used to assess cognition?
- ACE-III
- Montreal Cognitive Assessment (MOCA)
- Mini Mental State Examination (MMSE)
What tool is used to assess frontal lobe function in older age patients?
The Frontal Assessment Battery (FAB)
What are the categories assessed in the ACE-III and what are they scored out of?
- Attention (18)
- Memory (26)
- Visuo-spatial (16)
- Fluency (14)
- Language (26)
What instruments can be used to assess the functional aspects of dementia patients?
- ADL questionnaire
- Functional activities questionnaire
- Bristol Functional assessment
What instruments can be used to assess the psychological aspects of dementia patients?
Neuropsychiatric inventory (NPI)
What instruments can be used to assess the care giver strain aspects of dementia patients?
MBRC caregiver strain instrument
Which dementias can be managed somewhat with medication?
Lewy Body dementia
Alzheimer’s dementia
What are the 3 drug classes that can be used to help slow down the process of dementia?
- Cholinesterase inhibitors - donepezil, galantamine
- Butyrylcholinesterase and acetylcholinesterase inhibitors - Rivastigmine
- NMDA receptor blockers - memantine
What does BPSD stand for?
Behavioural and psychological symptoms of dementia
List some BPSD
- Hallucinations
- Delusions
- Anxiety
- Marked agitation
- Aggression
- Wandering
- Hoarding
- Sexual disinhibition
- Apathy
- Shouting
What investigations need to be carried out prior to starting a patient on a medication for dementia control?
- ECG - some medications can cause bradycardia, prolonged QTc and LBBB
- U&E - memantine can cause acute renal failure
What psychological managements are available to patients with dementia?
- CBT
- Cognitive stimulation therapy
- Reminiscence therapy
- Aromatherapy
- Sensory stimulation
- Music therapy
What is ‘Lasting Power of Attorney’?
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
How much does a LPA cost?
£130 court fees
What is an ‘Advanced Care Plan’?
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
What is DoLS?
Deprivation of Liberty Safeguard
What do DoLS do?
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
What are the known risk factors for developing Alzheimer’s Dementia?
- Age - increases with increasing age
- Being female
- Being African
- Depression in mid-later life
- Lifestyle factors e.g. smoking, drinking, education
- Head injuries
What are the known risk factors for developing Vascular dementia?
- Age - increases with increasing age
- Being male
- Being of South Asian descent
- Depression in mid-later life
- Lifestyle factors e.g. smoking, drinking, education
- Head injuries
What are the known risk factors for Lewy Body dementia?
- Age - increases with increasing age
- Being African or Caribbean
- Depression in mid-later life
- Lifestyle factors e.g. smoking, drinking, education
- Head injuries
Describe the clinical presentation of Alzheimer’s Disease
- Cortical function involvement, 3A’s ; Aphasia (inability to communicate), Agnosia (inability to interpret sensations), Apraxia (inability to perform learned movements on command)
- Decreased motivation and drive - apathy and lack of spontaneity
- Slow rate of progression
When is it classed as ‘Early onset’ Alzhemier’s?
When someone presents before the age of 65
What percentage of people with Down’s Syndrome will develop Alzheimer’s dementia if they live to their 60s?
50%
What are the 2 types of vascular dementia?
- Single infarct dementia - symptoms dependent on where this has occurred
- Multi-infarct dementia
How does Vascular dementia clinically present if there is small vessel disease in the sub-cortex?
- Personality changes
- Slowness of thought
- Affective symptoms
- Executive skills - planning, organising, making decisions or solving problems becomes very difficult
There is a step-wise progression in VD
How does Lewy Body Dementia (LBD) typically present clinically?
- Sleep disturbance - nightmares, aggressive movements, disruption of sleep cycle
- Autonomic dysregulation
- Variable cognition
- Psychotropic medication hypersensitivity
- Urinary incontinence
- Cognition - visio-spatial issues, language impairment, dyspraxia
When comparing AD to LBD, what happens with; facial expression?
AD - decrease in facial expression comes at a later stage
LBD - little facial emotion from early disease
When comparing AD to LBD, what happens with; cognitive impairment?
AD - progressive loss
LBD - fluctuating cognitive impairment
When comparing AD to LBD, what happens with; Hallucinations?
AD - they may occur but in the later stages of disease
LBD - visual hallucinations occur early on
When comparing AD to LBD, what happens with; physical status?
AD - deteriorates in the later stages
LBD - Balance problems early on
