Old Age Psych Flashcards
How does depression in the elderly present?
Similar to younger people but with more:
Physical symptoms
Agitation/retardation
Memory problems (pseudo dementia)
Epidemiology of depression in the elderly
15% in the community
30% in hospital
Multiple bereavements, social isolation, poverty, physical illness and chronic pain are more common in the elderly
What is late-onset schizophrenia?
Positive symptoms more prominent than negative
More common in women
Especially if: isolated, single, widowed or childless
Reduce sensory impairment
Exclude organic cause
Low dose antipsychotics
What is Charles Bonnet syndrome?
Complex visual hallucinations secondary to visual impairment alone
What is dementia?
An acquired chronic and progressive cognitive impairment
Sufficient to impair activities of daily living
How is dementia diagnosed?
Low MMSE
Effect on ADLs
Symptoms present in clear consciousness for at least 6 months
What might cause a low MMSE?
Dementia Delirium Psychiatric illnesses Learning disability Sensory impairment Language barrier Feeling unwell, tired, irritable
What comprises the activities of daily living?
Financial management Using toilet Washing Dressing Grooming Shopping Cooking Housework Mobilising
What is the epidemiology of dementia?
5% over 65 yrs 20% over 80 yrs Alzheimers = most common 2/3 Vascular dementia Lewy body dementia
What are the clinical features of dementia?
Forgetfulness Disorientation Loss of independence Poverty of thought + speech Anxiety Depression
What behavioural and psychiatric problems might you expect to see with dementia?
Wandering
Sleep disturbance
Delusions
Hallucinations
vocalisations: swearing, shouting, screaming
Inappropriate behaviour incl sexual disinhibition
Aggression
What are the risk factors for developing Alzheimer’s ?
Age Genetics Vascular risk factors e.g. HTN Low IQ Head injury
What are the familial forms of Alzheimer’s?
Early onset: AD causing increased beta- amyloid
Presenilin 1 gene Chr 14
Presenilin 2 gene Chr 1
Beta-amyloid precursor protein APP gene Chr 21
Late onset: >65 AD
Apolipoprotein E4 allele Chr 19
Is inherited risk greater if a parent has early or late onset Alzheimer’s
Early Familial alzheimers: Chr 21 = APP gene Chr14 = presenelin 1 Chr 1= presenelin 2 Down's >= 60 yrs = 50% prevalence
Why are people with Down’s syndrome at greater risk of Alzheimer’s?
Most likely due to extra copy of APP gene
What is the pathology seen in Alzheimer’s ?
Atrophy: due to neuronal loss, particularly hippocampus early, temporal and parietal later
Plaque formation: APP abnormally cleaved into beta-myeloid which aggregates into insoluble lumps, dystrophic neuritis filled with hyperphosphorylated tau protein surround these
Intracellular neurofibrillary tangles (hyperphosphorylated tau)
Severity of dementia most assoc with the number NFTs
Cholinergic loss
What is the clinical presentation in Alzheimer’s ?
Insidious onset
Amnesia: disorientation
Aphasia: issues finding words= muddled speech
Agnosia: recognition problems e.g. Faces
Apraxia: inability to dress etc despite normal motor function
What is vascular dementia?
Caused by infarcts due to thromboembolism or arteriosclerosis
RF: old age, male, smoking, HTN, DM, hypercholesteraemia, AF
May have had MIs or TIAs
What is the pathology seen in vascular dementia?
Arteriosclerosis
Cortical ischaemia
Infarction, seen on CT as multiple lucencies
What is the clinical presentation in vascular dementia?
Stepwise progression
Sudden deterioration following infarcts
Many tiny infarcts cause a smoother more subtle deterioration
Symptoms reflect sites of lesions
May present with neuro signs e.g. Hemiparesis or aphasia
Night time confusion
What is the pathology seen in DLB?
Lewy bodies:
Eosinophilic intra cytoplasmic neuronal structures of alpha synuclein and ubiquitin
Found in congrats gyrus and neocortex
What is the clinical presentation in DLB
2/3
Fluctuating confusion with marked variation in alertness
Vivid visual hallucinations (people or animals)
Spontaneous parkinsonian signs
Also: repeated falls, syncope, transient loss of consciousness
Short term memory affected
Why is it imperative that patients with DLB are not prescribed antipsychotics?
Extreme neuroleptic sensitivity!
Can result in death
Do not misdiagnose as delerium.
What is the mirror sign?
Sometimes seen in dementia
Sufferers no longer recognise their own reflection
