Old Age Psych

Question 1

Risks of psychosis in old age?

Answer 1

Female,
Deafness
Past psych history

Question 2

What is a delusional disorder?

Answer 2

Delusion is non-bizarre,
Able to function
Not schizophrenic

Rx: atypical antipsychotics

Question 3

What are 3rd person or 2nd person hallucinations?

Answer 3

3rd- first rank symptoms (schizophrenia)

Question 4

Which factors make you think depression rather than dementia?

Answer 4

Short hx.
Biological sx- lack of sleep, appetite
Pt is worried about poor memory
Global memory loss

Question 5

What is a Lewy body?

Answer 5

Alpha-synuclein protein deposits (found in the substantia nigra, paralimbic and neocortical areas.

Question 6

What are the features of Lewy body dementia?

Answer 6

Progressive cognitive impairment
Parkinsonism
Visual hallucinations

Dx- SPECT/ daTScsn 90% sensitivity, 100% specificity

Question 7

What Are the features of dementia?

Answer 7

Behaviour- restless, fixed routine
Personality- sexual disinhibition, shop lifting
Speech - syntax errors, mutism
Thinking - slow, muddled, poor memory, no insight
Perception- illusion, hallucinations (often visual)
Mood- irritable, depressed, labile mood

Question 8

What’s the treatment for Alzheimer’s?

Answer 8

Donepezil, rivastigmine, galantamine (increase acetylcholine)
Memantine (nmda receptor agonist)

Question 9

Features which suggest depression >dementia

Answer 9

Rapid onset
Biological symptoms (weight loss, sleep)
Pt worried about memory, 
Disappointed with test results
Global memory loss (rather than recent memory loss)

Question 10

Which genes can increase Alzheimer’s disease?

Answer 10

Presenilin 1 gene
Presenilin 2 gene
Beta-amyloid precursor protein (APP) gene on chromosome 21.

Late onset associated with - apolipoprotein E4 allele.

Question 11

What’s the pathopsyiology in Alzheimer’s?

Answer 11

Atrophy(neuroma loss)
Plaques
Neurofibrillary tangles (abnormal tau)
Cholinergic loss

Question 12

How does vascular dementia clinically present?

Answer 12

Step-wise deterioration due to infarcts over time.

Question 13

What is the clinical presentation of Lewy body dementia?

Answer 13

Fluctuating confusion with marked variation in levels of alertness.
Vivid visual hallucinations
Spontaneous Parkinsonian signs

Might look like deleruim do NOT give antipsychotics… in LBD can result in death!

Question 14

What happens in fronto-temporal dementia?

Answer 14

Loss of spindle neurones in the frontal and temporal lobes.

Changes in personality,