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Old Age Psych Flashcards

1
Q

3 main conditions encountered in Old Age Psych

A

Delirium
Dementia
Depression

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2
Q

2 Aspects of Dementia

A

Cognitive Features

Neuropsychiatric

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3
Q

Cognitive features in diagnosis of dementia

A 
Memory loss - Dysemnesia
\+ 1 or more of
Dyspraxia
Dysphasia
Dysnosia
Dysexecutive functioning

Functional decline - ADLs

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4
Q

How to investigate cognitive features of dementia?

A

Mini Mental State Examination

MOCA

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5
Q

5 features of Neuropsychiatric disturbance in Dementia

A 
Depression
Psychosis
Altered circadian rhythm - sundowning
Agitation
Anxiety
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6
Q

What elements can be adjusted/investigated when targeting change in behaviour known as sundowning in dementia?

A

Routine
Lighting
Distraction techniques
Sleep

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7
Q

Aetiology of Dementia

A

Alzheimer’s
Vascular dementia
Mixed alzheimer’s and vascular
Lewy Body

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8
Q

Average course from symptoms progressing to death in dementia

A

7 years

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9
Q

Investigations required to diagnose dementia

A

Symptoms showing cognitive impairment
Clinical assessment - History, Collateral history, examination, MSE
Physical examination and bloods
Cognitive assessment - MMSE, MOCA
Differentials - B12, foate, hyperthyroid
Eclude delirium, depression
Referral - confirm diagnosis - brain scanning, neuropsychology

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10
Q

Management of dementia diagnosis

A

Patient and caregiver counselling
Management and symptomatic treatment
Follow-up

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11
Q

What imaging techniques can be used in diagnosis of dementia?

A

MRI
CT
SPECT

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12
Q

Which investigation is poorly tolerated in elderly?

A

MRI

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13
Q

What sign of dementia is present on MRI?

A

Atrophy of mediotemporal lobes

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14
Q

Signs of Alzheimers on SPECT

A

Parietal and temporal areas blue

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15
Q

Signs of Frontotemporal dementia on SPECT

A

Blue areas in frontal and temporal lobes - reduced blood flow

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16
Q

Lewy Body dementia - differences from alzheimers

A

Memory not affected
Deficit of attention
Fluctuation, visual hallucinations, parkinsonism
REM sleep disorder, severe antipsychotic sensitivity
Abnormal DAT
Falls, syncope, loss of consciousness, autonomic impairment
Less likely diagnosis if stroke

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17
Q

Investigation for lewy body dementia

A

DAT
Normal reuptake of dopamine transporter in head of caudate nucleus - comma sign (present in AD)
In Lewy Body, reuptake in putamen reduced - gives full stop sign

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18
Q

Signs of frontotemporal dementia

A 
Emotional blunting
Speech disorder - echolalia, output, stereotypy, preservation, mutism
Frontal dysexecutive syndrome
Parkinsonism signs present later
Autonomic, incontinence
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19
Q

Drug treatment for dementia

A 
Acetylcholinesterase inhibitors
Antidepressants - sertraline, mirtazipine
Antipsychotics - risperidone, quetiapine
Anxiolytics - lorazepam
Hypnotics
Anticonvulsants
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20
Q

Which ACIs are used in mild to moderated AD?

A

Donepezil
Rivastigimine
Galantamine

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21
Q

Which AChIs are used for moderate to severe AD?

A

Memantine

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22
Q

Side effects of cholinesterase inhibitors

A

Nausea, vomiting, diarrhoea

Dizziness, headaches, fatigue, muslce cramps, syncope, breathing problems

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23
Q

Factors that cna help prevent dementia

A 
Activity
Caffeine
Alcohol
HRT
Statins
Hypertension
NSAIDs
Good nutrition
Fish oil
Vitamins
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24
Q

Rarer causes of dementia

A

CJD
Huntington’s
Pick’s disease
HIV

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25
What percentage of AIDS patients will develop dementia?
50%
26
Differentials to dementia
``` Hypothyroidism, Addison's B12/folate/thiamine deficiency Syphilis Brain tumour Normal pressure hydrocephalus Subdural haematoma Depression Chronic drug use - alcohol, barbituates ```
27
Main types of Vascular dementia
Stroke related Subcortical Mixed
28
Risk factors for vascular dementia
``` Stroke Smoking Hypertension Atrial fibrillation Obersity Coronary Artery Disease Diabetes mellitus Hyperlipidaemia A cardiovascular or stroke family history ```
29
Typical presentation of vascular dementia
``` STEPWISE DETERIORATION Focal neurological abnormalities e.g. visual disturbance, sensory or motor symptoms The difficulty with attention and concentration Seizures Memory disturbance Gait disturbance Speech disturbance Emotional disturbance ```
30
Which criteria is used to diagnose Vascular dementia?
NINDS-AIREN criteria for probable vascular dementia
31
What is the NINDS-AIREN criteria?
Recommended by NICE for diagnosis of Vascular dementia 1. Presence of cognitive decline that interferes with activities of daily living, not due to secondary effects of the cerebrovascular event - established using clinical examination and neuropsychological testing 2. Cerebrovascular disease defined by neurological signs and/or brain imaging 3. A relationship between the above two disorders inferred by: the onset of dementia within three months following a recognised stroke an abrupt deterioration in cognitive functions fluctuating, stepwise progression of cognitive deficits
32
What is the pathological feature of lewy body dementia?
alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas.
33
What feature in a history could indicate lewy body dementia?
Deterioration following antipsychotic treatment
34
Which medication should be avoided in patients with lewy body dementia?
neuroleptics should be avoided in Lewy body dementia as patients are extremely sensitive and may develop irreversible parkinsonism
35
Symptoms of Pick's disease
``` Change in personality Impaired social conduct Hyperorality Disinhibition Decreased appetite ```
36
Microscopic changes in pick's disease
Pick bodies - spherical aggregations of tau protein (silver-staining) Gliosis Neurofibrillary tangles Senile plaques
37
In which patients is doneprezil contraindicated?
Bradycardia | Adverse effect includes insomnia
38
Classic features of normal hydrocephalus
Triad urinary incontinence dementia and bradyphrenia gait abnormality (may be similar to Parkinson's disease)
39
Name a reversible consequence of dementia
Normal hydrocephalus
40
Findings on imaging in normal hydrocephalus
hydrocephalus with an enlarged fourth ventricle | in addition to the ventriculomegaly there is typically an absence of substantial sulcal atrophy
41
Management of normal hydrocephalus
Ventricuoloperitoneal shunting
42
Complications of ventriculoperitoneal shunting
Seziures Intracerebral Haemorrhage Infection
43
What deficiency gives rise to Pellagra?
Nictonic acid (NIACIN)
44
3 Classical feautres of Pellagra
Dementia, diarrhoea, dermatitis
45
What medical treatment can cause pellagra?
Isoniazids - inhibits conversion of tryptophan to niacin
46
Which patient population is at risk of pellagra?
Alcoholics
47
Describe the type of rash classical of pellagra?
(brown scaly rash on sun-exposed sites - termed Casal's necklace if around neck)
48
Classic triad of parkinson's symptoms
bradykinesia, tremor and rigidity
49
Other features of parkinsons
``` mask-like facies flexed posture micrographia drooling of saliva psychiatric features: depression is the most common feature (affects about 40%); dementia, psychosis and sleep disturbances may also occur impaired olfaction REM sleep behaviour disorder fatigue autonomic dysfunction: postural hypotension ```
50
What is the mode of inheritance of Wilson's disease?
Autosomal recessive
51
What is Wilson's disease?
Autosomal recessive condition whereby there are excess copper deposits in tissues Increased copper absorption in small intestine Decreased excretion by liver
52
Which gene is implicated in Wilson's disease
ATP7B Chr 13
53
When does onset of Wilson's disease occur?
10-25 years
54
How does the presentation of symptoms in Wilson's disease differ between children and young adults?
Children - liver disease | Adults - neurological disease
55
Features of Wilson's disease
``` Hepatitis, cirrhosis Basal ganglia degeneration Speech behavioural and psychiatric problems Asterixis, chorea, parkinsonism Kayer-Fleishcher rings Renal tubular acidosis - Fanconi syndrome Haemolysis Blue nails ```
56
What are Kayer-Fleischer rings?
Green brown rings in the iris in Wilson's disease
57
Where is copper mostly deposited in the brain?
Basal ganglia | - putamen and globus pallidus
58
Diagnosis of Wilson's disease
``` Slit lamp Reduced serum caeruloplasmin Reduced total serum copper Free copper is increased Increased 24 hour urinary copper ```
59
Management of Wilson's disease
penicillamine (chelates copper) has been the traditional first-line treatment trientine hydrochloride is an alternative chelating agent which may become first-line treatment in the future tetrathiomolybdate
60
Tropheryma whippelii infection causes?
Whipple disease | - gives rise to dementia
61
Features of Whipple's disease
malabsorption: diarrhoea, weight loss large-joint arthralgia lymphadenopathy skin: hyperpigmentation and photosensitivity pleurisy, pericarditis neurological symptoms (rare): ophthalmoplegia, dementia, seizures, ataxia, myoclonus
62
Investigation of Whipple's disease?
jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules
63
Management of Whipple's disease
oral co-trimoxazole for a year is thought to have the lowest relapse rate, sometimes preceded by a course of IV penicillin
64
Features of Creutzfeldt-Jakob disease (CJD
Dementia - rapid onset | Myoclonus
65
CJD is caused by?
Prion proteins | induce the formation of amyloid folds resulting in tightly packed beta-pleated sheets resistant to proteases.
66
Investigation for CJD
CSF is usually normal EEG: biphasic, high amplitude sharp waves (only in sporadic CJD) MRI: hyperintense signals in the basal ganglia and thalamus
67
Mode of inheritance in Alzheimer's
Only 5% inherited - Autosomal dominant
68
Risk factor for inherited Alzheimer's
Downs Syndrome
69
Genes implicated in inherited Alzheimer's
Amyloid Precursor Protein chr 21 | Presenilin 1 and 2 (chr 14, chr 1)
70
Function of tau protein
interacts with tubulin to stabilize microtubules and promote tubulin assembly into microtubules
71
8 causes of tremor
``` Parkinsonism Essential tremor Anxiety THyrotoxicosis Hepatic encephalopathy Carbon dioxide retention Cerebellar disease Drug withdrawal - alcohol, opiates ```

Psychiatry (6 decks)

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