Old Age psychiatry Flashcards

1
Q

ABCD of dementia

A

A - ADLs
B - behavioural and psychiatric symptoms of dementia
C - cognitive impairment
D - decline

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2
Q

cognitive features of dementia

A

memory (dysmenesia/amnesia)
+
- dysphagia (communication)
- dyspraxia (inability to carry out motor skills)
- dysgnosia (not recognising objects)
- dysexecutive functioning (initiation, inhibition, set-shifting, abstraction)

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3
Q

What are examples of instrumental ADLs?

A

keyboard
phone
appointments
buses

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4
Q

What type of functional decline occurs first in dementia?

A

Instrumental ADLs

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5
Q

Neuropsychiatric disturbance in dementia

A
Psychosis
Depression 
Anxiety
Altered circadian rhythms 
Agitation
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6
Q

Types of dementia

A

Alzheimer’s
Vascular (step wise progression)
Lewy body (parkinsons)
Mixed Alzheimer’s and vascular

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7
Q

Course of dementia

A
Symptoms
diagnosis
loss of functional independence 
behavioural problems
nursing home placement 
death
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8
Q

Features of dementia

A
INSIDIOUS ONSET WITH UNKNOWN DATE
slow, gradual, progressive decline
generally irreversible 
disorientation in late illness 
SLIGHT DAY TO DAY VARIATION 
LESS PROMINENT PHYSIOLOGICAL CHANGES 
consciousness clouded only in late stage 
normal attention span 
disturbed sleep - wake cycle
Psychomotor changes late in illness
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9
Q

Features of delirium

A
ABRUPT, PRECISE ONSET, KNOWN DATE 
Acute illness, lasting days or weeks 
Usually reversible
Disorientation early in illness
VARIABLE, HOUR BY HOUR
PROMINENT PHYSIOLOGICAL CHANGES
Fluctuating levels of consciousness 
short attention span 
disturbed sleep wake cycle; hour to hour variation n
Marked early psychomotor changes
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10
Q

Features of depression

A
Abrupt onset
history of depression 
HIGHLIGHTS DISABILITIES
dont know answers
diurnal variation in mood
fluctuating cognitive loss 
tries less hard to perform and gets distressed by losses
short and long term memory loss
depressed mood coincides with memory loss 
associated with anxiety
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11
Q

What does a brain scan tell you about dementia?

A

The aetiology

NOT THE DIAGNOSIS

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12
Q

Criteria for dementia with lewy bodies (DLB)

A
Dementia
Amnesia not prominent 
- deficits of attention 
- frontal executive
- visuospatial 
Two of these factors = probable, one = possible
- fluctuation (marked, important feature)
- visual hallucinations
- parkinsonism 
Suggestive features
- REM sleep disorder
- severe antipsych severity
- abnormal DAT scan
supportive by 
- falls, syncope, loss of consciousness
- other psychiatric symptoms 
- autonomic dysfunction 
- scans
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13
Q

Diagnosis of LBD is less likely if

A

stroke disease

other brain / systemic illness

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14
Q

What does a DAT scan look at?

A

Dopamine receptors

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15
Q

LBD on a DAT scan

A

reuptake of dopamine transporter in the head of the caudate nucleus and putamen is reduced in the putamen, leading to the “full stop sign” instead of the “comma sign”

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16
Q

Signs of Alzheimer’s on MRI

A

Brain atrophy

Gyri more obvious

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17
Q

Presentation of frontotemporal dementia (FTD)

A
Behavioural disorder - personality change 
Can be early onset 
Early emotional blunting
Speech disorder
- altered output
- sterotypy 
- echolalia 
- preservation 
- mutism 
Frontal dysexecutive syndrome
Neuroimaging abnormalities in frontotemporal lobes 
Neurological signs commonly absent early, parkinsonism later, autonomic; incontinence, primitive reflexes 
Picks disease
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18
Q

Features of frontal dysexecutive syndrome

A

Memory
Praxis
Visuospatial function not severely impaired

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19
Q

Presentation of subcortical vascular dementia

A

gradual deterioration in executive function
mood changes such as apathy or irritability
memory often relatively spared
may have additional neurological features
- falls
- incontinence
- seizures

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20
Q

Why is memory often relatively spared in subcortical vascular dementia?

A

Due to the preservation of cortical grey matter

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21
Q

Drug treatment of dementia

A
Acetylcholinesterase inhibitors (AChl) for mild to moderate SDAT 
- donepezil

Memantine for moderate to severe SDAT

Antipsychotics (e.g. risperidone) to manage behavioural problems and psychosis

Antidepressants (e.g. sertraline)
- to enable sleep, and to deal with mood problems and anxiety

Anxiolytics e.g. lorazepam

Hypnotics e.g. zolpidem

Anticonvulsants e.g. valproate for behavioural disturbance but not much used

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22
Q

What is there a risk of in the use of hypnotics to treat dementia?

A

Falls

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23
Q

What do cholinesterase inhibitors do?

A
Improve cognitive function 
Slow decline
Improve non cognitive symptoms
- ADL
- longer at home
- reduce carer stress
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24
Q

S/Es of cholinesterase inhibitors

A
nausea, vomiting 
diarrhoea
fatigue 
insomnia 
muscle cramps
headaches
dizziness
syncope
breathing problems
25
Q

What is capacity?

A

Abilities relevant to competence

  • understanding
  • manipulating
  • approaching the situation and its consequences
  • communicating choices
26
Q

When is guardianship used?

A

When the patient no longer has the capacity to get a power of attorney

27
Q

What are the two types of power of attorney?

A

Finance

Welfare

28
Q

In old age psychiatry, who is most associated with suicide?

A

Elderly males - associations with alcohol and widowed etc

29
Q

Normal symptoms of grief, mourning and bereavement

A
alarm 
numbness
pining - illusions or hallucinations may occur 
depression 
recovery and reorganisation
30
Q

Abnormal symptoms of grief, mourning and bereavement

A
Persisted beyond 2 months 
guilt
thoughts of death 
worthlessness
psychomotor retardation 
prolonged or marked functional impairment 
psychosis
31
Q

Suicide rate for the elderly has the same rate as what age group?

A

< 25 y/o

32
Q

Presentation of late onset schizophrenia like psychosis

A

Spectrum from circumscribed persecutory delusions to full schizophrenia like psychosis

33
Q

Causes of late onset schizophrenia like psychosis

A

Sensory loss
social isolation
genetic - possible minor abnormalities

34
Q

Treatment of late onset schizophrenia like psychosis

A

often needs compulsory admission
neuroepileptics
social contact

35
Q

Prognosis of late onset schizophrenia like psychosis

A

May fail to regain insight

high relapse rate if stop neuroepileptics

36
Q

Who should not drive in dementia?

A

Those with poor short term memory, disorientation or lack of insight

37
Q

Simple definition for dementia

A

Cognitive and functional decline > 6 months

38
Q

Definition of dyspnogia

A

Poor recognition

39
Q

Definition of dyspraxia

A

Motor skills

40
Q

What makes up executive function?

A
Initiation of tasks
Inhibition (knowing when to stop)
Set shifting 
Abstraction 
Problem solving
41
Q

What is set shifting?

A

Multi-tasking

42
Q

What do you look at to see if the person is functioning?

A

ADLs

43
Q

What is “reversible” dementia?

A

Not actually dementia, another condition causing the symptoms

44
Q

Causes of reversible dementia

A
Normal pressure hydrocephalus
Subdural haematoma
Tumours
Neurosyphillis / HIV
Vitamin deficiencies - B12, folate
Hypothyroidism
45
Q

Types of dementia

A
Alzheimers
Vascular
Mixed AD + VD
Lewy Body 
Frontotemporal 
Alcohol 
Subcortical 
Prion protein
46
Q

Pathology of alzheimers dementia

A

Atrophy of key brain regions

47
Q

Type of progression of alzheimers

A

Progressive

48
Q

Type of progression of VD

A

Step wise (up and down)

49
Q

Features of lewy body dementia

A

Dementia
Parkinsonism
Hallucinations
Fluctuation

50
Q

What type of hallucinations tend to be seen in lewy body dementia?

A

Visual

51
Q

Features of FTD

A

Behavioura
DNFA
Progressive non fluent aphasia
Semantic

52
Q

Examples of subcortical dementia

A

Parkinsons
Huntingtons
HIV

53
Q

What indicates LBD? (motor and cognitive decline)

A

Onset of motor and cognitive decline within 1 year

54
Q

What indicates parkinsons dementia (motor and cogntivie decline)?

A

Onset of cognitive decline 1 year after motor symptoms

55
Q

Differential diagnosis for confusion

A
Normal 
Dementia
Depression 
Delerium / acute confusional state 
Mild cognitive impairement (mild memory impairment)
56
Q

What does BPSD stand for?

A

Behavioural and psychological symptoms in dementia

57
Q

Presentation of BPSD

A
Agitation 
Psychosis 
Affective
Disinhibition 
Behaviour
58
Q

How can depression be differentiated from dementia?

A

Depression - short history and rapid onset