Old Age Psychiatry

Question 1

What are the ABCD of dementia?

Answer 1

A- activities of daily living
B- behavioural and psychiatric symptoms
C- cognitive impairment
D- decline

-> in order for a diagnosis of dementia to be made, has to effect daily life of patient and meet these criteria

Question 2

What are some of the cognitive features of dementia?

Answer 2

Memory (dysmnesia)

Plus one or more of
dysphasia (communication)
dyspraxia (inability to carry out motor skills)
dysgnosia (not recognising objects)
dysexecutive functioning (initiation, inhibition, set-shifting, abstraction)

Question 3

If a patient has dementia, which organisation do you need to inform?

Answer 3

DVLA

Question 4

List some of the reversible causes of dementia.

Answer 4

Delirium
Normal pressure hydrocephalus
Subdural haemorrhage
Tumours
Vitamin B12 deficiency
Hypothyroidism
Hypercalcaemia
Alcohol misuse
Neurosyphilis
Drugs
Anticholinergics

Question 5

Which tests can be done to assess cognitive impairment?

Answer 5

MMSE- mini mental state examination
MOCA- Montreal Cognitive Assessment

->note that this is not a good test to di with patients with Parkinson’s as they may struggle writing regardless of cognitive function.
Also some language barriers for MOCA if English isn’t first language

Question 6

Which test for cognitive function may be done if the patient with suspected dementia doesn’t have much schooling and cannot answer MMSE or MOCA?

Answer 6

LACLS-5

Question 7

What features may be seen on a scan with Alzheimer’s?

Answer 7

Amyloid plaques
Tau tangles

->also atrophy, reduction of acetylcholine

Question 8

List some of the different types of dementia.

Answer 8

Alzheimer’s
Vascular
Mixed
Lewys-Body
Frontotemporal

Question 9

Features of Alzheimer’s?

Answer 9

Early impairment of memory and executive function
Gradually progressive

Question 10

Features of vascular dementia?

Answer 10

Step wise decline with sudden changes
Unequal distribution of deficits
Evidence of focal impairments on neuro exam

Question 11

Key features of Lewy’s body dementia?

Answer 11

Visual hallucinations
Fluctuations
Parkinsonism

Question 12

Features of frontotemporal dementia?

Answer 12

Behavioural changes
Early emotional blunting
Speech disorders

Question 13

List some of the potential behavioural and psychological symptoms seen in various types of dementia.

Answer 13

Agitation (Restlessness, Wandering)
Psychosis (Delusions, Hallucinations)
Affective (Depression, Anxiety, Lability, Hypomania, Apathy)
Disinhibition (Aggression, Sexual)
Behaviour (Eating, toileting, dressing, Sleep-wake cycle)

Question 14

Are there drug treatments for dementia?

Answer 14

Yes, three on the market, but none are that good.

They are acetylcholinesterase inhibitors; Donepezil, Galantamine, Rivastigmine.

However, antidepressants and antipsychotics are sometimes used for symptom management. Antipsychotics can be a bit controversial though as increase risks of stroke and death.

->Newer drugs beginning to be seen, Mabs (monoclonal antibodies) which are being looked into. Thought they slow down the progression of dementia by removing amyloid.

Question 15

Capacity?

Answer 15

The ability to understand information relevant to a decision or action, and to appreciate the reasonably foreseeable consequences of not taking action or decision

Question 16

What are some points to consider when it comes to assessing whether a patient has capacity?

Answer 16

1) Does the patient UNDERSTAND the information?

2) Does the patient RETAIN the information long enough to make a decision?

3) Can the patient COMMUNICATE the decision?

4) Can the patient WEIGH UP the information in order to make a decision?

5) Does the patient BELIEVE the information they are given?

Question 17

What are the two types of Power of Attorney?

Answer 17

Financial
Welfare

Question 18

If a Power of Attorney is not set up when a person has capacity to make the decision, what can be done instead if a patient no longer has capacity?

Answer 18

Guardianship