Old Age Psychiatry Flashcards
what is the ABCD of dementia?
- A for activities of daily living (ADLs)
- B for behavioural and psychiatric symptoms of dementia (BPSD)
- C for cognitive impairment
- D for decline
list the cognitive features of dementia
Memory (dysmnesia), plus one or more of:
- dysphasia (communication): expressive receptive
- dyspraxia (inability to carry out motor skills)
- dysgnosia (not recognising objects)
- dysexecutive functioning (initiation, inhibition, set-shifting, abstraction)
systematic approach in diagnosing Alzheimer’s disease
If there is symptoms suggestive of cognitive impairment > clinical assessment:
- clinical history and exam
- mental state examination (MMSE)
- physical and bloods
- cognitive assessment e.g. MOCA, LACLS-5
If there is evidence of functional decline and cognitive impairment > exclude differential diagnosis:
- delirium
- depression
- other causes of ‘dementia’
If AD diagnosis > specialist referral for:
- confirmation of diagnosis with brain scanning and neuropsychology
- patient and caregiver counselling
- management and symptomatic treatment
- follow-up
what is the aetiology of dementia?
i.e. diseases causing dementia
- Alzheimer’s disease (60%)
- vascular dementia (15%)
- mixed dementia (10%)
- dementia with Lewy Bodies (10%)
- frontotemporal dementia (2%)
- Parkinsons dementia (2%)
- other (1%)
what are some ‘reversible’ causes of dementia?
- delirium
- normal pressure hydrocephalus
- subdural haemorrhage
- tumours
- vitamin B12 deficiency
- hypothyroidism
- hypercalcaemia
- alcohol misuse
- neurosyphilis
- drugs
- anticholinergics
symptoms of hypercalcaemia
- abdominal pain
- bone pain
- kidney stones
- depression
- confusion
what are the main pathophysiological changes caused by Alzheimer’s disease?
- amyloid plaques and tau tangles
- atrophy following neuron death
- reduction in acetylcholine
What causes vascular dementia?
- Caused by impaired blood flow to areas of the brain due to vascular damage i.e. lots of micro-infarcts in someone with CV disease risk factors.
- Can have a ‘step-wise’ progression due to progressive infarcts over time.
what are the key features of Lewy body dementia?
- visual hallucinations
- fluctuations
- Parkinsonism
clinical features of fronto-temporal dementia
Presents with:
- cogntitive impairment
- personality change
- speech disorder
- repetitive checking behaviour
- disinhibition
- memory loss is a late feature
- younger age than other forms of dementia
behavioural and psychological symptoms in dementia
- agitation (restlessness, wandering)
- psychosis (delusions, hallucinations)
- affective (depression, anxiety, lability, hypomania, apathy)
- disinhibition (aggression, sexual)
- behaviour (eating, toileting, dressing, sleep-wake cycle)
List the different type of drugs used to treat dementia.
- Acetylcholinesterase inhibitors (AchI) for mild-moderate AD e.g. donepezil, rivastigmine, galantamine.
- Memantine (glutamate receptor antagonist) for moderate-severe AD.
- Antipsychotics e.g. risperidone, quetiapine, amisulpride).
- Antidepressants e.g. mitrazapine, setraline.
- Anxiolytics e.g. lorazepam.
- Hypnotics e.g. zolpidem, zoplicone, clonazepam.
- Anticonvulsants e.g. valproate, carbamazepine
side effects of acetylcholinesterase inhibitors
- nausea, vomiting, diarrhoea
- fatigue, insomnia
- muscle cramps
- headaches, dizziness
- syncope
- breathing problems
what is Lecanemab?
A monoclonal antibody, and the 1st treatment for any type of dementia to reverse physical changes and slow decline in memory and thinking.
monoclonal antibodies risks in treating dementia
brain swelling and bleeds
