Old Age Psychiatry Flashcards
What is delirium?
An acute, transient, global, organic disorder of higher nervous system function involving altered consciousness and attention
What does the DSM IV / ICD-10 require for the diagnosis of delirium?
Altered consciousness PLUS perceptual / cognitive impairment PLUS sudden onset with fluctuations PLUS evidence of organic aetiology
How is delirium managed?
- Identify and treat underlying organic cause e.g. infection
- Stable environment for the patient e.g. consistent staffing, good lighting, safe environment
- Medication for psychosis e.g. low, single-dose antipsychotic (haloperidol)
- Regular review
Give 4 types of dementia
Alzheimer’s disease
Vascular dementia
Lewi body dementia
Fronto-temporal lobe dementia
What is the most common type of dementia?
Alzheimer’ disease - Accounts for 50-70% of dementias
What is dementia?
An acquired syndrome where there is progressive decline in cognitive, intellectual functioning and a change in personality with behavioural problems affective the activities of daily living
What is the diagnostic criteria for ‘probable Alzheimer’s Disease’?
- Impairment of 2 or more domains of cognition
- Progressive loss of memory and other cognitive function
- No disturbance of consciousness
- Onset between 40 and 90 years old
What is the ‘supporting criteria’ for diagnosis of Probable Alzheimer’s Disease?
- Progressive deterioration of language, motor skills, perception
- Evidence of cerebral atrophy on CT scan
- Worsening ability to perform ADLs
- Family history of Alzheimer’s disease
- Normal EEG
What is the diagnostic criteria for ‘Definite Alzheimer’s Disease’?
All the criteria of ‘Probable’, but with the addition of histopathological changes on biopsy or autopsy
Mutations in which genes are thought to be responsible for ‘early onset’ Familial Autosomal Dominant Alzheimer’s Disease?
- Amyloid Precursor Protein (APP)
- Presenilin 1 and 2
Which sex is at higher risk of Alzheimer’s?
Female
Give the names of 3 cholinesterase inhibitors used in the treatment of Alzheimer’s
Donepazil
Rivastigmine
Galantamine
Give the name of an NMDA receptor antagonist used in the treatment of Alzheimer’s
Memantine - Reserved for late stages of the disease process
What is the most common sign elicited on neurological examination of a patient with vascular dementia?
Reflex asymmetry
What are the 3 central features of dementia with Lewy bodies?
- Dementia i.e. progressive cognitive decline
- Memory impairment as the disease progresses
- Deficits of attention, visuospacial ability, executive function
What are the 3 core features of dementia with Lewy bodies?
- Visual hallucinations
- Extra-pyramidal signs
- Fluctuating cognition, variation in attention and alertness
What is the first line therapy for depression in older people?
SSRIs
Give 3 options which may be used as 2nd line therapy for depression in older people
Venlafaxine
Mirtazepine
Trazodone
True / False: Older people who attempt suicide are more likely to succeed than younger people who attempt suicide
True
What is the most common symptom of psychosis in elderly people?
Persecutory delusions
True / False: Negative symptoms, first-rank symptoms of schizophrenia, and thought disorder is common in psychosis of elderly people
False - These are UNCOMMON
Which 5 cognitive domains are assessed by the MMSE?
Orientation Registration Attention Calculation Language
Give 4 tests which could evaluate a patient’s cognitive function
Mini Mental State Examination (MMSE)
CLOX1
Confusion Assessment Method (CAM)
Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)
Which domain of cognition is assessed using the CLOX1 test?
Executive function
Give 3 tools which might help in the assessment and diagnosis of a patient for dementia
MMSE - Mini Mental State Examination
MOCA - Montreal Cognitive Assessment
ACE-III - Adenbrooke’s Cognitive Examination
What is the gold standard diagnostic test for Alzheimer’s disease?
National Institute of Neurological and Communicative Disorders and Stroke; Alzheimer’s Disease and Related Disorders (NINCDS-ADRDA)
Which type of dementia classically gives a step-wise deterioration?
Vascular dementia
True / False: Treatment for vascular dementia is the same as for Alzheimer’s dementia
False
Drugs used in the treatment of Alzheimer’s are NOT indicated in the treatment of vascular dementia. The treatment of vascular dementia is focussed on treating the vascular cause to prevent further decline. This means reducing smoking etc, and optimising BP / diabetes control etc.
What treatment is available for Lewy Body dementia?
Rivastigmine - may help with visual hallucinations and cognition
Clonazepam - For REM sleep disturbance
Psychological therapies as with the other types of dementia
Which physical observation is it most important to monitor with the use of anti cholinesterase inhibitors? Why?
Heart rate - These drugs can cause bradycardia and can cause arrhythmias, syncope and collapse in patients with heart block
What are the 3 ‘suggestive’ features of Lewy Body dementia?
REM sleep disturbance
Hypersensitivity to neuroleptics
Low dopamine transporter uptake in basal ganglia demonstrated on imaging
What is the key investigation in Lewy Body dementia?
DAT scan
