Old Age Psychiatry

Question 1

What are the differential diagnosis for dementia? (Think; DEMENTIA)

Answer 1

D - Drugs, delirium
E - Emotions/depression
M - Metabolic disorders
E - Eye and ear impairment
N - Nutritional disorders
T - Tumours, Toxins, Trauma
I - Infections
A - Alcohol, arteriosclerosis

Question 2

What are the different subtypes of dementia? (8 total)

Answer 2

Alzheimer's Dementia
Vascular Dementia
Mixed Alzheimer's and Vascular Dementia
Lewy-Body Dementia
Fronto-temporal Dementia

Parkinsons-disease Dementia
HIV Dementia
Huntingtons Dementia

Question 3

What is the commonest cause of dementia?

What are some risk factors?

Answer 3

Alzheimer’s disease

Social interaction, old age, genetics (trisomy 21), lifestyle risk factors

Question 4

What are the main symptoms of Alzheimer’s? (5 A’s)

Answer 4

AMNESIA memory
APHASIA speech
AGNOSIA recognition
APRAXIA doing
Associated behaviours BPSD

Question 5

What are BPSD and what are some examples of both?

Answer 5

Behavioural and Psychological Symptoms of Dementia

Behavioural:
• physical aggression
• wandering
• restlessness
• agitation
• culturally inappropriate behaviour

Psychological:
• anxiety
• misidentifications
• depressed mood
• sleeplessness
• delusions

Question 6

What does the mnemonic PINCHME and WHIMP stand for in regards to identifying causes of symptoms in dementia and delirium?

Answer 6

• Pain
• Infection
• Nutrition (lack of)
• Constipation
• Hydration
• Medication
• Environmental

Wernicke's encephalopathy
Hypertensive encephalopathy
Intracranial haemorrhage
Meningitis/encephalitis
Poisoning

Question 7

What are the symptoms of deliriums? (Think DELIRIUM)

Answer 7

Disordered thinking
Euphoria/fearful/angry
Language impairment
Illusions/delusions/hallucinations
Reversal of the sleep wake cycle
Inattention
Unaware/disorientated
Memory deficits

Question 8

What is the second most common dementia in those over the age of 65?

Answer 8

Vascular dementia

Question 9

What are the biological treatments for vascular dementia?

Answer 9

Treat reversible causes
Consider anticoagulants
Consider medications to modify risk factors

Question 10

What is the second most common dementia in those under the age of 65?

Answer 10

Fronto-temporal dementia

Question 11

What are the three subtypes of fronto-temporal dementia?

Answer 11

Behavioural-variant FTD
• changes in personality, behaviour, interpersonal and executive skills
Progressive Non-Fluent Aphasia (PNFA),
• loss of language skills (ability to produce or understand language)
Semantic Dementia
• Loss of semantic memory

Question 12

What are the core symptoms and additional features of Lewy-body dementia?

Answer 12

Core:
• Fluctuating cognition (attention & alertness)
• Spontaneous motor features of Parkinsonism (up to 70%)
• ~2/3 visual hallucinations (~70%)

Additional:
• Sleep (REM) disorder
• Neuroleptic sensitivity (severe)
• SPECT/ PET changes
• ~2/3 systematised delusions (70%)
• 40-50% have depressive episode
• Recurrent falls, syncope, LOC

Question 13

What are the screening and diagnostic tools for assessing cognition?

Answer 13

AMTS and ACE-III

Question 14

What are the basic domains you are assessing in a cognitive assessment?

Answer 14

Orientation
• Time (day, date, month, year, season)
• Place (location, city, county, country)
• Person (name, age, DoB, address)
Attention & Concentration
Memory (short term & long term)
Language
Construction (apraxia)

Question 15

What are the 10 questions in the AMTS? (Think BRAINYREST)

Answer 15

Birthdate
Recall (47 west street)
Age
Identify where you are
Name of current monarch/PM
Year
Recognise 2 people/objects
Enumeration (20-1)
Specify the end of the 1st (1914-1918)
Time