Old Age Psychiatry

Question 1

Key features of dementia

Answer 1

Impaired activities of daily living, behavioural and psychiatric symptoms of dementia, cognitive impairment, decline and functioning

Question 2

Cognitive features of dementia

Answer 2

Dysmnesia (loss of memory). Plus one or more of
Dysphasia (communication)
Dyspraxia (inability to carry out motor skills)
Dysgnosia (not recognising objects)
dysexecutive functioning (impaired frontal lobe functioning)

Question 3

Neuropsychiatric Disturbance in Dementia

Answer 3

Psychosis, depression, atered circadian rhythms, agitation, anxiety

Question 4

Features of dementia in relation to delirium

Answer 4

Insidious onset with unknown date
* Slow, gradual, progressive decline
* Generally irreversible
* Disorientation late in illness
* Slight day-to-day variation
* Less prominent physiological
   changes
* Consciousness clouded
   only in late stage
* Normal attention span
* Disturbed sleep­wake cycle;
   day­night 
* Psychomotor changes late in illness

Question 5

Features of delirium

Answer 5

• 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 sleep­wake cycle;
  hour-to-hour variation
• Marked early psychomotor
  changes

Question 6

Dementia in relation to depression

Answer 6

• Insidious onset
• No psychiatric history
• Conceals disability
• Near-miss answers
• Mood fluctuation day to day
• Stable cognitive loss
• Tries hard to perform but is
  unconcerned by losses
• Short-term memory loss
• Memory loss occurs first
• Associated with a decline in social function

Question 7

Physiological changes in delirium

Answer 7

Tachycardia, hypotension, pyrexia, low SATS

Question 8

Percentage of Dementia caused by alzheimers disease

Answer 8

50%

Question 9

Percentage of dementia caused by vascular dementia

Answer 9

25%

Question 10

Percentage of dementia caused by lewy body dementia

Answer 10

5%

Question 11

Clinical Assessment of Dementia

Answer 11

History and collateral history
Risk assessment 
Cognitive testing - MMSE/MOCA
Physical and blood
Neuroimaging 
Follow up (pre-dementia syndrome for up to 1 year) 
Consider care needs/other supports

Question 12

Risk assessment

Answer 12

Vulnerable to financial exploitation, self care risk, risk to others, risk of violence, risk of self harm

Question 13

Cognitive Testing in dementia (MMSE)

Answer 13

Orientation (what is the date etc, where are you?
Memory (name three objects and ask the patient to repeat them)
Attention (serial sevens or ask patient to spell word backwards)
Recall (ask for three words asked before)
Language (name a pencil and a watch, repeat, three stage command, read and obey, write a sentence, copy aa double pentagon )

Question 14

Dementia with Lewy Bodies

Answer 14

Inattention, frontal symptoms (dishinibtion), marked fluctuation, visual hallucinations, parkinsonism

Question 15

Why should antipsychotics not be given to patients with suspected Lewy Body Dementia

Answer 15

Severe sensitivity can result in death

Question 16

Frontotemporal Dementia

Answer 16

More of a behavioural disorder and there will be marked personality change. Speech disorders present with altered output, echolalia

Question 17

Neuropsychology of FTD

Answer 17

frontal dysexecutive syndrome. Memory, praxis and visuospatial function not severely impaired

Question 18

Neuroimagine in FTD

Answer 18

Abnormalities in frontotemporal lobes - knife blade atrophy of frontol and temporal lobes on coronal MRI

Question 19

Drug treatment of Dementia

Answer 19

Acetylcholinesterase Inhibitors (AChEI) for mild to moderate SDAT
donepezil, rivastigmine, galantamine
LBD - Rivastigmine

Question 20

Cholinesterase Inhibitors

Answer 20

Improve non cognitive symptoms
Do not stop disease progression
Generally safe but there are side effects
Nausea, vomiting, diarrhoea
Fatigue, insomnia
Muscle cramps
Headaches, dizziness

Question 21

Other psychotropics that can be used in the treatment of dementia

Answer 21

Antipsychotics, antidepressants (mirtazapine, sertraline), anxiolytics (lorazepam), hypnotics (zolpidem, zopiclone), anticonvulsants (valproate, carbamazepine)

Question 22

Fitness to drive in patients with dementia

Answer 22

Notify at diagnosis. Those with poor short term memory, disorientation or lack of insight should almost certainly not drive.

Question 23

Abilities relevant to competence

Answer 23

Understanding
Manipulating
Approaching the situation and its consequences
Communicating choices

Question 24

Differences in Depression in the elderly

Answer 24

More likely to suffer from insomnia, hypochondriasis, suicide, agitation

Question 25

Abnormal Grief

Answer 25

Persisted beyond 2 months
Guilt
Thoughts of death
Worthlessness
Psychomotor retardation
Prolonged and marked functional impairment
Psychosis