Old Age Psychiatry Flashcards
ABCD of dementia?
Activities of daily living
Behaviour and psychiatric symptoms
Cognitive impairment
Decline
Cognitive features of dementia?
Memory (dyskinesia) plus one or more of
Dysphasia, dyspraxia, dysgnosia or dysexecutvie functioning
Functional decline
Features of delirium to distinguish it from dementia
Abrupt, precise onset known date acute illness usually reversible variable hour by hour Fluctuating levels of conciousness
Features of depression to distinguish it from dementia
Abrupt onset history of depression Don't know answers Highlights disabilities Diurnal mood fluctuation Associated with anxiety
Clinical assessment
History and collateral Risk assessment Cognitive testing - MMSE/MOCA Physical and bloods neuroimaging consider care needs/ other support
Dementia with Lewy Bodies
1.Dementia, amnesia not prominent
Deficits of attention, frontal executive, visuospatial
2. fluctuation, visual hallucinations, parkinsonism (two=probable, 1=possible)
3. Suggestive - REM sleep disorder, severe antipsych sensitivity, abnormal DAT scan
4. Supported by falls, syncope, LOC, other psych symptoms, autonomic dysfunction, scans
5. DX less likely if stroke or other brain/systemic illness
Frontotemporal dementia
Behavioural disorder - personality change
Speech disorder
Neuoropsychology
Neuroimaging
Nuerological signs absent early, parkinsonism later
Drug Treatment of Dementia?
Acetylcholinesterase inhibitors for mild to moderate (donepezil, rivastigme - LBD)
memantine for moderate to severe SDAT
Cholinesterase inhibitors
Slow decline, improve non cognitive symptoms but don’t stop disease progression
S/E N+V+D, fatigue, insomnia, muscle cramps, headaches, dizziness
Bradycardia, syncope, gastric ulcer and respiratory problems
What are signs of abnormal grief?
> 2months Guilt Thoughts of death Worthlessness Psychomotor retardation Prolonged and marked functional impairment Psychosis
Normal signs of grief?
Alarm Numbness Pining Depression Recovery and reorganisation
