Old Age Psychiatry Flashcards
Macroscopic changes seen in Alzheimer’s Disease
Hippocampal atrophy
Cerebral atrophy
Low brain weight
Enlargement of the inferior horn of the lateral ventricle
Microscopic changes seen in Alzheimer’s Disease
Senile plaques (extracellular beta amyloid in gray matter)
Neurofibrillary tangles (intracellular tau protein)
Gliosis
Degeneration of the nucleus of Meynert
Hirano bodies
Progressive supranuclear palsy
Neurodegenerative disease that affects cognition, eye movements, and posture.
Vertical gaze dysfunction
Extrapyramidal symptoms
Cognitive dysfunction
Types of fronto-temporal lobar degenerataion
Pick’s disease
Progressive non-fluent aphasia/CPA
Sementic dementia
Features of fronto-temporal dementia
Onset before 65
Insidious onset
Relatively preserved memory and visuospatial skills
Personality change and social conduct problems
Macroscopic features of fronto-temporal dementias
Atrophy of frontal and temporal lobes
Microscopic features of fronto-temporal dementias
Pick bodies (tau protein)
Gliosis
Neurofibrillary tangles
Senile plaques
Features of Pick’s disease
Personality change
Impaired social conduct and disinhibition
Hyperorality and increased appetite
Perseveration .
Pathological features of Pick’s disease
Focal gyral atrophy with a knife-blade appearances (thin and narrow)
Features of chronic progressive aphasia
Non fluent speech with short and agrammatic utterances
Comprehension is relatively preserved.
Features of semantic dysphasia
Speech is fluent but empty and conveys little meaning.
Unlike in Alzheimer’s memory is better for recent rather than remote events.
Dementia due to Parkinson’s
Marked problems with executive function.
Verbal and visual memory are affected to a lesser extent.
Other cognitive deficits, such as dysphasia, apraxia, alexia, agraphia, anomia and acalculia, are less pronounced.
Features of cortical dementias
Impaired memory
Impaired visuospatial ability
Impaired executive function
Impaired language
Types of cortical dementia
Alzheimer’s disease
Pick’s disease
Creutzfeldt-Jakob disease
Features of sub-cortical dementias
Generalised slowing of mental processes
Personality change
Mood disorders
Presence of abnormal movements
Imaging studies to differentiate Alzheimer’s, vascular dementia and FTD
HMPAO SPECT
FDG PET is the second choice.
Imaging to confirm dementia with Lewy Bodies
(FP-CIT) SPECT (aka DaTscan)
Risk factors for paraphrenia
Female Hearing/visual impairment Single, no children CVAs Social isolation
Risk factors for SIADH
Being elderly Being female Being a smoker Having medical co-morbidity Polypharmacy
Antipsychotics recommended in delirium
haloperidol or olazapine
Risk of developing Alzheimer’s disease
1% at age 60, doubling every 5 years to 30-50% by age 85
Donepezil
Reversible acetylcholinesterase inhibitor
Galantamine
Reversible acetylcholinesterase inhibitor and binds allosterically to the nicotinic acetylcholine receptor
Rivastigmine
Reversible acetylcholinesterase inhibitor and butyrylcholinesterase inhibitor
Memantine
NMDA receptor antagonist t
Recommended for patients intolerant of or have a contraindication to AChE inhibitors or for severe Alzheimer’s disease
Risk factors for Charles Bonnet syndrome
Advanced age Peripheral visual impairment Social isolation Sensory deprivation Early cognitive impairment
Prevalence of dementia
- 1% in over 65s
1. 3% of the entire UK population.
Breakdown of dementia severity
- 4% have mild dementia
- 1% have moderate dementia
- 5% have severe dementia
Antipsychotics suitable in Parkinson’s
Quetiapine and clozapine
