Old age psychiatry Flashcards
What are the clinical features of dementia?
Dysmnesia plus 1 or more of -dysphasia -dyspraxia -dysgnosia -dysexecutive functioning Fucional decline Neuropsychiatric disturbance -psychosis, depression, altered circadian rhythm, agitation, anxiety
What is the differential for dementia?
Delirium
Depression
Reversible cause
Organic cause
How is dementia diagnosed
History MSE Physical exam and bloods Brain scan Neuropsychology
What are the symptoms of dementia with Lewy Body?
Dementia- attention, frontal executive and visuospatial > amnesia Fluctuation Visual hallucinations Parkinsonism REM sleep disorder Falls and syncope Autonomic dysfunction
What investigations are done to diagnose Dementia with Lewy Body?
CT scan- full stop sign
What causes the full stop sign in Lewy Body?
Reduced reuptake of dopamine transported in putamen
What are the features of frontotemporal dementia?
Early emotional blunting and personality change
Speech disorder- altered output, mutism…
Frontal dysexecutive syndrome
Abnormalities in fronto temporal lobes
Pakinsonism later
What is the presentation of vascular dementia?
Mixed picture
Stepwise progression
What is the management of dementia?
Drugs- antipsychotics, antidepressants, anxiolytics, hypnotics, anticonvulsants
Care homes
Notify DVLA
What drugs can be used to treat Alzheimer’s?
Acetylcholinesterase inhibitors for mild to moderate- slows decline
Memantine for moderate to severe
What are the side effects of acetylcholinesterase inhibitors?
N&V, diarrhoea
Fatigue, insomnia
Muscle cramos
Headaches, dizziness
What are the features of depression?
Depressed mood Suicidal ideas Insomnia Hypochondriasis Agitation
What is the management of depression?
Antidepressants
CBT
ECT
What is late onset schizophrenia-like psychosis?
Spectrum from circumscribed persecutory delusions to full schizophrenia like psychosis
What is the management of late onset schizophrenia like psychosis?
Often requires admission
Antipsychotics
How can dementia and delirium be compared in onset?
Dementia- progressive, unknown date
Delirium- abrupt, precise, known date
How can dementia and delirium be compared in disorientation?
Dementia- late
Delirium- early
How can dementia and delirium be compared in variation?
Dementia- slight day to day
Delirium- hour by hour
How can dementia and delirium be compared in consciousness?
Dementia- only clouded in late
Delirium- fluctuating
How can dementia and delirium be compared in attention span?
Dementia- normal
Delirium- short
How can dementia and depression be compared in History?
Dementia- often no psych
Depression often previous episodes
How can dementia and depression be compared in answers?
Dementia- near miss answers
Depression- don’t know answers
How can dementia and depression be compared in fluctuation?
Dementia- mood fluctuation daily
Depression- diurnal
How can dementia and depression be compared in memory loss?
Dementia- short term
Depression- short and long term
