Old age psychiatry

Question 1

3 Big D’s in elderly

Answer 1

dementia
delirium
depression

Question 2

ABCD of dementia

Answer 2

Activities of daily living
Behavioural and psychiatric symptoms of dementia
Cognitive impairment
Decline

Question 3

What else in needed in the ABCD of dementia?

Answer 3

collateral history

flexible cognitive testing

Question 4

Cognitive features of dementia

Answer 4

memory plus 1 of 
- dysphasia 
-dysgnosia 
- dyspraxia 
- dysexecutive function 
functional decline - ADL

Question 5

Neuropsychiatric disturbance of dementia

Answer 5

depression 
anxiety 
circadian rhythm altered 
agitation
psychosis

Question 6

BPSD of dementia

Answer 6

paranoia
aggression
anxiety
hallucinations etc

Question 7

Ockham’s razor of dementia

Answer 7

Alzheimer's = 50%
Vascular = 25%
15% - mixture of both 
DLB = 5%
other = 5%

Question 8

Course of dementia

Answer 8

symptoms 
diagnosis 
loss of functional independence
behavioural problems 
nursing home placement 
death

Question 9

Diagnosing AD in primary care

Answer 9

symptoms suggesting cognitive impairment
history and collateral, MSE, physical and bloods, cognitive assessment
exclude delirium, depression
brain scan, neuropsychology

Question 10

Best view to assess atrophy of medial temporal lobes

Answer 10

T1 weighted MRI scans

Question 11

SPECT

Answer 11

helps to determine aetiology by looking at blood flow

Question 12

Dementia with Lewy bodies

Answer 12

attention, frontal executive, visuospatial
visual hallucinations, parkinsonism, fluctuation
DAT scan abnormal
syncope, falls

Question 13

DAT scan use

Answer 13

DLB
dopamine - comma with caudate nucleus and putamen
“full stop” sign

Question 14

Pick’s disease

Answer 14

fronto-temporal dementia

knife blade gyri

Question 15

Fronto-temporal dementia

Answer 15

behavioural disorder - personality change
speech disorder
frontal dysexecutive syndrome
brain scan

Question 16

Subcortical vascular dementia

Answer 16

gradual deterioration in executive function, mood (apathy)
memory relatively spared
falls, incontinence, seizures

Question 17

Drug treatment of dementia

Answer 17

Acholinesterase inhibitors 
memantine 
antipsychotics 
anxiolytics 
antidepressants 
anticonvulsants 
hypnotics

Question 18

Cholinesterase inhibitors

Answer 18

improve cognitive function
slow decline
SE = N&, syncope, muscle cramps, fatigue

Question 19

Neuroleptics

Answer 19

controversial - efficacy, death

Question 20

Capacity

Answer 20

decision specific

act, make, communicate, remember and understand

Question 21

Power of attorney

Answer 21

finance

welfare

Question 22

Guardianship

Answer 22

finance or welfare
lack capacity to grant POA
GP and psychiatrist certificate
detailed MHO report

Question 23

What else apart from dementia?

Answer 23

depressive symptoms or illness
anxiety disorders 
mania 
schizophrenia 
alcohol 
suicide

Question 24

Abnormal grief

Answer 24

> 2 months
guilt
thoughts of death
psychosis

Question 25

Suicide in elderly

Answer 25

same as under 25’s
males>females
most are depressed
lonely, widow, chronic pain

Question 26

Cars - fitness to drive

Answer 26

notify DVLA

license may be yearly

Question 27

How to avoid dementia

Answer 27

choose your patients 
activity 
caffeine 
alcohol 
hypertension 
statins 
NSAIDs
fish oils