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Psychiatry > Old Age Psychiatry > Flashcards

Old Age Psychiatry Flashcards

1
Q

What are the three big ‘D’s in the hospital?

A

Dementia
Delirium
Depression

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2
Q

What age are the majority of people in hospital?

A

2/3rd hospital beds filled by elderly patients?

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3
Q

How do you diagnose dementia?

A

Clinically using criteria, flexible cognitive testing and a collateral history!

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4
Q

What is the ABCD of dementia?

A 
A = ADL affected
B = BPSD (behavioural and psychiatric symptoms of dementia)
C = cognitive impairment
D = decline
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5
Q

What are the features of dementia required for diagnosis?

A 
Amnesia/dysmnesia (foregetfulness) + 1 or more of:
Dyphasia (expressive/receptive)
Dysgnosia
Dsypraxia
Dysexecutive function

AND FUNCTIONAL DECLINE (ADLs)

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6
Q

What is expressive dysphasia?

A

Difficulty finding the right word, but can understand what you are saying

E.g. nominal aphasia = difficulty finding the names of things

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7
Q

What is receptive aphasia?

A

Difficulty understanding

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8
Q

What is dyspraxia?

A

Difficulty carrying out motor skills despite an intact nervous system

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9
Q

What is dysgnosia?

A

Not recognising things/people etc. (can be any of 5 senses)

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10
Q

What is dysexecutive functioning?

A

Problems with sequencing, planning, mood, sexuality, personality,
FRONTAL pathology

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11
Q

In dementia there is classically a long/short progression

A

Long

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12
Q

What correlates with ability to perform daily activities?

A

MMSE score

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13
Q

Describe the difference between instrumental activities of daily living and basic activities of daily living

A

BADL = basic things you do before going to bed/after getting up

IADL = using computers, keeping to appointments etc.

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14
Q

What neuropsychotic disturbances are common in dementia?

A 
Psychosis (esp. paranoid ideas relating to theft, plotting etc.)
Depression 
Altered circadian rhythms
Agitation 
Anxiety
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15
Q

What is the nature of the BPSD in terms of when they are present?

A

Relapsing, remitting nature

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16
Q

What is the most common cause of dementia?

A

Alzhiemers disease

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17
Q

How do you distinguish between Parkinson’s and Lewy body dementia?

A

Parkinson’s - motor symptoms come on first (1y before cognitive problems) - vice versa for Lewy body

Commonly get hallucinations in lewy body which you don’t get as often in Parkinsons

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18
Q

What are the three stages of dementia progression?

A

Early - tends to be unnoticed
Mild-moderate - progressive decline in functional ability/cognition
Severe - requires institutionalisation

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19
Q

What is the pathway of diagnosis/treatment etc. for dementia?

A

Brought to primary care –> history, collateral history, MSE, physicals and blood, cognitive assessment –> if suspicion of dementia –> exclude other causes of dementia, delirium and depression –> refer

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20
Q

What happens after specialist referral?

A

Confirmation of diagnosis
Brain scanning and neuropsychology
Management and counselling

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21
Q

What two tools can you use to assess cognition?

A

MMSE and MOCA

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22
Q

What components of cognition does MOCA look at?

A 
Executive/visuospatial
Naming
Memory
Attention 
Language 
Abstraction 
Delayed recall 
Orientation
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23
Q

What brainscans can you do in dementia?

A

CT
SPECT (functional scanning)
MRI best if suspect vascular dementia

24
Q

What would you see in the CT of someone with AD?

A

Temporal lobe and hippocampal atrophy

25
Q

What should changes in personality, apathy and headache raise your suspicion of?

A

Space occupying lesion in frontal cortex

26
Q

What will you see on a SPECT of someone with frontotemporal dementia?

A

Frontal hypoperfusion

27
Q

What will you see on a SPECT of someone with AD?

A

Temporal and parietal and occipital hypoperfusion

28
Q

What things will you tend to see in lewy body dementia?

A 
Amnesia not that prominent (deficits of attention, frontal executive, visuospatial)
1 = possible, 2 = probable
Fluctuation
Visual hallucinations
Parkinsonism

Suggestive: REM sleep disorder, severe antipsych sensitivity, abnormal DATscan, restless, kicking out

29
Q

What may support a diagnosis of lewy body dementia?

A

Falls, syncope, loss of consciousness, psychiatric symptoms, autonomic dysfunction/instability

30
Q

What does a DATScan do?

A

Lights up dopamine in the brain

31
Q

What does a DATscan in a normal person look like?

A

Normal re-uptake of dopamine transporter in caudate nucleus and putamen

32
Q

What does a DATscan in someone with lewy body dementia look like?

A

Re-uptake in putamen is reduced –> small dot of uptake

33
Q

A patient gradually stopping caring about his appearance and personal hygiene with a clear change in personality (apathy, withdrawn) is likely to indicate what?

A

Frontotemporal dementia

34
Q

What does a CT of someone with frontotemporal dementia’s brain look like?

A

Gryi thinner and sulci bigger in frontotemporal region

35
Q

What is Pick’s disease?

A

Classic FT dementia

36
Q

What features are consistent with FT dementia?

A 
Personality change (apathy)
Can be early onset 
Early emotional blunting
Speech disorder (echolalia, mutism, altered output etc.) 
Frontal dysexecutive function
37
Q

Why is memory often spared in vascular dementia?

A

Due to preservation of grey mater

38
Q

What features are consistent with vascular dementia?

A

Step wise decline, deterioration in executive function, mood changes (e.g. irritability)

Depends where is affected really

39
Q

How do you treat mild-moderate AD, LBD, FT dementia?

A

Acetylcholinesterase inhibitors (e.g. donepezil, galantamine, rivastigmine)

40
Q

How do you treat moderate-severe AD?

A

Memantine (can use combo with AChI)

41
Q

What other drugs may be used in treating AD/FT dementia?

A

Antipsychotics (amisulfride, quetiapine, risperidone) - increases risk of stroke!!

Antidepressants (e.g. mirtazapine, sertraline)

Anxiolytics, e.g. lorazepam

Hypnotics (e.g. clonazepam) but increase fall risk

Anticonvulsants

42
Q

What should you definitely not use in LDB?

A

Antipsychotics - make hallucinations worse

43
Q

What are side effects of cholinesterase inhibitors?

A

N/V, diarrhoea, fatigue, insomnia, muscle cramps, dizziness, headaches, syncope, breathing problems

44
Q

More elderly females/males are depressed

A

Males

45
Q

What are the precipitating factors for depression in the elderly?

A 
Loneliness
Widowed
Ill health 
Chronic pain 
Recent life events
46
Q

What is late-onset schizophrenia like psychosis?

A

Tends to be elderly women, who are cognitively intact but present with paranoid delusions, ideas of reference or of being observed

Do well on antipsychotics

47
Q

What is the rules governing driving and dementia?

A

Must inform DVLA
Yearly license

Those with poor short term memory, disorientation or lack of insight are not fit to drive

48
Q

What pathology characterises AD?

A

Beta-amyloid plaques
Tangles

Macroscopically - brain atrophy, gryri narrow and sulci and ventricles enlarge and hippocampus atrophies

49
Q

What features are characteristic of AD?

A 
Short term memory loss
Loss of motor skills
Language problems
Long term memory loss
Disorientation
50
Q

What is the pathology associated with FT dementia?

A

Tangles in the frontal and temporal lobes

51
Q

What characteristics are most associated with FT dementia?

A

Personality and behaviour changes
Aphasia
Memory, concentration, ability to learn new things

IMPULSIVE, INAPPROPRIATE BEHAVIOUR

52
Q

What is vascular dementia?

A

Multi-infarct dementia: progressive loss of brain function due to long term hypoperfusion of the brain (typically due to small strokes)

53
Q

What risk factors are associated with vascular dementia?

A

HTN, smoking, vascular disease, previous stroke/TIA, AF, DM, hyperlipidaemia, obesity

54
Q

What are lewy bodies?

A

Protein build up inside neurons

55
Q

What is the function of the substantia nigra?

A

Initiating movements

56
Q

What kinds of neurons are in the substantia nigra?

A

Dopaminergic neurons

57
Q

What three things would ring alarm bells for lewy body dementia?

A

Dementia, parkinsonism, hallucinations

Psychiatry (26 decks)

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