Old Age Psychiatry Flashcards
What is the ABCD of dementia?
A - affect on activities of daily living (ADLs)
B - behavioural and psychiatric symptoms
C - cognitive impairment
D - decline
What are the behavioural symptoms (B)?
Agitation
Altered circadian rhythm
Personality change
What are the psychiatric changes in dementia?
Anxiety
Depression
Psychosis
What are the 4 D’s of cognitive impairment in dementia?
Dysphasia
Dyspraxia
Dysgnosia
Dysexecutive function
What is dysphasia?
Loss of ability to express/understand
What is dysgnosia?
Loss of sense of “whereness”
What other part of cognition is impaired in dementia apart from dysphasia, dyspraxia, dysgnosia and dysexecutive function?
Memory
What is the course of alzheimers disease?
Symptoms –> diagnosis –> loss of ADL’s –> Behavioural decline –> moved to a home –> death
What are the main differences between alzheimers and delerium?
Alzheimers
- Gradual onset
- Day to day variability
- Normal attention span
- Disturbed sleep wake cycle
- Disorientation, psychomotor changes and consciousness changes only occur late in disease
Delerium
- Very acute illness with abrupt onset
- Presents with hourly variation and reduced attention spans
- Disorientation/psychomotor and consciousness changes occur earlier on
What is a typical difference between depression and delerium/dementia?
Depression presents with a lot of “don’t know” answers as apposed to the others where the patient tries to remember but can’t
Also associated with anxiety more than the other two
What are investigations for older people presenting with symptoms of dementia?
Collateral history most important
MMSE
MOCA
Addenbrookes clinical assessment (ACE)
Bloods
Specialist referral
What is the MOCA good for?
Delerium
What bloods should be tested?
B12
Thiamine
What imaging should be done?
MRI head - alzheimers
DATscan
What will be seen on MRI in alzheimers?
Marked temporal atrophy in early
General atrophy later
