Old age psychiatry Flashcards
What is dementia?
Dementia is a progressive neurodegenerative condition in which there is disturbance of higher cortical functions without clouding of consciousness. There may be decline in memory, learning new information, judgement and thinking, processing of information, emotional control, social behaviour or motivation
What is the commonest cause of dementia in any age group?
Alzheimer’s
What are the 5 pathological findings in Alzheimer’s?
- Cerebral atrophy (medial temporal lobe atrophy)
- Senile plaques
- Amyloid deposition
- Neuro-fibrillary tangles
- Acetyl choline: levels reduced
What are the 5 As of Alzheimer’s?
Amnesia, Aphasia, Agnosia, Apraxia, Associated behaviours (Behavioural and Pyschological Symptoms of Dementia)
What drugs are used in the medical management of Alzheimer’s?
No cure but drugs which help temporarily reduce the symptoms…
Acetylcholinesterase inhibitors - Donepazil, Galantamine, Rivastigmine
Mod-to-severe disease: NMDA receptor antagonists - Memantine
What is the second most common cause of dementia in over 65s?
Vascular dementia
What medications can be used for vascular dementia?
No specific drugs to help the dementia but consider anticoagulants and other risk-factor modifying drugs to prevent further vascular decline
What is the second most common cause of dementia in under 65s?
Fronto-temporal dementia
What is the investigation of choice and management for Fronto-temporal dementia?
MRI - shows fronto-temporal atrophy
Psychosocial interventions mainstay of treatment. Some evidence for SSRIs. NO PLACE FOR ACETYLCHOLINE ESTERASE INHIBITORS
What are the core features of Lewy-body dementia?
Fluctuating cognition (attention & alertness)
Spontaneous motor features of Parkinsonism (up to 70%)
~2/3 visual hallucinations
How can a SPECT (DaT scan help differentiate between Lewy-body dementia and Alzheimer’s dementia?
Scan shows reduced striatal uptake of ligand for presynaptic dopamine transporter site FP-CIT in DLB but not AD
Why is management of Lewy-body dementia difficult?
Psychiatric symptoms may worsen with l-dopa
Neurological symptoms may worsen with neuroleptics
Acetyl cholinesterase inhibitors can help (RIVASTIGMINE)
Psychosocial interventions are vital in helping manage the condition
What is delirium?
An acute confusional state with fluctuating cognition and consciousness usually due to a medical problem, surgery or medications.
What are the 2 types of delirium?
Hyperactive delirium - the classical presentation of visual hallucinations, paranoia, agitation etc.
Hypoactive delirium - slow or sleepy, easy to miss
