OLD AGE PSYCHIATRY Flashcards
do elderly people have a higher or lower sensitivity to benzodiazepines?
Higher sensitivity
How do the following components of pharmacodynamics change in the elderly? Absorption Distribution Metabolism Excretion
Absorption- slower, delayed/slower onset of action Distribution- increased volume, longer duration of action, increased ‘free’ drugs Metabolism – (hepatic metabolism lipid soluble drugs) reduced liver volume no significant effect metabolic capacity Excretion – reduced renal clearance, slow excretion
Give 3 functions of the limbic system?
Learning and memory
Emotions
Cognition
What is the blood confusion screen(9)?
FBC, U+E(Na), LFT, Ca, TFT, gluc, B12, Folate, CRP.
Compare the findings in delirium vs dementia for the following components
- Onset
- Course
- Duration
- Awareness
- Alertness
- Orientation
- Working memory
- Thinking
- Perception
- Speech
- Sleep-wake cycle
- Acute vs Insidious
- Fluctuating vs Stable
- Hours to weeks vs Months to years
- Reduced vs Clear
- Low or high vs normal
- Impaired time/place/ person vs Impaired later stages
- Impaired vs Normal (early stages)
- Disorganised,delusional vs impoverished
- Illusions and hallucinations (visual) vs Absent early stages
- Incoherent, hesitant , slow/ rapid vs Word finding difficulties
- disrupted vs normal
What is the definition of dementia?
Dementia is a syndrome due to disease of the
brain, usually of a chronic or progressive nature,
in which there is disturbance of multiple higher
cortical functions, including memory, thinking,
orientation, comprehension, calculation, learning
capacity, language and judgement.
Name 4 key diagnostic indicators of peudodementia opposed to dementia?
- Decrease in effort ‘don’t know’
- Rapid progression of symptoms after onset
- Behaviour incongruent with severity of cognitive impairment
- Marked variability on performance of tasks of similar difficulty
Which is more common in men vs women?
- Alzheimers
- Vascular dementia
- AD- Women
- VD- Men
Does Alzheimers come on slowly or quickly?
Slowly
In Alzheimers there is usually a change in what 3 things prior to cognitive decline?
Impairment of cognitive function is accompanied by and occasionally preceded by deterioration in emotional
control, social behaviour or motivation.
What are the two drug classes in Alzheimers management? Give 1 example for each.
Acetylcholinesterase inhibitors- Donepezil, Galantamine
NMDA anatagonist- Memantine
What are the 3 requirements for diagnosing dementia?
- History
- Evidence of cognitive decline
- Imaging evidence
What are the 3 paths that vascular dementia can follow?
- Acute onset: Dementia follows stroke
- Multi-infarct dementia: Stepwise deterioration following numberof TIA episodes
- Subcortical dementia: association with Hypertension and deep white matter ischaemia. Clinically appears like Alz picture.
What typical changes are seen on CT with frontotemporal dementias?
Knife blade changes
Does frontotemporal disease tend to affect memory or behaviour more?
Behaviour
Does frontotemporal dementia tend to come on younger or older?
Younger
Echolalia is seen in frontotemporal dementia. What is echolalia?
meaningless repetition of another person’s spoken words as a symptom of psychiatric disorder.
What 3 movement disorders do dementia with Lewy bodies develop?
- Bradykinesia
- Tremor
- Rigidity
Think Parkinson’s
What is the difference between Lewy body dementia and Parkinsons disease?
In Lewy body dementia the movement disorders and cognitive decline occur simultaneously.
In Parkinsons disease the movement disorders occur at least 12 months in advance of the cognitive symptoms
What needs to be avoided at all costs in lewy body dementia? Why?
Anticholinergic medications should be avoided because they exacerbate the symptoms of dementia. Traditional antipsychotic medications can precipitate severe reactions and may double or triple the rate of mortality in patients who have dementia with Lewy bodies.
What 4 symptoms are assessed at the patient-relative interview for Behavioural and Psychological Symptoms of Dementia (BPSD)?
- Anxiety
- Depression
- Delusions
- Hallucinations
What are the three Cs which are a major risk factor for developing late onset depression?
The 3 C’ʹs -
- cardiovascular disease,
- central nervous system disorders (e.g. strokes, vascular pathology, dementia, Parkinson’s disease),
- cancer – medical conditions associated with a high risk
How does late onset depression differ from ealy onset depression?
- Low mood less prominent
- Reduced complaints of ‘feeling sad’
- More frequent reports of hypochondriasis and somatic concerns
What are the three branches of management for late onset depression?
- Anti-depressants (start low go slow)
- Psychological interventions
- ECT
