Old Age Psychiatry

Question 1

What is the ABCD of dementia?

Answer 1

A - ADLs
B - Behavioural and Psychiatric Symptoms of dementia
C - cognitive impairment
D - Decline

Question 2

What are cognitive features of dementia?

Answer 2

Memory (dysmnesia)
- plus one or more of: dysphasia, dyspraxia, dysgnosia, dysexecutive functioning

Functional decline
- ADLs

Question 3

Describe delirium vs dementia

Answer 3

Dementia; insidious onset, slow and gradual decline, generally irreversible, slight day-to-day variation

Delirium; abrupt, precise onset, acute illness, usually reversible, variable hour by hour, short attention span

Question 4

Describe dementia with lewy bodies

Answer 4

1. Dementia; amnesia not prominent, deficits of attention, frontal executive, visuospatial
2. Two = probable, One = possible
   - fluctuation
   - visual hallucinations
   - parkinsonism
3. Suggestive; REM sleep disorder, severe antipsych sensitivity, abnormal DAT scan
4. Supported by falls, syncope, loss consciousness

Question 5

Describe DATScan

Answer 5

Used in DLB

Sensitivity and specificity ~85%

DATScan on normal or AD patient will show normal re-uptake of dopamine transporter in head of caudate nucleus and putamen in shape of a comma

In DLB, re-uptake in putamen is reduced leading to full-stop sign

Question 6

What is Pick’s disease?

Answer 6

A type of fronto-temporal dementia

Question 7

Describe fronto-temporal dementia

Answer 7

Behaviorual disorder; personality change

Can be early onset, early emotional blunting

Speech disorder; altered output, echolalia, mutism

Neuropsychology; frontal dysexecutive syndrome - memory, praxis and visuospatial function not severely impaired

Neuroimaging; frontotemporal loss

Neurological signs commonly absent early; parkinsonism later

Question 8

What is drug treatment for dementia?

Answer 8

Acetylcholinesterase inhibitords ; donepezil, rivastagmine, galantamine

Memantine for moderate to severe

Antipsychotics

Antidepressants

Anxiolytics

Hypnotics

Anticonvulsants

Question 9

Describe cholinesterase inhibitors effects

Answer 9

Improve cognitive
Slow decline
Improve non-cognitive symptoms

Side effects include;

• nausea, com, diarrhoea
• fatigue, insomnia
• muscle cramps
• headaches, dizziness