Old Age Psychiatry

Question 1

what are the most common mental illnesses in old age?

Answer 1

dementia
depression
delirium

Question 2

what are the ABCD features of Dementia?

Answer 2

• Activities of Daily Living (ADLs)
• Behavioural and psychiatric symptoms of dementia (BPSD)
• Cognitive Impairment
• Decline

Question 3

what features related to memory loss can present in dementia?

Answer 3

dysphasia (expressive or receptive)
dyspraxia
dysgnosia
dysexecutive functioning

Question 4

define dysphasia, dyspraxia, dysgnosia and dysexecutive functioning

Answer 4

dysphasia - inability to communicate
dyspraxia - inability to carry out motor skills
dysgnosia - inability to recognise objects
dysexecutive functioning - inability to organise/plan activities

Question 5

what are the two main cognitive features of dementia?

Answer 5

memory

functional decline

Question 6

name some neuropsychiatric disturbances that can occur in dementia

Answer 6

• psychosis
• depression
• altered circadian rhythm
• agitation/aggression
• anxiety

Question 7

what are the three most common types of dementia?

Answer 7

alzheimer’s disease
vascular dementia
mixed alzheimer’s and vascular dementia

Question 8

what is the average timescale between diagnosis and death?

Answer 8

7 years

Question 9

alzheimer’s disease represents how much of the overall prevalence of dementia?

Answer 9

50%

Question 10

name a few common symptoms found in Lewy body Dementia (DLB)

Answer 10

• attention/frontal executive and visuospatial deficit
• fluctuation
• visual hallucinations
• parkinsonism
• sleep disorder

Question 11

what type of scan is done for patients with Lewy Body Dementia, and what does it look for?

Answer 11

DATScan - looks at the reuptake of dopamine transporter in the caudate nucleus

Question 12

which type of dementia is characterised by personality changes and apathy?

Answer 12

frontotemporal dementia (FTD)

Question 13

name a few features of frontotemporal dementia

Answer 13

personality changes
early onset
emotional blunting
speech disorder
abnormalities in frontotemporal lobe

Question 14

what is the firstline drug treatment for mild to moderate Alzheimer’s dementia?

Answer 14

Acetylcholinesterase Inhibitors

- donepezil, rivastigmine, galantamine

Question 15

what is the first line treatment for moderate to severe Alzheimer’s?

Answer 15

Memantine

Question 16

name a few neuroleptic drugs that are sometimes used for dementia

Answer 16

• antipsychotics
• anxiolytics
• anticonvulsants
• antidepressants
• mood stabilisers
• hypnotics

Question 17

what are the two areas of remit for Power of Attorney and guardianship?

Answer 17

financial

welfare

Question 18

what are the 5 principles to establish if someone has capacity?

Answer 18

Act
Make
Communicate
Understand
Retain memory of

Question 19

what is the difference between guardianship and power of attorney?

Answer 19

• PoA is appointed by a patient who has capacity

- guardianship is appointed when a patient does not have capacity

Question 20

what percentage of elderly admissions are due to late onset schizophrenic psychosis?

Answer 20

10%

Question 21

what is a typical feature of elderly patients presenting with late onset schizophrenia?

Answer 21

elderly patients with sensory loss, often deafness

Question 22

do patients need to tell DVLA when they get diagnosed with dementia?

Answer 22

yes

Question 23

what are the common brain scans carried out to confirm a diagnosis of dementia?

Answer 23

CT scan

SPECT scan

Question 24

name the most common tests for cognitive function

Answer 24

MMSE questionnaire

MOKA questionnaire

Question 25

which type of dementia can often present with visual hallucinations? why is that difficult to treat?

Answer 25

Dementia with Lewy Bodies. visual hallucinations are difficult to treat because these patients are also very sensitive to antipsychotics and can have bad reactions to them

Question 26

in what way is guardianship more complicated to obtain than power of attorney?

Answer 26

because in absence of patient’s capacity, it requires two medical certificates (GP and psych) along with a report from a social worker