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Psychiatry > Old age psychiatry > Flashcards

Old age psychiatry Flashcards

1
Q

What is the ABCD of dementia?

A

A - activities of daily living
B - Behavioural and psychiatric symptoms of dementia (BPSD)
C - cognitive impairment
D - decline

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2
Q

What are cognitive features of dementia?

A 
Memory - dysmnesia
Dysphasia
Dyspraxia
Dysgnosia
Dysexecutive
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3
Q

What are the 2 types of dysphasia?

A

Expressive and receptive

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4
Q

What is dysphasia?

A

Impaired communication

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5
Q

What is dyspraxia?

A

Impaired motor skills function

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6
Q

What is dysgnosia?

A

Not recognising objects

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7
Q

What neuropsychotic disturbances can happen with dementia?

A 
Psychosis
Depression
Altered circadian rhythms
Agitation
Anxiety
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8
Q

What is the most common form of dementia?

A

Alzheimer’s

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9
Q

What is the course of dementia?

A 
Cognitive abilities become more impaired
Symptoms
Diagnosis
Loss of functional independence
Behavioural problems
Nursing home placement
Death
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10
Q

How is Alzheimer’s diagnosed?

A

Case-finding - symptoms
Clinical assessment
Differential exclusions
Specialist referral

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11
Q

What is done in clinical assessment for Alzheimer’s?

A 
Clinical history and collateral history
Mental state examination
Physical examination
Bloods
Cognitive assessment
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12
Q

What are differentials for Alzheimer’s?

A

Delirium
Depression
Other causes of dementia

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13
Q

What is done after specialist referral in Alzheimer’s?

A

Confirm diagnosis with brain scanning and neuropsychology
Patient and caregiver counselling
Management and symptomatic treatment
Followup

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14
Q

What are the main differences between dementia and delirium?

A

Dementia is gradual, progressive, and has little variation

Delirium is acute, highly variable and abrupt

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15
Q

How is cognitive ability measured?

A

Mini-mental state examination or MOCA test

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16
Q

What are criteria of Dementia with Lewy Bodies?

A

Dementia with deficits of attention, frontal executive and visuospatial, amnesia ot prominent
1 or more of : Fluctuation, visual hallucinations, parkinsonism
REM sleep disorder, severe antipsych sensitivity, abnormal DAT scan
Supported by falls, syncope, loss of consciousness
Diagnosis less likely if stroke disease

17
Q

What sha[e will the DATScan show in dementia with Lewy bodies?

A

Reuptake of dopamine in the putamen will be reduced and will show a ‘full stop’ sign rather than a ‘comma’

18
Q

What is the main feature of frontotemporal dementia?

A

Personality change

19
Q

What problems with speech do people with frontotemporal dementia have?

A 
Altered output
Stereotypy
Echolalia
Perseveration
Mutism
20
Q

What is echolalia?

A

Meaningless repetition of another person’s words

21
Q

What drugs can be used for dementia?

A 
Acetylcholinesterase inhibitors for mild to moderate Alzheimer's
Memantine for severe Alzheimer's
Antipsychotics
Antidepressants
Anxiolytics
Hypnotics
Anticonvulsants
22
Q

What are benefits to acetylcholinesterase inhibitors?

A

Improve cognitive function
Slow down decline
Improve non-cognitive symptoms - improved activities of daily living, longer at home, reduced carer stress

23
Q

What are possible side effects of acetylcholinesterase inhibitors?

A 
Nausea
Vomiting
Diarrhoea
Fatigue
Insomnia
Muscle cramps
Headahces
Dizziness
Syncope
Breathing problems
24
Q

What abilities are related to capacity?

A

Understanding
Manipulating
Approaching situation and consequences
Communicating choices

25
Q

What are 2 types of power of attorney?

A

Finance

Welfare

26
Q

What is normal for someone grieving/mourning?

A 
Alarm
Numbness
Pining - illusions or hallucinations may occur
Depression
Recovery and reorganisation
27
Q

What is abnormal for someone grieving/mourning?

A 
Persisted beyond 2 months
Guilt
Thoughts of death
Worthlessness
Psychomotor retardation
Prolonged and marked functional impairment
Psychosis
28
Q

What are reasons for suicide in the elderly?

A 
Loneliness
Widowed
Ill health
Chronic pain
Recent life events
Few seeing psychiatrist
29
Q

What is done in terms of a dementia patient’s fitness to drive?

A

Notify DVLA at diagnosis
May get yearly reviews at early diagnosis
If poor short term memory, disorientation, or lack of insight, don’t drive

Psychiatry (18 decks)

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