Old age psychiatry Flashcards
What is the ABCD of dementia?
A - activities of daily living
B - Behavioural and psychiatric symptoms of dementia (BPSD)
C - cognitive impairment
D - decline
What are cognitive features of dementia?
Memory - dysmnesia Dysphasia Dyspraxia Dysgnosia Dysexecutive
What are the 2 types of dysphasia?
Expressive and receptive
What is dysphasia?
Impaired communication
What is dyspraxia?
Impaired motor skills function
What is dysgnosia?
Not recognising objects
What neuropsychotic disturbances can happen with dementia?
Psychosis Depression Altered circadian rhythms Agitation Anxiety
What is the most common form of dementia?
Alzheimer’s
What is the course of dementia?
Cognitive abilities become more impaired Symptoms Diagnosis Loss of functional independence Behavioural problems Nursing home placement Death
How is Alzheimer’s diagnosed?
Case-finding - symptoms
Clinical assessment
Differential exclusions
Specialist referral
What is done in clinical assessment for Alzheimer’s?
Clinical history and collateral history Mental state examination Physical examination Bloods Cognitive assessment
What are differentials for Alzheimer’s?
Delirium
Depression
Other causes of dementia
What is done after specialist referral in Alzheimer’s?
Confirm diagnosis with brain scanning and neuropsychology
Patient and caregiver counselling
Management and symptomatic treatment
Followup
What are the main differences between dementia and delirium?
Dementia is gradual, progressive, and has little variation
Delirium is acute, highly variable and abrupt
How is cognitive ability measured?
Mini-mental state examination or MOCA test
What are criteria of Dementia with Lewy Bodies?
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
What sha[e will the DATScan show in dementia with Lewy bodies?
Reuptake of dopamine in the putamen will be reduced and will show a ‘full stop’ sign rather than a ‘comma’
What is the main feature of frontotemporal dementia?
Personality change
What problems with speech do people with frontotemporal dementia have?
Altered output Stereotypy Echolalia Perseveration Mutism
What is echolalia?
Meaningless repetition of another person’s words
What drugs can be used for dementia?
Acetylcholinesterase inhibitors for mild to moderate Alzheimer's Memantine for severe Alzheimer's Antipsychotics Antidepressants Anxiolytics Hypnotics Anticonvulsants
What are benefits to acetylcholinesterase inhibitors?
Improve cognitive function
Slow down decline
Improve non-cognitive symptoms - improved activities of daily living, longer at home, reduced carer stress
What are possible side effects of acetylcholinesterase inhibitors?
Nausea Vomiting Diarrhoea Fatigue Insomnia Muscle cramps Headahces Dizziness Syncope Breathing problems
What abilities are related to capacity?
Understanding
Manipulating
Approaching situation and consequences
Communicating choices
What are 2 types of power of attorney?
Finance
Welfare
What is normal for someone grieving/mourning?
Alarm Numbness Pining - illusions or hallucinations may occur Depression Recovery and reorganisation
What is abnormal for someone grieving/mourning?
Persisted beyond 2 months Guilt Thoughts of death Worthlessness Psychomotor retardation Prolonged and marked functional impairment Psychosis
What are reasons for suicide in the elderly?
Loneliness Widowed Ill health Chronic pain Recent life events Few seeing psychiatrist
What is done in terms of a dementia patient’s fitness to drive?
Notify DVLA at diagnosis
May get yearly reviews at early diagnosis
If poor short term memory, disorientation, or lack of insight, don’t drive
