old age psychiatry Flashcards
ABCD of dementia
Activities for Daily Living Behavioral and Psychiatric symptoms of dementia Cognitive Impairment Decline Collateral history flexible cognitive testing
Cognitive features
Memory plus dysphasia -expressive -receptive dyspraxia dysgnosia functional decline
BPSD
Paranoia Activity disturb Diurnal rhythm dist anxiety
hallucinations
agression
affect disturb
dementia
insidious onset with unknown date slow gradual progressive decline generally irreversible disorientation late to illness slight day to day variation less prominent physiological changes consciousness clouded only in late stage normal attention span disturbed sleepwake cyclep psychomotor changes late
delirium
abrupt, precise onset, known date acute illness usually reversible disorientationearly in illness variable hour by hour prominent physiological changes fluctuating levels of consciousness short attention span disturbed ssleepwake cycle; hour to hour variation psychomotor early
depression
Abrupt onset history of depression highlights disabilities dont know answers diurnal variation in mood tries less hard to perform and gets distressed by losses depresed mood coincides with memory loss
best view to access astrophy in medial temporal lobes
coronal sections of T1 weighted MRI scans
dementia with lewy bodies
dementia, amnesia not prominent deficits of attention, frontal executive, visuospatial two=probable, one= possible fluctuation-marked, important Visual hallucinations parkinsonism REM sleep disorder loss of consciousness, other psychiatric symptoms, autonomic dysfunction, scans
- Dx less likely if stroke disease or other brain/systemic illness.
DATScan
The DATScan on a normal or AD patient will show normal re-uptake of the dopamine transporter in the head of the caudate nucleus and putamen in the shape of a ‘comma’, whereas in DLB, re-uptake in the putamen is reduced, leading to the ‘full-stop’ sign
Frontotemporal dementia
Behavioural disorder – personality change
Can be early onset
Early emotional blunting
Speech disorder - altered output, stereotypy, echolalia, perseveration, mutism
Neuropsychology - frontal dysexecutive syndrome. Memory, praxis and visuospatial function not severely impaired
Neuroimaging - abnormalities in frontotemporal lobes
Neurological signs commonly absent early; parkinsonism later; MND in a few; autonomic; incontinence; primitive reflexes
Drug treatment of dementia
acetylcholinesterase (improve cognitive function) inhibitors, side effects N&V, diarrhoea
muscle cramps
headaches
neuroleptics
