Old age psychiatry Flashcards
define a dementia syndrome.
dementia is a syndrome in which there is deterioration in thinking, memory, behaviour and ability to perform everyday activities
what are the commonest types of dementia?
alzheimer’s
vascular
lewy body
frontotemporal
what tests can be carried out to test cognitive function?
mini mental state examination (MMSE)
montreal cognitive assessment (MOCA)
what are the main features of dementia?
ABCD
activities of daily living
behavioural and psychiatric symptoms;
- depression
- anxiety
- psychosis
- aggression
cognitive impairment
decline
what is dyspraxia?
inability to carry out motor skills
what is dysgnosia?
inability to recognise objects
what is dysexecutive functioning ?
inability to forward plan or organise
inhibitory control
working memory
cognitive flexibility
what are the 2 types of dysphasia ?
expressive - difficulty producing speech
receptive - difficulty understanding what is being said
if someone presented to the GP with signs of cognitive impairment, what would be involved in the clinical assessment?
history + collateral Hx
mental state examination
cognitive assessment (MMSE, MOCA)
physical exam + bloods (B12, thyroid)
what imaging modality is useful for diagnosing lewy body dementia?
DAT scan
what imaging modalities are useful for diagnosing alzheimers?
coronal MRI
SPECT comparison
what are the main features of lewy body dementia?
deficits of attention, frontal executive and visuospatial
(memory loss isn’t prominent)
fluctuation
visual hallucinations
parkinsonism
REM sleep disorder
severe antipsych sensitivity
what are the main features of frontotemporal dementia?
rapidly progressive
behaviour change / change in personality
apathy, emotional blunting
speech disorder neuropsychology - frontal dysexecutiev syndrome - memory -praxis - visuospatial not severely impaired
what imaging modalities is useful for diagnosing frontotemporal dementia?
MRI
PET scan
what drug treatment is used in alzheimers?
mild-moderate disease - acetylcholinesterase inhibitors e.g. Donepezil
severe disease - Memantine
how do you assess someones capacity?
assess whether they can;
- act
- make
- communicate
- understand
- retain memory
regarding their health and treatment etc
how does depression present in the elderly?
insomnia
hypochondriasis
suicide
agitation
what are the treatment options for depression in the elderly?
antidepressants
CBT
anxiolytics
ECT
when does the reaction to bereavement become abnormal?
persistant for > 2 motnhs feelings of guild feelings of worthlessness thoughts of suicide psychomotor retardation prolonged and marked functional impairment psychosis
what are the causes of schizophrenia like psychosis in the elderly?
sensory loss i.e. hearing/visual
social isolation
genetic
what is the treatment for schizophrenia like psychosis in the elderly?
antipsychotics i.e. olanzapine, risperidone, quetiapine
what are the management options for dementia?
acetylcholinesterase inhibitors i.e. Donepzil NMDA receptor antagonist i.e. Memantine antipsychotics i.e. Olanzapine antidepressants i.e. Fluoxetine anxiolytics i.e. Benzodiazepine anticonvulsants i.e. Carbamazepine
what is the pathology behind lewy body?
deposition of alpha-synuclein in the brain
what is the pathology behind alzheimers disease?
neurofibrillary tangles and amyloid containing senile plaques deposits in the brain
atrophy of the cortical and subcortical areas
what lobes of the brain does alzheimers affect?
temporal-parietal
what is the most common causes of admission into the general hospital in people with dementia?
UTI & pneumonia
