Old age psychiatry

Question 1

define a dementia syndrome.

Answer 1

dementia is a syndrome in which there is deterioration in thinking, memory, behaviour and ability to perform everyday activities

Question 2

what are the commonest types of dementia?

Answer 2

alzheimer’s
vascular
lewy body
frontotemporal

Question 3

what tests can be carried out to test cognitive function?

Answer 3

mini mental state examination (MMSE)

montreal cognitive assessment (MOCA)

Question 4

what are the main features of dementia?

Answer 4

ABCD
activities of daily living

behavioural and psychiatric symptoms;

• depression
• anxiety
• psychosis
• aggression

cognitive impairment

decline

Question 5

what is dyspraxia?

Answer 5

inability to carry out motor skills

Question 6

what is dysgnosia?

Answer 6

inability to recognise objects

Question 7

what is dysexecutive functioning ?

Answer 7

inability to forward plan or organise
inhibitory control
working memory
cognitive flexibility

Question 8

what are the 2 types of dysphasia ?

Answer 8

expressive - difficulty producing speech

receptive - difficulty understanding what is being said

Question 9

if someone presented to the GP with signs of cognitive impairment, what would be involved in the clinical assessment?

Answer 9

history + collateral Hx
mental state examination
cognitive assessment (MMSE, MOCA)
physical exam + bloods (B12, thyroid)

Question 10

what imaging modality is useful for diagnosing lewy body dementia?

Answer 10

DAT scan

Question 11

what imaging modalities are useful for diagnosing alzheimers?

Answer 11

coronal MRI

SPECT comparison

Question 12

what are the main features of lewy body dementia?

Answer 12

deficits of attention, frontal executive and visuospatial
(memory loss isn’t prominent)

fluctuation
visual hallucinations
parkinsonism

REM sleep disorder
severe antipsych sensitivity

Question 13

what are the main features of frontotemporal dementia?

Answer 13

rapidly progressive
behaviour change / change in personality
apathy, emotional blunting

speech disorder
neuropsychology 
- frontal dysexecutiev syndrome 
- memory 
-praxis 
- visuospatial not severely impaired

Question 14

what imaging modalities is useful for diagnosing frontotemporal dementia?

Answer 14

MRI

PET scan

Question 15

what drug treatment is used in alzheimers?

Answer 15

mild-moderate disease - acetylcholinesterase inhibitors e.g. Donepezil

severe disease - Memantine

Question 16

how do you assess someones capacity?

Answer 16

assess whether they can;

• act
• make
• communicate
• understand
• retain memory

regarding their health and treatment etc

Question 17

how does depression present in the elderly?

Answer 17

insomnia
hypochondriasis
suicide
agitation

Question 18

what are the treatment options for depression in the elderly?

Answer 18

antidepressants
CBT
anxiolytics
ECT

Question 19

when does the reaction to bereavement become abnormal?

Answer 19

persistant for > 2 motnhs
feelings of guild 
feelings of worthlessness 
thoughts of suicide 
psychomotor retardation
prolonged and marked functional impairment 
psychosis

Question 20

what are the causes of schizophrenia like psychosis in the elderly?

Answer 20

sensory loss i.e. hearing/visual
social isolation
genetic

Question 21

what is the treatment for schizophrenia like psychosis in the elderly?

Answer 21

antipsychotics i.e. olanzapine, risperidone, quetiapine

Question 22

what are the management options for dementia?

Answer 22

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

Question 23

what is the pathology behind lewy body?

Answer 23

deposition of alpha-synuclein in the brain

Question 24

what is the pathology behind alzheimers disease?

Answer 24

neurofibrillary tangles and amyloid containing senile plaques deposits in the brain
atrophy of the cortical and subcortical areas

Question 25

what lobes of the brain does alzheimers affect?

Answer 25

temporal-parietal

Question 26

what is the most common causes of admission into the general hospital in people with dementia?

Answer 26

UTI & pneumonia