Old Age Psychiatry Flashcards
List the ABCD of dementia
- A: activities of daily living
- B: behavioural and psychiatric symptoms (BPSD)
- C: cognitive impairment
- D: decline
Give the cognitive features of dementia
-Memory (dysmnesia) plus one or more of:
-Dysphasia (expressive
and receptive)
-Dyspraxia
-Dysgnosia (not
recognising objects)
-Dysexecutive function
(problems with planning,
problem solving and
carrying out tasks)
-Functional decline
-ADLs
What features of neuropsychiatric disturbance can be seen in dementia?
- Psychosis
- Depression
- Altered circadian rhythms
- Agitation
- Anxiety
List the causes of dementia in order of likeliness
- Alzheimer’s
- Vascular
- Mixed Alzheimer’s and vascular
- Lewy Body
- Other causes
List the features of dementia
- Insidious onset
- Slow, gradual progressive decline
- Generally irreversible
- Disorientation late in illness
- Slight day to day variation
- Consciousness clouded in late stage
- Normal attention span
- Disturbed sleep wake cycle
- Psychomotor changes late in illness
List the features of delirium
- Abrupt, precise onset
- Acute illness
- Usually reversible
- Disorientation early
- Variable hour by hour
- Prominent physiological changes
- Fluctuating levels of consciousness
- Short attention span
- Disturbed sleep wake cycle
- Marked early psychomotor changes
Which scans can be used to diagnose Alzheimers?
SPECT scan
MRI
CT
What are the criteria for dementia with Lewy Bodies?
- Dementia (amnesia not prominent)
- Deficits of attention, frontal executive and visuospatial
- Fluctuation, visual hallucinations and parkinsonism
- Suggestive: REM sleep disorder, severe antipsych sensitivity and abnormal DAT scan
- Falls, syncope, LOC, other psych symptoms, autonomic dysfunction and scans
What does a DAT scan show?
- Dopamine uptake in the caudate nucleus and putamen
- Normally it looks like a comma
- In DLB it looks like a full stop
What are the features of frontotemporal dementia?
- Behavioural change: personality
- Can be early onset
- Early emotional blunting
- Speech disorder: altered output, stereotypy, echolalia, perseveration and mutism
- Neuropsychology: frontal dysexecutive syndrome
- Memory, praxis and visuospatial function not impaired
- Imaging: abnormalities in frontotemporal lobes
- Neurological signs: incontinence and primitive reflexes
What are the medical treatments for dementia?
- Acetylcholinesterase inhibitors for mild to moderate AD
- Memantine for moderate to severe AD
- Antipsychotics
- Antidepressants (SSRIs)
- Anxiolytics
- Hypnotics (e.g. zolpidem, zopiclone and clonazepam)
- Anticonvulsants
What are the pros and cons of cholinesterase inhibitors?
- Pros: improve cognitive function, slow decline and improve non cognitive symptoms
- Cons: do not stop disease progression and have side effects
What are the side effects of cholinesterase inhibitors?
- Nausea, vomiting and diarrhoea
- Fatigue and insomnia
- Muscle cramps
- Headaches and dizziness
- Syncope
- Breathing problems
Which features make grief abnormal?
- Persisting beyond 2 months
- Guilt
- Thoughts of death
- Worthlessness
- Psychomotor retardation
- Prolonged and marked functional impairment
- Psychosis
