Old Age Psychiatry

Question 1

ABCD of dementia

Answer 1

A- Activities of Daily Living
B- Behavioural and Psychiatric symptoms of dementia
C-Cognitive Impairment
D-Decline

Question 2

Cognitive features of Dementia

Answer 2

Dysmnesia,
Dysphasia,
Dyspraxia,
Dysgnosia, 
Dysexecutive functioning,

Functional decline of activities of daily living

Question 3

Neuropsychiatric disturbances in psychiatry

Answer 3

Psychosis, 
Depression, 
Altered circadian rhythm,
Agitation,
Anxiety

Question 4

Types of dementia in order of prevelance

Answer 4

1- Alzheimer’s
2- Vascular
3- Mixed (Alzheimer’s + vascular)
4- Lewy body and other causes

Question 5

How to distinguish between dementia and delirium?

Answer 5

Dementia - insidious onset with unknown date
Delirium- abrupt, precise onset, known date

Dementia- generally irreversible
Delirium- usually reversible

Dementia- disorientation late in illness
Delirium- disorientation early in illness

Dementia- slight day to day variation
Delirium- variable hour to hour

Dementia- consciousness clouded in late stage
Delirium-fluctuating levels of consciousness

Dementia- normal attention span
Delirium- short attention span

Dementia- disturbed sleep-wake cycle day-night
Delirium-disturbed sleep wake cycle- hour to hour variation

Dementia- psychomotor changes late in illness
Delirium-marked early psychomotor changes

Question 6

How to distinguish between dementia or depression

Answer 6

Dementia- insidious onset
Depression- abrupt onset

Dementia-conceals disability
Depression- highlights disabilities

Dementia-near miss answers
Depression-“don’t know” answers

Dementia-mood fluctuation day to day
Depression-diurnal variation in mood

Dementia-short term memory loss
Depression- short and long term memory loss

Dementia-memory loss occurs first
Depression-depressed mood coincides with memory loss

Dementia-associated with a decline in social function
Depression-associated with anxiety

Question 7

Alzheimer’s dementia characteristics

Answer 7

Gradual and progressive deterioration in memory,

Dysexecutive dysfunction

Question 8

Alzheimer’s dementia investigations?

Answer 8

MRI,

SPECT

Question 9

Dementia with Lewy bodies criteria

Answer 9

1- Dementia
Deficits of attention, frontal executive, visuospatial
2- Fluctuation of confusion
Visual hallucinations
Parkinsonism
3- REM sleep, severe antipsych sensitivity, abnormal DAT scan
4- supported by falls, loss of consciousness

Question 10

What is a DAT scan and what would it look like in DLB?

Answer 10

DAT scan measures the reuptake of dopamine

In a normal or AD patient there will be reuptake of dopamine in head of caudate nucleus and put amen in the shape of a “comma”
Whereas in DLB reuptake in the putamen is reduced leading to the “full stop” sign.

Question 11

Frontotemporal dementia (Pick’s disease) characteristics?

Answer 11

Behavioural disorder- personality change,
Early emotional blunting,
Speech disorder- altered output, stereotypy, echolalia, perseveration, mutism
Neuropsychology- frontal dysexecutive syndrome

Question 12

Imaging of someone with Frontotemporal dementia would show

Answer 12

Abnormalities in frontotemporal lobes

Question 13

Drug treatment for dementia

Answer 13

Acetylcholinesterase inhibitors (donezipil, rivastigmine, galantamine)
Memantine
Antipsychotics (risperidone, quetiapine)
Antidepressants
Anxiolytics (lorazepam)
Hypnotics (eg zolpidem, zopiclone, clonazepam)
Anticonvulsants (valproate, carbamazepine)

Question 14

Who has to be present for guardianship?

Answer 14

Two medical certificates- GP, psychiatrist

Detailed report from MHO

Question 15

Risk factors for late onset schizophrenia like psychosis

Answer 15

Sensory loss,
Social isolation,
Genetic- minor abnormalities