Old Age Psychiatry Flashcards
What is the ABCD of dementia?
A - activities of daily living become difficult.
B -Behavioural and psychiatric symptoms e.g depression, psychosis, aggression.
C - Cognitive Impairment
D - Decline
What are some cognitive features of dementia?
Memory (dysmnesia) + 1 or more of following:
Dysphasia - expressive or receptive.
Dyspraxia (inability to carry out motor skills)
Dysgnosia (not recognising objects).
Dysexecutive functioning (problems planning, problem solving).
Functional decline.
What are some neuropsychiatric disturbances that can occur with dementia?
Psychosis - delusions/hallucinations (visual or auditory).
Depression
Altered circadian rhythms - sundowning (getting more agitated later in day after 4pm).
Agitation
Anxiety
What are the different types of dementia?
Alzheimer’s disease
Lewy body dementia
Vascular dementia
Mixed Alzheimer and vascular
What are some key features of Dementia?
Insidious onset Slow, gradual progressive decline. Generally irreversible Disorientation late in illness Slight day to day variation Less prominent physiological changes Consciousness clouded only in late stage Normal attention span Disturbed sleep wake cycle Psychomotor changes late in illness.
What are some key features of Delirium?
Abrupt precise onset Acute illness lasting days or weeks. Usually reversible Disorientation early in illness Variable hour to hour prominent physiological changes Fluctuating levels of consciousness Short attention span Disturbed sleep wake cycle Marked early psychomotor changes.
What are some investigations you would carry out for dementia?
MME MOCA MRI/CT SPECT Comparison Neurological testing
What are some key features of Dementia with Lewy bodies?
Amnesia is not prominent Deficits of attention, frontal executive and visuospatial. Fluctuation Visual hallucinations Parkinsonism REM sleep disorder Severe antipsych sensitivity Falls, syncope, autonomic dysfunction.
What is a scan specific for Dementia with Lewy bodies?
DATScan
Normally caudate nucleus and putamen are in shape of comma.
In DLB re-uptake of dopamine transporter is reduced so looks like full stop.
What are some features of Frontotemporal dementia?
Personality change
Early onset
Early emotional blunting
Speech disorder - altered output, stereotypy, echolalia (repeat back what you’ve just been told), preservation, mutism.
Frontal dyexecutative syndrome.
Abnormalities in frontotemporla lobes on imaging.
Neurological signs commonly absent early, Parkinsonism later.
What are some drug treatments for Dementia?
Acetylcholinesterase Inhibitors to mild to moderate AD.
Memantine for moderate to severe AD.
Antipsychotics
Antidepressants
Anxiolytics
Hyponotics (zolpidem, zopiclone, clonazepam)
Anticonvulsants
What are are some side effects of Cholinesterase inhibitors?
Nausea Vomiting Diarrhoea Fatigue Insomnia Muscles cramps Headaches Dizziness Syncope Breathing problems.
What are some abnormal reactions to grief, mourning or bereavement?
Persists longer than 2 months Guilt Thoughts of death Worthlessness Psychomotor retardation Prolonged and marked functional impairment Psychosis.
