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A- Psych > old age psychiatry > Flashcards

old age psychiatry Flashcards

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1
Q

Generate a management plan for dementia using a bio-psycho-social approach with consideration to risk assessment

A
  1. Social approaches;

Always carry ID, address, and contact number. Reality orientation: visible clocks, calendars. Change gas to electric.
personal care, meal preparation, medication prompts.
day centre daily activities
emotional support, education about dementia
treat sensory impairment, stop unecessary meds,

  1. Psychological therapies, e.g.
    Behavioural approaches - modify risky behaviours
    Reminiscence therapy
    Validation therapy: reassure and validate the emotion
    Cognitive stimulation therapy: memory training
    and relearning.
    multisensory therapy
  2. (SSRIs) are usually first line (e.g. citalopram) - if depressed
    - > Acetylcholinesterase inhibitors - eg donepizil
    - > last resort for behavioural disturbance; benzo’s etc
  3. Electroconvulsive therapy (ECT) is sometimes used
    for psychotic or life-threatening depression

lewy body dementia;
1. you must not prescribe antipsychotics (e.g. haloperidol) - neuroleptic sensitivity

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2
Q

Identify the possible complications of dementia and its management

A

as dementia advances and speech is lost, it may be easier to respond to touch, music, etc. - multisensory therapy

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3
Q

Summarise the prognosis for patients with dementia

A

Two-thirds of people with dementia live in their own
home or with a carer. As dementia progresses, increasing
levels of help may be needed.

best to keep them in their houses for a s long as possible

Elderly mentally infirm (EMI) placements
care for the small proportion of people with otherwise
unmanageable behavioural problems.

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4
Q

In which chromosal abnormality is there increased risik of Alzheimers? why?

A

People with Down syndrome are at high risk of AD by
middle age, probably because of the extra copy of the
APP gene* in trisomy 21.

*Beta-amyloid precursor protein (APP) gene (chromosome 21).

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5
Q

plaques in alzhiemers are visulaised how?

A

via silver stain

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6
Q

The
severity of dementia is most closely associated with
the number of ______

A

NFTs - neurofibrillary tangles

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7
Q

multiple lucencies on ct scans are associated with which dementia? why?

A

vascular dementia

due to infarcts

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8
Q

multiple lucencies on ct scans are associated with which dementia? why?

A

vascular dementia

due to infarcts

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9
Q

lewy body diseases include which 2 popular dementia’s?

A

lewy body dementia

parksinsons dementia

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10
Q

what is the ivx for lewy body dementia?

how is it diagnosed?

A

Clinical daignosis

then:
immunohistochemsitry - looking for A-synuclein (biopsy after death) to confirm

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11
Q

define autoprosopagnosia?

  1. and prosopagnosia?
A

Sufferers no longer recognize their own reflection

  1. dont recognise faces
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12
Q

the presence of Focal neurology is consitent with which dementia ?

A

vascular dementia

focal neurology - signs pointing to the fact that the function of an area of the brain has been altered/wiped out. in this case by an infarct or vascular damage.

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13
Q

Autonomic instability
Recurrent falls
Syncope
is pathognomic of which dementia?

A

lewy body

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14
Q

what does this patient have;

cognitive impairment that resolves when treated

A

‘Reversible’ dementias

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15
Q

what does this patient have;

presents suddenly with altered or ‘clouded’
consciousness—losing touch with surroundings (poor
attention is a good marker of this). The presentation
usually fluctuates and there may be evidence of underlying
physical problems; symptoms resolve once the
underlying cause is treated

A

delirium

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16
Q

what does this patient have;

memory problems in severe depression

A

pseudodementia

In depression, low mood usually precedes cognitive problems

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17
Q

what is Charles Bonnet syndrome?

list some risk factors?

A

Charles Bonnet syndrome: complex visual hallucinations,
secondary to visual impairment alone.

Advanced age
Peripheral visual impairment
Social isolation
Sensory deprivation
Early cognitive impairment
18
Q

prognosis for vascualr dementia?

A

stepwise progression/ deterioration

vascular dementia can be a direct cause of death due to the possibility of a fatal interruption in the brain’s blood supply - death can be via stroke / MI due to risk factors.

Earlier death from onset compared to Alzheimers.

19
Q

what are the main symptoms of dementia?

A

Main:
GLOBAL cognitive decline
visuospatial difficulty
memory issues

Behavioural and psychotic sx:
Mood changes
Abnormal behaviour
Exaggeration of former traits or uncharacteristic behaviour, e.g. agitation, aggression, disinhibition.
Hallucinations and delusions
20
Q

list some differentials for dementia?

A
  1. Delirium
  2. Depressive pseudo dementia
    - usually too depressed to perform tasks eg counting
    from 1-10
    - screen for mood + biological sc
    - inconcsitent test results
    - at risk of vascular dementia later
21
Q

epidemiology for dementia?

A

20% of over 80s

some present earlier - can affect young people

22
Q

list some sx of FTLD?

A 
Personality change
§ Behaviour problems
§ Early loss of insight
Hyperorality
Propensity for sweet food

speech issues: aphasia, echolalia

23
Q

treatment for alzhiermers dementia?

A
  1. ACholinestrase inhibitors: rivastigmine etc
    mild- moderate disease

1B. Memantine
- in combination with 1. so add memantine to above. unless cannot tolerate above.
moderate- severe disease

these drugs are not usually initiated by gp - likely old age psychiatrists or neurologists

  1. Memory clinics
    - met: psychiatrists, neurologists, geriatricians
    - assess and diagnose dementia
    - manage above meds
24
Q

what are the caveats of antipsychotic use for psychotic sx in dementia?

A

3x increase risk of cardiovascular events

25
Q

what happens to driving with a dementia diagnosis?

A
  1. patient must inform dvla
  2. dvla ask for reeport about dementia level
  3. dvla decide if you can continue to drive. 3 outcomes:

a. might have your licence renewed annually
b. revoked
c. or reviewed - yearly or so

tell them to inform their insurance as well!
if they dont stop, you have a duty to protectt others - tell dvla

26
Q

what is mixed dementia?

A

mixture of alzheimers and

vascular dementia

27
Q

apart from obvious symptoms how can one differentiate between alzheimers and lewy body dementia ?

A

if cognitive sx comes first - alzheimers

if motor sx comes before cognitive - Lewy body

28
Q

what is the most common cognitive illness in odler adults?

A

depression

29
Q

how might the treatment of depression vary in older adults?

A

the following may be needed:

longer trials on the drugs

higher doses

dose titration: may need to slow at low dose and build up intake gradually

30
Q

how does alzheimers present?

A

Starts first with memory issues

Middle stages:
problems with thinking, reasoning, language or perception;
speech, oncentrating, planning or organising, orientation
speech- hard to follow a conversatoin, repeat themselves
mood; anxiety depression, aeily angered

Late stages:
everything gets worse
aggression

Live 8-10 years on avergae from onset of 1st sx

31
Q

Lewy body Dm: what are the core and supportive sx ?

A

Core clinical features include: recurrent visual hallucinations; cognitive fluctuations; REM sleep behaviour disorder; and one or more spontaeous cardinal features of parkinsonism: bradykinesia, rest tremor, or rigidity.

Supportive clinical features include sensitivity to antipsychotic agents, postural instability and falls, syncope, autonomic dysfunction, delusions and non-visual hallucinations, apathy, anxiety, and depression.

32
Q

distinguish Parkinsons from lewy body dm?

A

This is distinguished from
dementia with Lewy bodies (DLB) by the presence of
PD before cognitive impairment

33
Q

which dementia has a stepwise declien and what does this mean?

A

stepwise” progression of their symptoms, meaning that their symptoms stay the same for a while and then suddenly get worse - eg when they have a stroke of vascular event

34
Q

what are the 4 As of alzheimers?

A

aphasia - impaired production or comprehension of speech and the ability to read or write

amnesia

agnosia - cant recognise

apraxia - difficulty producing learned movements

35
Q

which dementia is personality preserved ?

which is it eroded

A

vascular

eroded - alzheimers

36
Q

Absence of physical signs is seen in which dementia ?

A

alzheimers

37
Q

hyperphosphorylated tau is seen in which dementias?

A

FTLD

Alzheimers - forms neurofibrillary tangles

38
Q

plaques in alzhiemers made from what?

A

B amyloid deposits

39
Q

what causes vascular dementia?

A

VD is due to infarcts caused by thrombo-embolus or

arteriosclerosis

40
Q

what is the aetiology of early AND late onset alzheimers?

A

Familial early-onset AD is usually due to
rare autosomal dominant gene mutations causing
increased β-amyloid:

• Amyloid precursor protein
- APP located on Chromosome 21 therefore extra APP, leading to increased expression of APP, therefore AD progresses in Tr21 by age 40 - downs syndrome

  • Presenilin-1
  • Presenilin-2

Late-onset: ApoE E4 (Apolipoprotein E)

41
Q

what are 4 processes in the pathology of Alzheimers disease?

A
  1. Brain atrophy - due to neuron loss. affects hippocampus, parietal and temporal lobes most.
  2. Neurofibrillary tangles - tau
  3. Plaque formation - b amyloid
  4. Cholinergic loss

A- Psych (24 decks)

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