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y4 psychiatry > Old Age Psychiatry > Flashcards

Old Age Psychiatry Flashcards

1
Q

What are the 5 key factors that affect the mental health and wellbeing of older people?

A
  • Participation in meaningful activities
  • Relationships
  • Poverty
  • Physical health
  • Discrimination
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2
Q

What percentage of over-65’s have dementia?

A

22% of males

28% of females

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3
Q

What differentials should you consider when older people present in psychiatry?

A

Mnemonic: DEMENTIA

Drugs, delirium
Emotions/depression
Metabolic disorders
Eye and ear impairment
Nutritional disorders
Tumours, toxins, trauma
Infections
Alcohol, arteriosclerosis
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4
Q

True or false: Usually symptoms must have been ongoing for at least 6 months for a diagnosis of dementia.

A

True

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5
Q

What is the general clinical presentation for a patient with Alzheimer’s Dementia?

A

Gradual onset over a long time

Memory impairment is the core feature

Usually first noticed by close family, later by the individual

Impact on ADL’s (inc. shopping and finances)

Investigations normal except head CT: enlarged ventricles and decreased brain volume.

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6
Q

What pathological findings are found in Alzheimer’s Disease?

A
  1. Cerebral atrophy (medial temporal lobe atrophy)
  2. Senile plaques
  3. Amyloid deposition
  4. Neurofibrillary tangles
  5. Reduced acetylcholine levels
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7
Q

What are the most common biopsychosocial management options for Alzheimer’s Dementia?

A

Bio

  • Treat reversible causes
  • Acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine)
  • NMDA receptor antagonist (memantine)

Psycho

  • Emotional support
  • Cognitive rehab, stimulation, training
  • Treatment for comorbid illness (e.g. CBT for anxiety)

Social

  • Carer support
  • Occupational therapy
  • Social care
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8
Q

True or false: Antipsychotics can be helpful in managing the behavioural and psychological symptoms of dementia (BPSD)?

A

False

Antipsychotics are not licensed for the treatment of agitation (except risperidone) and their use leads to greater side effects in older people:

  • Stroke risk
  • CV risk
  • Parkinsonian side effects
  • Falls
  • Increases mortality
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9
Q

What are the treatable causes of dementia symptoms?

A

Think: PINCH ME

Pain

INfection

Constipation

Hydration

Medication

Environmental

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10
Q

Typical history of Vascular Dementia?

A

History of stroke/TIA

Increasing memory impairment, especially after CVA (stepwise decline)

Smoking, hypertension, diabetes

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11
Q

What are the biological treatments for Vascular Dementia?

A

Treat reversible causes

Consider anticoagulants

Modify risk factors

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12
Q

What changes occur in frontotemporal dementia?

A
  • Personality, behaviour, interpersonal and executive skills
  • Language skills (aphasia)
  • Loss of semantic memory (ability to recall meaning)
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13
Q

What investigation confirms a diagnosis of FTD?

A

MRI head: frontotemporal atrophy seen on scans

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14
Q

True or false: You should NOT use acetylcholinesterase inhibitors to manage FTD.

A

True

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15
Q

How should you manage FTD?

A

Treat symptoms

SSRI’s may be effective

Psychosocial interventions

DO NOT use AChEi’s!

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16
Q

What are the core features of Lewy-body dementia?

A

Fluctuating cognition (attention and alertness)

Spontaneous Parkinsonian motor symptoms

Visual hallucinations

Other symptoms:
Sleep disorder, neuroleptic sensitivity, depression, falls/syncope/loss of consciousness

17
Q

Which drug is generally recommended for treating Lewy-body Dementia?

A

Rivastigmine (AchEi)

18
Q

True or false: AMTS is an example of a diagnostic cognitive assessment

A

False

AMTS is a cognitive screening test, not diagnostic.

An example of a diagnostic tool is ACE-III

19
Q

Perform an AMTS

A
  1. How old are you? (exact age = 1pt)
  2. What is your date of birth? (date + month = 1pt)
  3. What is the year now? (exact year = 1pt)
  4. What is the current time of day? (within 1hr of correct time = 1 pt)
  5. Where are we? What is this building? (exact place name = 1pt)
  6. Who is the current monarch? (1pt)
  7. What was the date of the 1st World War? (start/end year = 1pt)
  8. Can you count backwards from 20 to 1? (no mistakes/corrected spontaneously = 1pt)
  9. Can you tell me what those 2 people do for a living? (1pt for recognising 2 identifiable members of staff)
  10. Can you remember the address I gave you? (exact recall = 1pt)

Score 6 or less suggest cognitive impairment.

20
Q

You ask a patient to complete a test that involves drawing a cube and naming animals. Which assessment are you using?

A

MoCA to assess cognitive function.

21
Q

What is considered a ‘normal’ score in the MoCA test?

A

Above 25.

y4 psychiatry (9 decks)

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