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Y5 Psych > Old Age Psychiatry > Flashcards

Old Age Psychiatry Flashcards

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1
Q

What is dementia?

A

Aquired, chronic, progressive global cognitive impairment that interferes with activities of daily living.

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2
Q

What are causes of dementia?

A

Alzheimers (60%)
Vasculat (15%)
Lewy body Dementia (10%)

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3
Q

What are the two types of Alzheimers in terms of onset, and how do we classify them?

A

Late onset/sporadic (>65 yo): multiple gene involvement, including for protein APOE E4 (which cannot break down beta amyloid any more)

Familial / early onset: AD mutations

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4
Q

What are pathological features of AD?

A

Beta amyloid plaques
Neurofibrillary tangles (tau hyperphosphorylation)
Cortical atrophy

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5
Q

What fields does dementia present itself in?

A 
Memory 
Language 
Problems 
Personality changes 
Subcortical symptoms
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6
Q

How does dementia affect memory?

A

Anterograde amnesia (forgetfulness, hard to lay down new memories)

Retrograde amnesia (loss of old memories, starting with more recent ones)

Disorientation in TIME, then PLACE, then PERSON

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7
Q

How does dementia affect language?

A

Receptive dysphagia: difficulty understanding

Expressive dysphagia: difficulty producing speech

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8
Q

What are behavioural symptoms of dementia?

A 
restless, wandering
disturbed sleep, night/day reversal 
Shouting, screaming, swearing 
Inappropriate, sexually disinhibited behaviour
Aggression
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9
Q

What are psychological sx of dementia?

A

delusions
hallucinations
depression, anxiety

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10
Q

what are the 4 As of alzheimers?

A

Amnesia - recent memories lost first
Aphasia - inability to comprehend/formulate language
Apraxia - inability to perform everyday movements
Agnosia - inability to recognise objects

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11
Q

Describe aetiology of vascular dementia

A

Caused by small infarcts due to thromboemboli

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12
Q

what does CT for vascular dementia show

A

multiple small lucencies

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13
Q

what is the clinical presentation of vascular dementia

A

stepwise progression

symptoms dependent on site of infarcts

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14
Q

explain cause of lewy body dementia

A

deposition of lewy bodies in cyngulate nucelus and neocortex

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15
Q

what are lewy bodies made up of

A

alpha-synuclein and ubiquitin

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16
Q

what other disease also has lewy bodies, and where do they deposit

A

Parkinsons

they deposit in the brainstem

17
Q

what is the clincal presentation of lewy body dementia

A

fluctuating confusion/alertnesss
Vivid visual hallycinations
Spontaneous parkinsonian signs

18
Q

WHat must you NOT prescribe in lewy body dementia

A

do NOT prescribe haloperidol

19
Q

what are differentials for dementia?

A
  1. exclude ORGANIC causes of REVERSIBLE dementia:
    - Neuro: SOL, hydrocephalus, subdural haematoma
    - Endo: hypothyroid, hyperparathyroid, Addisons, Cushings
    - Vit deficiency: B12, folate, thiamine, niacin
  2. Pseudodementia
  3. Delirium
20
Q

what is pseudodementia

A

memory problems in severe depression

low mood BEFORE cognitive problems

21
Q

how can you investigate dementia

A

Physical exam, basic obs
Blood tests: FBC (infection/anaemia), U&E (dehydration, renal failure, hyponatraemia), glucose, TFT (hypothyroid) , LFT (alcohol), B12, folate, calcium levels, VDLR (neurosyphilis)

MMSE / MOCA / AMTS

Collateral history +

Septic screen

CT/MRI head is suspecting neuro cause.

22
Q

How do you manage dementia - SOCIAL

A

FOCUS ON SAFETY, QOL & PRESERVATION OF INDEPENDENCE

  1. Social:
    - patient adaptations
  • always carry ID, address, contact number
  • Dossett boxes for medication
  • change gas to electricity
  • Reality orientation (visible clocks and calendars)
  • Envirnoment modification (carpets)
  • Assistive technology e.g. door mat buzzer
  • Social support (personal care, meal prep, mediocation prompting). Consider day centre (enjoyable activities and social contact), day hospital (daily psychiatric care for more complex patients)
  • Support carers
  • Optimise physical health (treat auditory impairment, exclude superimposed delirium, treat underlying risk factors)
  • PROVIDE SINGLE NAMED COORDINATOR
23
Q

How do you manage dementia - PSYCH

A

Behavioural approach (identify and modify underlying triggers for difficulr and reisky behaviours)
Reminiscence therapy (validates sense of belonging)
Validation therapy (reassure and validate their emotion)
Multisensory therapy
Cognitive stimulation therapy

24
Q

How do you manage dementia - BIO

A

Start doses LOW and increase SLOWLY

acetylcholinesterase inhibitors e.g. donepezil, rivastigmine

25
Q

what is the MoA of acetylcholinesterase inhibitors

A

they increase acetylcholine supply by stopping acetylcholine breakdown

26
Q

explain function of. Acherase inhibitors on. dementia

A

symptomatic relief

but does not stop progression

27
Q

how do you manage severe alzheimers dementia

A

Memantine (NMDA Agonist)

28
Q

what happens if you give antipsychotic to someone with Lewy body dementia?

A

it WORSENS IT - also they are dangerous

Y5 Psych (17 decks)

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