Old Age Psychiatry Flashcards
What is dementia? Main types?
A blanket term for progressive conditions of brain deterioration
- Alzheimer’s
- Vascular
- Frontal lobe
- Lewy body
What are the criteria for diagnosis with dementia?
6 + months of cognitive decline, usually progressive in nature
Dysmnesia + one more minor symptom
What investigations may be done for dementia?
Often not routinely done, diagnosis often made based on history
- Cognitive testing with focus on diff lobes
- Physical examination and bloods
- Brain imaging (CT - amyloid plaques etc.)
What symptoms may lead to a diagnosis of dementia?
Dysmnesia + 1 of the following:
- Dysphasia
- Dyspraxia
- Dysgnosia
- Dysexecutive functioning
How do MMSE scores affect the treatment needed for dementia patients?
More wholistic treatment needed for patients with a lower MMSE score as lower score correlates with reduced ability to perform tasks of daily living
Once a diagnosis of dementia is suspected and the patient is referred from primary care to secondary what tests are done?
Brain scans:
- CT / (CT SPECT)
- DAT Scan
- MRI
Not always done, especially if symptoms and history show a strong chance of dementia
How common are each of the types of dementia, relatively?
Alzheimer’s dementia – 62%
Vascular dementia – 17%
Mixed Dementia – 10%
Lewy body dementia – 4%
What are some of the reversible causes of dementia?
Delirium Normal pressure hydrocephalus Subdural haemorrhage Tumours Vitamin B12 deficiency Hypothyroidism Hypercalcaemia Alcohol misuse Neurosyphilis Drugs
What are the common steps in the course of dementia for most patients?
- Symptoms
- Diagnosis
- Loss of functional independence
- Behavioural problems
- Nursing home placement
- Death
What causes Alzheimer’s disease? What can be seen on scans?
Hypoxia, hypoperfusion and inflammation cause amyloid plaques, atrophy and a reduction in acetylcholine
Can see reduction in brain volume, amyloid plaques
Most prominent symptoms of Alzheimer’s?
Early impairment of memory and executive function
How does vascular dementia tend to present?
Unequal distribution of neurological deficits
Defecits come on in a stepwise manner
Due to vascular injury causing infarcts in separate lobes, not global injury each time
What are the key features of lewy body dementia?
Visual hallucinations
Fluctuations of consciousness / functioning
Parkinsonism
REM sleep disorder
Increased falls
What is a useful test for the diagnosis of lewy body dementia? What drugs should be avoided in Lewy body dementia?
DAT scan - shows reduced dopamine uptake
Antipsychotics - work by reducing dopamine transmission which is highly contraindicated in LBD due to the already reduced dopamine uptake
How does frontotemporal dementia (FTD) tend to present?
Behavioural disorder - personality change
Early onset and early emotional blunting
Speech disorder
In later stage disease: parkinsonism, motor neuron disease, incontinence, hyporeflexia
