old age psychiatry

Question 1

age

Answer 1

> 65

some under 65 if confirmed dementia

Question 2

ABCD of dementia

Answer 2

A: activities of daily living (ADLs)
B: behavioural + psychiatric symptoms of dementia
C: cognitive impairment
D: decline

Question 3

cognitive features of dementia

Answer 3

dysmnesia

+ 1+ of:

• dysphasia (communication): expressive, receptive
• dyspraxia - inability to carry out motor skills
• dysgonia - not recognising objects
• dysexecutive functioning (initiation, inhibition, set-shifting, abstraction)

Question 4

expressive dysphasia

Answer 4

word finding difficulty

struggle to get through sentences

Question 5

receptive dysphasia

Answer 5

struggle to understand language

Question 6

dementia: functional impairment

Answer 6

ask about daily routine; 
driving 
using phone 
toileting/showering
cooking
housework/cleaning 
taking medication 
manage finances

Question 7

fitness to drive

Answer 7

dementia or organic brain syndrome

• notify DVLA at diagnosis
• if early dementia license may be yearly
• those with poor short term memory, disorientation or lack insight should almost certainly not drive

Question 8

dementia imaging

Answer 8

consider most approp for pt, do they need imaging?

CT
CT/SPECT
DAT scan

Question 9

cognitive tests can do in clinic

Answer 9

mini-mental state examination (MMSE)

montreal cognitive assessment (MOCA)

Question 10

causes/types of dementia

Answer 10

alzeimer's
vascular dementia
mixed demtia
lewy body dementia
alcohol related brain damage
parkinson's, Huntington's, HIV

Question 11

reversible causes of dementia: physical things to screen for

Answer 11

delirium 
normal pressure hydrocephalus 
subdural haemorrhage
tumours 
VitB12 deficiency 
hypothyroidism 
hypercalcaemia 
alcohol misuse
neurosyphilis 
drugs

Question 12

course of dementia

Answer 12

initially present with symptoms then diganosis
as progress likely to lose independence and need support (fam, care setting)
then behavioural problems and then thinking about nursing home
life limiting and palliative disease - will die of it

Question 13

general alzheimer’s presentation

Answer 13

early impairment of memory and executive function

gradual onset with often unclear onset

Question 14

pathological features of alzeiher’s i.e. what would u find on autopsy

Answer 14

amyloid plaques and tau tangles
atrophy of brain following neuron death
reduction in acetylcholine in brain

Question 15

risk factors alziehmer’s

Answer 15

inc age
family history
down syndrome
vascular risk factors

Question 16

vascular dementia features

Answer 16

unequal distribution of deficits
focal impairments on neuro exam
PMHx cerebrovascular disease

step wise decline with sudden changes

small vessel disease can give gradual decline

Question 17

key features of lewy body dementia

Answer 17

visual hallucinations
fluctuations - lucid, confused then back again
parkinsonism
REM sleep disorder
falls
sensitive to anti-psychotics

Question 18

what type of scan is usually done when Lewy body dementia suspected

Answer 18

DAT scan

Question 19

frontotemporal dementia key features

Answer 19

behavioural - personality change
early onset
early emotional blunting
speech disoder: altered output, preservation, echolalia

Question 20

frontotemporal dementia neuropsychology

Answer 20

frontal dysexecutive syndrome

memory, praxis and visuospatial function not severely impaired

Question 21

frontotemporal dementia neuroimaging

Answer 21

abnormalities in frontotemporal lobes

Question 22

behavioural and psychological symptoms in dementia

Answer 22

agitation - restlessness, wandering
psychosis - delusions, hallucinations
affective - depression, anxiety, hypomania, apathy
disinhibition - aggression, sexual
behaviour - eating, toileting, dressing, sleep-wake cycle

Question 23

drug treatments of dementia

Answer 23

acetylcholinesterase inhibitors (mild-moderate AD + lewy body)

memantine (mod-severe AD)

antipsychotics
antidepressants
anxiolytics
hypnotics
anticonvulsants

Question 24

acetylecholinesterase inhibitors

Answer 24

increase amount of acetylcholine in the brain

slowing down progression of functional + cognitive impairment

Question 25

acetylecholinesterase inhibitors: side effetcs

Answer 25

``` nausea, vomot, diarrhoea fatigue, insomnia muscle cramps headache dizziness syncope breathing probs ```

Question 26

dementia mangement" non-pharmalogical

Answer 26

other causes of distress ABC approach communication any form of distraction

Question 27

capacity

Answer 27

ability to understand info relevant to a decision or action | and to appreciate the reasonably foreseeable consequences of not taking action or decision

Question 28

5 points to consider when it comes to capacity

Answer 28

1. does pt understand info? 2. does pt retain the info long enough to make decision? 3. can pt communicate decision? 4. can pt weigh up the info in order to make decision? 5. does pt believe the info they are given?

Question 29

key points when assessing capacity (8 of them)

Answer 29

1. patient deemed to have capacity unless proven otherwise 2. patient should be supported to make decision 3. person cannot be deemed to incapable if decision is eccentric or unwise 4. anything done for pt must be done in best interest 5. use least restrictive option 6. capacity should be assessed on topic of question 7. pt should be assessed at their 'peak time' 8. speak to fam to get historic veiws

Question 30

6Cs of capacity

Answer 30

``` capacity consent compliance coercion certification common sense ```

Question 31

functional illness in >65

Answer 31

basically anything that isn't dementia ``` depressive symptoms/illness anxiety disorders mania and BAD schizophrenia alcohol problems ``` (delirium)

Question 32

presentation of depression in older population

Answer 32

less likely to present with depressed mood, suicidal wishes etc more likely: insomnia, hypochondriasis, agitation, completed suicide

Question 33

psychosocial factors that may contribute to old age depression

Answer 33

loss; health, wealth (shit pension), spouse, work, home (e.g. moving to nursing home)

Question 34

treatment of depression in older people

Answer 34

1. antidepressants e.g. sertraline 2. CBT 3. ECT in severe cases most community cases not treated

Question 35

late onset schizophrenia like psychosis: features

Answer 35

spectrum from circumscribed persecutory delusions to full schizophrenia-like psychosis

Question 36

late onset schizophrenia like psychosis: aetiology

Answer 36

sensory loss social isolation genetic? minor abnormalities

Question 37

late onset schizophrenia like psychosis: management

Answer 37

often need compulsory admission neuroleptics increasing social contact