Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry > Old age psychiatry and dementia > Flashcards

Old age psychiatry and dementia Flashcards

1
Q

At what age do you start under old age psychiatry?

A

> 65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What happens with aging in terms of cognitive, physical, and social changes?

A

Reduced abilities and accumulative wisdom
Reduced functioning/complex needs and positive adaptation
Loss and isolation and freedom from responsibility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why does older adult services exist?

A 
Differences in presentation
Differences in needs
Impact often deteriorating physical health
- Causation/differential diagnosis
- Management
- Risk factors
Impact of mental health condition
- Physical health
- Suicide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the impact of physical health?

A

Bidirectional relationship
- Physical illness is a risk factor
- Consequences of mental illness on physical health
Sensory impairments direct risk factors for MH problems
Considerations for treatment
- Increased body fat, decreased muscle, decreased relative body water
- Decreased renal blood flow and function
- Interactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How common is depression in older adults?

A

23% lifetime risk of developing over 75
Prevalence 3-15% higher in OA population - higher in care homes/hospital
Higher rates of suicide in OA
Approx 1/3 co-morbid with harmful drinking
Under-recognised and under-diagnosed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why is depression commonly under-recognised and under-diagnosed in OA?

A

Depression w/o sadness
Biological symptoms thought of as physical illness
Less likely to seek help
Vague presentations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is depressions relationship with physical health?

A

Bidirectional relationship

Higher physical morbidity and mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How might vascular depression present?

A 
Changes to cortical circulation
White matter hyperintensities on MRI
Cognitive impairment
Psychomotor retardation and apathy
Poor insight
Poor response to antidepressants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are reversible causes of depression?

A 
Drugs
- Beta blockers
- Opioids, antipsychotics, benzos
- Parkinson's medications
- Digoxin
Metabolic
- Anaemia, B12/folate
- Hypercalcaemia/hypothyroidism
- Hyper/hypokalaemia/natraemia
Infective
- Post viral 
- Neurosyphilis
Intracranial
- Post-stroke/subdural haematoma
- Parkinson's disease
- SOL
- Dementia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you treat depression in OA?

A

Same as for younger adults - SSRI/SNRI - often sertraline as cardiac safe and fewer interactions
Start low and go slow with antidepressants
Psychological therapies/social inclusion
ECT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the prognosis of depression in OA?

A 
Cerebrovascular changes are major risk factor
Good prognostic factors
- Onset < 70
- Absence of physical illness
- Good previous recovery
- Religious beliefs
2x increased risk of Alzheimer's
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the differentials for psychosis in OA?

A 
Dementia/depression
Secondary to hyperactive delirium?
Primary mental illness - often doesn't present in older adults apart from late onset
- Schizophrenia
- Late onset schizophrenia
- Delusional disorder
- Affective disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the psychotic elements of psychotic depression?

A 
Nilhilistic delusions
Hypochondriacal delusions
Delusions of poverty
Auditory hallucinations (2nd person derogatory)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you treat psychotic depression?

A

Anti-depressants +/- antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is late onset schizophrenia?

A 
AKA paraphrenia
Onset of symptoms > 60
F>M
Persecutory delusions
Negative symptoms and thought disorder uncommon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is delusional disorder?

A

Persistent delusions w/o hallucinations
Often more distressing to others than patient due to lack of insight
Patients often reluctant to seek help

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Charles Bonnet syndrome?

A 
Visual hallucinations
- Simple repeated patterns
- Complex images of people/landscapes/objects
Associated with visual impairments
No role for anti-psychotic treatment
Patient usually retains insight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do you manage psychosis in OA?

A

Base whether you give anti-psychotics on how much distress symptoms are causing due to S/E
Treat underlying cause - dementia/depresison/delirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is dementia?

A

Clinical syndrome of multiple causes defined by

  • An acquired loss of higher mental function affecting 2 or more cognitive domains including episodic memory, language function, frontal executive function, visuospatial function and apraxia
  • Sufficient severity to cause significant social or occupational impairment
  • Chronic and stable
  • Progressive
  • Acquired global impairment of intellect, memory, and personality without impairment of consciousness that is usually (but not always) progressive and usually irreversible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is mild cognitive impairment?

A

Intermediate state between normal cognition and dementia
Often mild memory impairment, greater than expected for age but not sufficient to class as dementia
Cognitive impairment without functional impairment
Similar aetiology to dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the prognosis for MCI?

A

1/3 improve
1/3 stay the same
1/3 progress to dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is pseudodementia?

A

Cognitive impairment secondary to mental illness - most commonly depression
Doesn’t know answers to questions
Impairments in executive functioning and attention
Frontal lobe changes identified
White matter hyperintensities on MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Name 3 types of degenerative dementia

A 
Alzheimer's
Dementia with lewy bodies
Frontotemporal dementia
Huntington's disease
Parkinson's disease
Prion disease eg CJD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Name 2 types of vascular cognitive impairment

A

Vascular dementia

Cerebral vasculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Name 2 types of metabolic cognitive impairment

A

Uraemia

Liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Name 2 types of toxic cognitive impairment

A

Alcohol related brain injury
Solvent misuse
Heavy metals

27
Q

Name 2 types of intracranial lesions causing cognitive impairment

A

Subdural haematoma
Tumours
Hydrocephalus

28
Q

Name 2 types of infections causing cognitive impairment

A

HIV
Neurosyphilis
Whipple’s disease
TB

29
Q

Name 2 types of endocrine conditions causing cognitive impairment

A

Hypothyroidism

Hypoparathyroidism

30
Q

Name 2 other conditions causing cognitive impairment

A

Vitamin B12 deficiency
Severe or repeated brain injury
Depression causing pseudodementia

31
Q

What questions should you ask about memory?

A

Repetitive?
Temporal gradient of amnesia? - preservation of more distant memories with amnesia of recent weeks
Difficulty learning to use new devices eg computer/mobile phone?

32
Q

What questions should you ask about functional ability?

A

Work performance or ability to do domestic tasks declined?
Responsibility for finances and administration shifted to spouse?
Get easily muddled?

33
Q

What questions should you ask about personality and frontal lobe function?

A

Personality altered?
More aggressive/apathetic/lacking initiative?
Disinhibition?
Change in food preference or religiosity?

34
Q

What should you ask about language?

A

Difficulty with work and/or finding or remembering names?

35
Q

What should you ask about visuospatial ability?

A

Get lost in familiar places?

Difficulty dressing?

36
Q

What should you ask about psychiatric features?

A

Any features of depression

37
Q

What other things should you ask about in a dementia history?

A 
Tempo of progression
FHx of dementia
Alcohol and drug use
Medication
Any other neurological problems eg parkinsonism, gait disorder, strokes
38
Q

What should you do in a dementia examination?

A 
MMSE
ACE
FAB
Primitive reflexes
Limb praxis and oro-buccal praxis
Neurological examination - papilloedema, parkinsonism, myoclonus, gait disorders
39
Q

What does asking about recent news assess?

A

Episodic memory

40
Q

What does clock drawing assess?

A

Visuospatial function

41
Q

What do naming and reading tasks assess?

A

Language function

42
Q

How do you test limb praxis?

A

Copying hand gestures and miming tasks

43
Q

How do you test oro-buccal praxis?

A

Show me how you blow out a candle

44
Q

What can increase your risk of dementia?

A 
Age > 65
Ethnicity - south Asian  African or afro-carribean
Stroke
Diabetes
Hypertension
High alcohol intake
CVD
Diet
Smoking
Lack of exercise
Low educational attainment
Obesity
FHx
Female
45
Q

How common is dementia?

A

Over 65, 6% prevalence
Over 85, 20% prevalence
Most common type Alzheimer’s
10 per 100,000 FTD prevalence before age of 65

46
Q

What could be a differential diagnosis of dementia?

A 
MCI
Delirium
Depression
Amnestic syndromes
Aphasia
47
Q

How does Alzheimer’s present?

A

Memory impairment - episodic memory, progressive loss of ability to learn, retain and process new information, temporal gradient with relative preservation of distant memory and amnesia for more recent events
Loss of working memory
Language impaired
Agnosia
Frontal executive function - organising, planning and sequencing impaired
Parietal presentation - visuospatial difficulties and orientation in space or navigation
Posterior cortical atrophy
Personality
Anosognosia - lack of insight
Tempo - insidious onset, gradual progression with eventual severe deficits
Late non-cognitive features - myoclonus, seizures, sleep-wake cycle reversal, incontinence, swallowing

48
Q

How does lewy body dementia present?

A

Early feature of visual hallucinations
Fluctuating cognition with variation in attention and alertness, sleep disorders
Dysautonomia
Parkinsonism
Memory loss absent in early stages
Delusions and transient loss of consciousness occur

49
Q

How does vascular dementia present?

A

Like AD
History of TIAs or succession of cerebrovascular events or stepwise course
Apraxia gait disorder
Pyramidal signs and urinary incontience
Widespread small-vessel disease seen on MRI

50
Q

How does frontotemporal dementia present?

A

Frontal
- Behavioural variant - personality change, emotional blunting, apathy, disinhibition, carelessness, behavioural change
Temporal
- Primary progressive aphasia

51
Q

What is the onset of Alzheimer’s like? Fluctuations? Hallucinations? Progressive? Personality changes? Insight?

A 
Gradual
No
Sometimes
Yes
Yes
Varies
52
Q

What is the onset of vascular dementia like? Fluctuations? Hallucinations? Progressive? Personality changes? Insight?

A 
Step-wise
Sometimes
Sometimes
Yes
Yes
Varies
53
Q

What is the onset of LBD/PDD like? Fluctuations? Hallucinations? Progressive? Personality changes? Insight?

A 
Gradual
Yes
Yes
Yes
Yes
Varies
54
Q

What is the pathology of Alzheimer’s?

A

MRI shows atrophy in mesial temporal love structures including hippocampi, progressive eventually to generalised cerebral atrophy
Beta-amyloid plaques in cortex
Structural and conformational changes in tau protein
Amyloid angiography

55
Q

What is the pathology of FTD?

A

25% cases familial associated with mutation in tau and progranulin genes
Disposition of abnormally aggregated proteins

56
Q

What investigations should you do for dementia?

A

Clinical syndrome so need to exclude differentials
Bloods - FBC, ESR, U&Es, glucose, liver biochemistry, serum calcium, TSH, HIV serology, B12 and folic acid
Imaging - CT/MRI and DaT/SPECT
Other - CSF, genetic studies, EEG, brain biopsy
Formal cognitive testing - ACE-III

57
Q

What is the management of dementia?

A 
Cognitive enhancing drugs
- Modest systematic benefit in AD
- Not disease modifying
Cholinesterase inhibitors
- Increase brain acetyl-cholinesterase by inhibiting CNS
Memantine
- NMDA receptor antagonist
Anti-depressants if depression symptoms
Lasting power of attorney
Inform DVLA
58
Q

Name an example of a cholinesterase inhibitor

A

Rivastigmine
Donepezil
Galantamine

59
Q

What are cholinesterase inhibitors used for?

A

Mild to moderate dementia in Alzheimer’s and Parkinson’s

60
Q

What are the S/E of cholinesterase inhibitors?

A 
Anxiety
Appetite decreased
Arrhythmia
Asthenia
Dehydration
Depression
Diarrhoea
Dizziness
Drowsiness
Fall
GI discomfort
Headache
Hyperhidrosis
Hypersalivation
Hypertension
Movement disorders
Nausea
Skin reactions
Syncope
Tremor
Urinary incontinence
UTI
Vomiting
Weight decreased
61
Q

What monitoring do you need to do with cholinesterase inhibitors?

A

Monitor body weight

62
Q

What is ACE-III?

A

Exam assessing 5 cognitive domains
Normal score 82/100
Change in score over time important
Normal score doesn’t exclude dementia

63
Q

What are the sub-scores in ACE-III?

A 
As important as overall score
Have different cut offs for dementia diagnosis
- Attention /18
- Memory /26
- Fluency /14
- Language /26
- Visuospatial /16

Psychiatry (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions