Old Age Psychiatry -Mentor &more 2 Flashcards
1
Q
What is the projected increase in the world’s population over 60 years from 2000 to 2050?
A
The proportion will double from about 11% to 22%.
2
Q
What is the expected increase in the absolute number of people aged 60 years and over between 2000 and 2050?
A
From 605 million to 2 billion.
3
Q
How many people in the UK are over 65 years old, and what is the projection for 2050?
A
10 million currently, projected to be 19 million by 2050.
4
Q
What percentage of the UK population is currently over 65 years old?
A
One sixth of the population.
5
Q
What is the average spending for retired households compared to non-retired households in the UK?
A
Nearly double.
6
Q
What are the domains in which older adults under mental health services present complex problems?
A
- Psychological
- Cognitive
- Functional
- Behavioural
- Physical
- Social
7
Q
What key standard did the National Service Framework for Older People (2001) establish?
A
Older people with mental health problems should have access to specialist services.
8
Q
What does the Everybody’s Business (2005) document clarify regarding older people’s needs?
A
It emphasizes the need for age-appropriate services.
9
Q
What is the significance of the No Health Without Mental Health (2011) document?
A
It outlines that services must be age-appropriate and non-discriminatory.
10
Q
What are the criteria for accessing Older People’s Mental Health Services as per the Royal College of Psychiatrists?
A
- People of any age with primary dementia
- People with mental disorder and physical illness or frailty
- People under 65 with psychological or social difficulties related to aging
11
Q
What percentage of carers for older people with mental health problems will suffer from depression?
A
30%.
12
Q
What can trigger movement from home into long-term care settings for older adults?
A
Inability of carers to continue providing support.
13
Q
List three key points from the JCPMH Guidance for commissioners of older people’s mental health services.
A
- Older people will form a larger proportion of the population
- Services must be commissioned based on need, not age
- Older people’s mental health services must address functional illnesses
14
Q
What is necessary for the assessment of older adults presenting with mental health problems?
A
- Cognitive assessment
- Assessment of functional abilities
- Assessment of physical health issues
- Understanding of imaging in dementia diagnosis
- Assessment of carer needs
- Assessment of capacity issues
15
Q
True or False: Depression in patients with Parkinson’s disease occurs in approximately two thirds of cases.
A
True.
16
Q
What are common cognitive deficits associated with Parkinson’s disease?
A
- Higher executive dysfunction
- Attention
- Memory
- Visuomotor processing
- Visual attention
17
Q
What is Normal Pressure Hydrocephalus (NPH) characterized by?
A
Dilatation of cerebral ventricles with normal CSF pressure, presenting with dementia, gait ataxia, and urinary incontinence.
18
Q
What is a common cause of young onset dementia (YOD)?
A
Alcohol related dementia.
19
Q
What are the common symptoms of Chronic Subdural Haematoma (SDH)?
A
- Headache
- Drowsiness
- Altered level of consciousness
- Confusion
20
Q
What is the most common inherited neurodegenerative illness associated with dementia?
A
Huntington’s Disease.
21
Q
What is the average worldwide prevalence of sporadic Creutzfeldt-Jakob Disease (CJD)?
A
Around 0.1 cases per 100,000.
22
Q
What is the characteristic clinical picture of sporadic CJD?
A
- Rapidly deteriorating dementia
- Myoclonus
- Cerebellar and extra pyramidal signs
23
Q
Fill in the blank: The definitive diagnosis of prion diseases is made by _______.
A
post-mortem microscopic examination.
24
Q
What is the treatment approach for dementia caused by Normal Pressure Hydrocephalus (NPH)?
A
Surgical placement of a ventriculo-peritoneal shunt.
25
What is the disease characterized by early anxiety and depressive symptoms, personality changes, and progressive dementia?
Variant Creutzfeldt-Jakob Disease (vCJD)
## Footnote
vCJD is associated with the consumption of contaminated beef from cattle with BSE.
26
What is the typical incubation period for vCJD after ingestion of contaminated meat?
Less than 20 years
27
What is the diagnostic 'pulvinar' sign associated with in vCJD?
Symmetric high-signal-intensity changes affecting the pulvinar and medial areas of the thalamus on FLAIR sequence MRI
28
Which protein is elevated in the cerebrospinal fluid (CSF) in cases of vCJD?
14-3-3 protein
29
What is the most common age range for the onset of Alzheimer’s disease?
Between ages 40 and 90, most often after age 65
30
What is the predicted risk of developing Alzheimer’s disease in first-degree relatives of probands with the disease?
15-19%
31
True or False: The risk of Alzheimer’s dementia doubles every 5 years after age 65.
True
32
What are the proven risk factors for Alzheimer’s disease?
* Age
* Down’s syndrome
* Apolipoprotein ε4 allele
33
What are the likely risk factors for developing Alzheimer’s disease?
* Female sex
* Head injury
* Postmenopausal estrogen decline
34
What is the protective factor proven to reduce the risk of Alzheimer’s disease?
Apolipoprotein ε2 allele
35
What is the role of the Presenilin 1 gene in Alzheimer’s disease?
It is associated with early onset Alzheimer's disease.
36
Which imaging technique can confirm the diagnosis of Alzheimer’s dementia?
Amyloid PET scanning
37
What is the average survival expectation for patients with dementia of the Alzheimer’s type?
8 years
38
What cognitive symptoms are characteristic of Alzheimer’s disease?
* Memory deficits
* Disorientation
* Language difficulties
* Apraxia
* Agnosia
39
What is the most commonly used cognitive test in old age psychiatry?
MMSE (Mini-Mental State Examination)
40
What are the common side effects of Donepezil?
* Nausea
* Vomiting
* Diarrhea
* Anorexia
41
Which drug is a non-competitive NMDA antagonist used in Alzheimer's treatment?
Memantine
42
What is the CSM's conclusion regarding the use of Olanzapine and Risperidone in dementia?
They increase the risk of stroke and should not be used.
43
What is the prevalence of psychosis in individuals with Alzheimer’s disease?
30 to 50%
44
What is the second most common cause of dementia after Alzheimer’s disease?
Vascular dementia
45
What criteria are required for the diagnosis of vascular dementia?
* Evidence of cerebrovascular disease
* Dementia occurring within 3 months of a stroke
* Abrupt deterioration in cognitive function
46
Fill in the blank: The beta amyloid precursor protein gene is located on chromosome ____.
21
47
What are common types of misidentifying delusions seen in Alzheimer’s disease?
* Capgras type
* Phantom boarder
* Mirror sign
* TV sign
* Magazine sign
48
What is the typical course duration of vCJD until death?
1-2 years
49
What is the second most common cause of dementia after Alzheimer’s disease?
Vascular dementia
## Footnote
Accounts for 20% of dementia cases.
50
What criteria does the NINCDS-AIREN use for diagnosing vascular dementia?
Requires evidence of cerebrovascular disease on examination and brain imaging and a relationship between the onset of dementia and cerebrovascular disease
## Footnote
This includes dementia occurring within 3 months of a stroke or abrupt deterioration.
51
What is the median number of neurological signs per patient in vascular dementia?
4.5 neurological signs
## Footnote
Reflex asymmetry is the most prevalent symptom.
52
List the three main subtypes of vascular dementia.
* Cognitive deficits following a single stroke
* Multi-infarct dementia
* Progressive small vessel disease (Binswanger’s disease)
53
What characterizes cognitive deficits following a single stroke?
Not all cases result in cognitive impairment; more often seen in midbrain and thalamic strokes
## Footnote
Cognitive deficits may remain fixed or recover.
54
What is the Hachinski Ischemic Score Index?
A scoring system to quantify the likelihood of vascular dementia
## Footnote
Scores < 4 unlikely, scores > 7 likely to be vascular dementia.
55
What are common risk factors for vascular dementia?
* Old age
* Hypertension
* Ischaemic heart disease
* Smoking
* Alcohol consumption
* Hyperlipidemia
* Atrial fibrillation
* Family history
* Valvular disease
* Atrial myxoma
* Carotid artery disease
* APOE4 allele
* Polycythemia
* Sickle cell anaemia
* Coagulopathies
56
What distinguishes Alzheimer’s disease from vascular dementia?
* Females more affected in Alzheimer’s
* Onset is insidious in Alzheimer’s
* Gradual progressive course in Alzheimer’s
* Focal neurological signs absent in Alzheimer’s
* Insight often lost in Alzheimer’s
57
What is CADASIL?
A form of vascular dementia transmitted as an Autosomal dominant trait
## Footnote
Associated with recurrent strokes and subcortical dementia.
58
What imaging techniques are used in vascular dementia?
* CT: Increased number of infarcts
* MRI: More numerous white matter lesions
* SPECT: Irregular perfusion deficits
* PET: Reduced cerebral blood flow and metabolism
* MRS: Absence of phospholipids changes
59
What are the core features required for a probable diagnosis of Lewy Body Dementia (LBD)?
Fluctuating cognition and two of the following: recurrent visual hallucinations, spontaneous motor features of parkinsonism
## Footnote
One core feature is necessary for a possible diagnosis.
60
What are the clinical features of Lewy Body Dementia?
* Progressive dementia with parkinsonism
* Fluctuation in attention
* Recurrent visual hallucinations
* Sensitivity to antipsychotics
61
What is the mean survival rate of cognitive decline in Lewy Body Dementia?
Similar to Alzheimer’s disease
## Footnote
Sudden deterioration can occur over 1-2 years.
62
What is the treatment for Lewy Body Dementia?
Cholinesterase inhibitors may improve cognition, delusions, and hallucinations
## Footnote
Not currently licensed in the UK for LBD treatment.
63
What characterizes dementia in Parkinson’s disease?
Degeneration of subcortical structures, primarily the substantia nigra
## Footnote
Cognitive symptoms are more likely in late onset disease.
64
What is the difference between Lewy Body Dementia and Parkinson’s Disease Dementia?
LBD if both motor and cognitive symptoms develop within 12 months; PDD if parkinsonian symptoms exist for more than 12 months before dementia
65
What is Frontotemporal Dementia (FTD)?
A term encompassing several forms of dementia affecting younger populations, characterized by changes in personality and behavior
## Footnote
Age of onset ranges from 40 to 75.
66
What are the early clinical features of Frontotemporal Dementia?
* Prominent changes in personality
* Disinhibition
* Apathy
* Mutism
* Repetitive behaviors
67
What is Pick's disease?
A behavioral or frontal variant of Frontotemporal Dementia
## Footnote
Characterized by emotional blunting and social disinhibition.
68
What are the pathognomic features of Pick's disease?
Pick’s cells appear swollen and stain pink on H and E stains.
69
What are early symptoms of Pick's disease?
Personality change and social disinhibition preceding memory or other cognitive impairment
## Footnote
These symptoms can manifest before more significant cognitive decline occurs.
70
What is the typical age of onset for Pick's disease?
Between 45-65 years
## Footnote
This age range indicates that it commonly affects middle-aged individuals.
71
Which gender is more affected by Pick's disease?
Men
## Footnote
Epidemiological studies show a higher prevalence in males compared to females.
72
What is the average duration of illness for Pick's disease?
8 years
## Footnote
This duration can vary among individuals.
73
What percentage of cases have a positive family history in Pick's disease?
50%
## Footnote
This suggests a potential genetic component to the disorder.
74
What mutation causes Pick's disease?
Autosomal dominant mutation in the Tau gene (chromosome 17q 21-22)
## Footnote
This genetic mutation has complete penetration, meaning all individuals with the mutation will develop the disease.
75
What are Pick's cells?
Pathognomic cells in Pick's disease that appear swollen and stain pink on H and E stains
## Footnote
Their presence is a key diagnostic feature of the disease.
76
What additional findings may be present in the brain of a person with Pick's disease?
Demyelination and Fibrous gliosis of the frontal lobe white matter
## Footnote
Senile plaques and Neurofibrillary tangles are absent in Pick's disease.
77
What does a CT/MRI scan typically show in Pick's disease?
Mild generalised atrophy but marked atrophy of frontal and temporal lobes with sparing of the posterior third of the superior temporal gyrus called ‘Knife blade atrophy’
## Footnote
This specific pattern of atrophy is characteristic of Pick's disease.
78
What is primary progressive aphasia?
A condition where patients have a progressive decline in language with relative sparing of other cognitive deficits
## Footnote
Patients may become mute in the later stages.
79
What is typically observed in MRI scans of patients with primary progressive aphasia?
Predominant atrophy of the perisylvian region
## Footnote
This atrophy affects areas crucial for language processing.
80
How does speech in semantic dementia differ from primary progressive aphasia?
Speech is fluent in semantic dementia
## Footnote
Patients experience various language difficulties while other cognitive domains remain preserved.
81
What cognitive difficulties do patients with semantic dementia experience?
Impaired understanding of word meaning, naming difficulties, and use of substitute words
## Footnote
These language issues are notable even though other cognitive functions may remain intact.
82
What does an MRI show in patients with semantic dementia?
Disproportionate asymmetric atrophy of the temporal lobe, particularly the left more than the right
## Footnote
The anterior temporal lobe atrophy is more pronounced than the posterior temporal lobe.
