Older Adults Flashcards
What’s the most common side-effect of donepezil?
Nausea
What’s the action of Donepezil?
specific and reversible inhibitor of AChE
What’s the action of Galantamine?
- selective, competitive and reversible inhibitor of AChE
- enhances the effect of acetylcholine on nicotinic receptors
What’s the action of Rivastigmine?
- AChE inhibitor
- butyrylcholinesterase inhibitor
What’s the action of Memantine?
NMDA receptor antagonist (blocks the effects of pathologically elevated levels of glutamate that may lead to neuronal dysfunction)
What is the NICE recommendation for managing mild to moderate Alzheimer’s?
The three acetylcholinesterase (AChE) inhibitors donepezil, galantamine and rivastigmine
What is the NICE recommendation for using Memantine in Alzheimer’s?
- intolerance of or contraindication to AChE inhibitors
- severe Alzheimer’s
What are the scores on the MMSE for the different categories of Alzheimer’s?
Mild = MMSE 21-26 Moderate = MMSE 10-20 Severe = MMSE 0-10
Which test would uncover test would uncover a constructional apraxia?
Clock drawing test
Which characterises constructional apraxia?
the inability to copy drawings or to manipulate objects to form patterns or designs.
Which functions are examines in a clock drawing test?
- Visuospatial ability
- Motor function
- Attention
- Comprehension
- constructional apraxia
What is Ropinirole?
A dopamine agonist used in the treatment of Parkinson’s
What are the side effects of Ropinirole?
pathological gambling and hypersexuality
What is the strongest risk factor for dementia?
Age
What % of dementia does Alzheimer’s account for?
60-70%
What % of Alzheimer’s does vascular dementia account for?
15-20%
What are the risk factors for the development of Alzheimer’s disease?
- Age
- Family history
- Down syndrome
- apolipoprotein E4 allele
- Head trauma - especially if associated with loss of consciousness
- Hypertension
- Heart disease
- Diabetes
- CVA
- High cholesterol
- Lower educational level
- Female gender
On neurological examination in Parkinson’s which clinical findings are found?
- rigidity (usually one sided)
- bradykinesia (slowing of movement)
- resting pill rolling tremor
- Mask-like Face
- shuffling gait
Where is the principle abnormality in Parkinson’s?
degeneration of dopaminergic neurons in the pars compacta of the substantia nigra
What is the chemical deposited in abnormal dopaminergic neurons in Parkinson’s?
alpha synuclein
they are referred to as Lewy bodies
What’s the frequency of tremor in Parkinson’s?
5Hz
What’s the most useful scan when trying to diagnose Lewy body dementia?
DaT-SCAN (SPECT)
What is a finding on DaT-SCAN (SPECT) in people with Alzheimer’s?
temporal and parietal hypoperfusion
What’s the difference between Alzheimer’s disease and Lewy body dementia on DaT-SCAN (SPECT)?
- DLB shows lower perfusion in occipital cortex
- AD shows lower perfusion in medial temporal areas (
What is Early-onset dementia?
Occurs before 65 years of age
What % of all people with dementia in the UK is early onset?
~2%
What is the second most common diagnosis found in early onset dementia?
Vascular dementia
What is the most common diagnosis found in early onset dementia?
Alzheimer’s
What proportion of early onset dementia does Alzheimer’s account for?
1/3
What are the characteristics of cortical dementia?
(These are higher level dementias)
- Impaired memory
- Impaired visuospatial ability
- Impaired executive function
- Impaired language
What are the characteristics of subcortical dementia?
(These are lower levels e.g. basal ganglia)
- Generalised slowing of mental processes
- Personality change
- Mood disorders
- Presence of abnormal movements
What are some examples of cortical dementias?
- Alzheimer’s disease
- Pick’s disease (fronto temporal dementia)
- Creutzfeldt-Jakob disease
What are some examples of subcortical dementias?
- Binswanger’s disease
- Dementia associated Huntington’s disease
- Dementia associated AIDS
- Dementia associated with Parkinson’s disease
- Dementia associated with Wilson’s disease
- Dementia associated with progressive supranuclear palsy
Which findings on a PET scan would be most indicative of Alzheimer’s dementia?
temporoparietal glucose hypometabolism
What condition commonly presents with ataxia, dementia, and urinary incontinence?
Normal pressure hydrocephalus
What would a score of 7 or more on the Hachinski Ischaemic Score support?
Vascular Dementia
What presents as cognitive impairment accompanied by falls, tremor, hallucinations, and sensitivity to neuroleptics?
Lewy body dementia
Which scan recommended to help differentiate Alzheimer’s disease, vascular dementia and frontotemporal dementia?
- HMPAO SPECT
- FDG PET is the second choice
What are routine tests for people with Alzheimer’s?
- bloods - FBC, U&Es, calcium, glucose, LFTs, TFTS, vitamin B 12 and folate levels
- Structural imaging should be used in the assessment of people with suspected dementia to exclude other cerebral pathologies and to help establish the subtype diagnosis using MRI but imaging not always required
What is the half-life of donepezil?
70 hours
Waht is apomorphine?
A dopamine agonist used in the treatment of Parkinson’s
What are the common features of frontotemporal lobar dementias?
- Onset before 65
- Insidious onset
- Relatively preserved memory and visuospatial skills
- Personality change and social conduct problems
Which protein makes up the Pick bodies seen in frontotemporal dementia?
Tau
What’s the relative risk to a person of getting Alzheimer’s disease if they have a first degree relative who was diagnosed before age 85 years?
3-4x
Which scale is used to screen for depression in patients with dementia?
Cornell
From the age of 60 the risk of developing Alzheimer’s is estimated to do what?
Double every 5 years
What is the risk of developing Alzheimer’s aged 60?
1%
According to data from the EURODEM study, what is the average disease duration (from onset to death) of patients with dementia?
4 years
What % of people with dementia are thought to live in private households?
60%
What is the estimated total population prevalence of dementia among the entire UK population?
1.3%
Which antipsychotic has been proven to increase the risk of stroke in elderly patients with dementia?
Olanzapine
What does Maudsley recommend for behavioural and psychological (BPSD) symptoms in dementia (e.g. psychosis and agitation)?
Rsiperidone
Short term use - 6 weeks
*Memantine is as effective as Risperidone at alleviating difficulties relating to behavioural disturbances, but if Memantine has been trialled and not been effective, it is reasonable to trial Risperidone, taking into account potential adverse effects and associated risk factors.
Do AChE inhibitors reduce the frequency of incident dementia when used in MCI?
No
What are the features of pseudo dementia?
- sudden onset
- lack of motivation and unwilling to answer questions
- intact arithmetic skills
- intact paired associate learning
- memory deficits usually reported by patients NOT others
- attention and concentration preserved
- nocturnal accenttuation of dysfunction
Which scan is useful for diagnosing vascular dementia?
HMPAO
What are some tests of executive function in dementia or mild cognitive impairment?
Trail Making Test, Verbal Fluency Test, Clock Drawing Test (CDT), Digits Forward and Backward subtests (WAIS), Stroop Test and Wisconsin Card Sorting Test (WCST).
The rate of progression to Alzheimer’s dementia in amnestic MCI?
10-15% per year.
Most common medication for treating dementia with lewy bodies and psychosis?
Rivastigmine
Most common behavioural symptom in Alzheimer’s is?
Depression
Risk of developing Alzheimer’s if first degree relative has it?
15-19% Vs 5% in general population
3x risk
The best method to prevent MCI progression to dementia?
Cognitively active lifestyle and brain training
SPECT finding in older depressed patients?
Reduced cerebral blood flow sparing parietal cortex
MRI findings in older depressed patients
Cerebral atrophy
Ventricular enlargement
Periventricular white matter
MRI findings in Alzheimer’s
Reduced grey matter hippocampus amygdala and temporal lobe volumes
Drug choice in mild to moderate dementia associated with Parkinsons disease
Rivastigmine
Binge eating is seen in what proportion of patients with Alzheimer’s?
10%
% of patients with vCJD that present with cerebellar ataxia rather than cognitive impairment?
10%
Prevalence of Alzheimer’s in >95?
40-45%
> 70 rate of progression from MCI to dementia in 1 year?
10-15% *SPMM 9.6%
1-2% in normal >65 no MCI
Mode of inheritance of Picks disease (FTD)?
Autosomal dominant (mutation in Tau gene on Chromosome 17)
Macroscopic brain changes in patients with Alzheimer’s
Flattened cortical sulci and enlarged cerebral ventricles
Which dementia is carbohydrate craving commonly seen?
FTD
Relative sparing of medial temporal lobes on MRI seen in dementia suggests which diagnosis?
Lewy body dementia
Which drug is the most effective drug for treating psychosis associated with Parkinson’s?
Clozapine
Which subtype of Niemann-Pick disease present in the first few weeks of life and is characterised by adbominal swelling, a cherry red spot, feeding difficulties, and a progressive loss of early motor skills?
Type A
Lack of sphingomyelinase
Symptoms of Niemann-Pick Type C
Usually affects school-aged children, but may occur any time between early infancy to adulthood
Enlarged liver and spleen
Learning difficulties and intellectual decline
Seizures
Slurred, irregular speech
Dystonia and cataplexy
Ataxia and tremor
Vertical supranuclear gaze palsy
Causes of B12 deficiency
Vegan diet
HIV
Crohn’s
Lansoprazole
Symptoms of B12 deficiency
General:
Weakness, Fatigue, Anorexia, Failure to thrive, Irritability
Neuropsych:
Developmental delay/regression, paresthesias, Seizures, ataxia, dementia, abnormal movements, Depression
Haematologic:
Macrocytosis, Anaemia, hypersegmentation of neutrophils, Leukopenia, thrombocytopenia, pancytopenia
Others:
Glossitis, Skin hyperpigmentation, vomiting/diarrhea, icterus
Most common causes of early onset dementia
Alzheimer’s 31%
Other 25%
Vascular dementia 15%
FTD 13%
Most common causes of late onset dementia
Alzheimer's 62% Vascular dementia 17% Mixed Alzheimer's and vascular 10% Dementia with lewy bodies 4% FTD 2%
Early-onset refers to dementias that occur before what age?
65 years
Accounts for 2% of all dementia
% Huntington’s that present with Psychiatric symptoms?
30%
Prevalence of psychotic depression in elderly community
1.4-3%
The prevalence is estimated at around 0.4% of community adult samples
14.7-18.5% of depressed patients
Maudsley guidelines for treatment of psychotic depression
Tricyclics are probably first-line
SSRI/SNRI are second-line
Augmentation of antidepressant with olanzapine or quetiapine is recommended
The optimum dose and duration of antipsychotic augmentation are unknown. If one treatment is to be stopped during the maintenance phase then this should be the antipsychotic
ECT should be considered where a rapid response is required or where other treatments have failed
Which enzymes are donepezil metabolised by?
Donepezil is metabolised by CYP2D6, and CYP3A4
What’s the mechanism of action of donepezil?
specific and reversible inhibitor of AChE
What’s the mechanism of action of rivastigmine?
an AChE and butyrylcholinesterase inhibitor
What’s the mechanism of action of galantamine?
selective, competitive and reversible inhibitor of AChE, also enhances the effect of acetylcholine on nicotinic receptor
MMSE categories for Alzheimer’s severity
Mild = MMSE 21-26
Moderate = MMSE 10-20
Severe = MMSE 0-10
NICE guidelines for pharmacological management of Alzheimer’s
donepezil, galantamine and rivastigmine are recommended as options for managing mild to moderate Alzheimer’s disease
Memantine is recommended as an option for managing Alzheimer’s disease for people with moderate Alzheimer’s disease who are intolerant of or have a contraindication to AChE inhibitors or for severe Alzheimer’s disease
What is constructional apraxia?
Constructional apraxia is characterized by the inability to copy drawings or to manipulate objects to form patterns or designs.
Which functions does a clock drawing test examine?
Visuospatial ability
Motor function
Attention
Comprehension
Features of lewy body dementias
Fluctuating cognitive impairment
Hallucinations
Neuroleptic sensitivity (sensitivity to the side effects of antipsychotics such as sedation and EPSE’s)
Falls
Rigidity, stiffness and movement difficulties
Features of FTD
Gradual onset
Frontal lobe symptoms such as disinhibition, decline in personal hygiene, and personality change
Speech and language dysfunction including poverty of speech and echolalia
Focal gyral atrophy with a knife-blade appearance is characteristic of Pick’s disease
Carbohydrate craving
Features of Progressive supranuclear palsy
Shares many features of Parkinson’s disease apart from tremor
Presents with loss of balance and falls
Those affected have problems with voluntary eye movements but normal reflex eye movements
Supranuclear, primarily vertical gaze dysfunction
Extrapyramidal symptoms
Cognitive dysfunction
What is The Clifton Assessment Procedure for the Elderly (CAPE)?
is a tool used to assess quality of life, cognitive deficits, and physical dependency levels in the elderly to indicate areas of unmet need.
can be used both in hospital and community settings and takes 15-25 minutes to complete. It consists of the following scales:
The cognitive assessment scale
This tests orientation, basic cognition such as reading and counting, and psychomotor performance.
The behaviour rating scale
This assesses physical dependency and behavioral problems.
It can be used to differentiate between organic brain disease and functional psychiatric disorders. Scores can also be used to predict the likelihood of hospital discharge. It is often used to assist in the identification of the most appropriate placement
NICE guidelines suggest which investigations in people with dementia?
routine haematology
biochemistry tests (including electrolytes, calcium, glucose, and renal and liver function)
thyroid function tests
serum vitamin B 12 and folate levels
Structural imaging should be used in the assessment of people with suspected dementia to exclude other cerebral pathologies and to help establish the subtype diagnosis. MRI is the preferred modality to assist with early diagnosis and detect subcortical vascular changes
Which test can be used to help establish the diagnosis in those with suspected dementia with Lewy bodies (DLB) ?
Dopaminergic iodine-123-radiolabelled 2-carbomethoxy-3-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (FP-CIT) SPECT
Proportions of mild moderate severe dementia in late onset
Among those with late onset dementia, approximately 55% have mild dementia, 30% have moderate dementia and 15% have severe dementia.
Suicide rate in men aged 75 and over
10 per 100 000
PD greatest association with suicide in elderly?
Obsessive compulsive
Complex visual hallucinations occurring in clear consciousness which is associated with visual impairment is most indicative of?
Charles Bonnet syndrome
Risk factors for Charles Bonnet Syndrome
Advanced age
Peripheral visual impairment
Social isolation
Sensory deprivation
Early cognitive impairment
half-life of donepezil
70 hours
The most common opthalmological conditions associated with Charles Bonnet Syndrome
age-related macular degeneration, followed by glaucoma and cataract.
What is the meaning of testamentary capacity?
Ability to execute a will
estimate for the prevalence of Charles Bonnet syndrome in visually impaired people?
10-30%
Which of could be an artefact for low calcium?
Low albumin
What is recommended by NICE in the management of non-cognitive symptoms of dementia?
Massage
Aromatherapy
Multisensory stimulation
Therapeutic use of music and/or dancing
Animal-assisted therapy
Approximately what proprotion of completed suicide occur in people over the age of 65?
20%
Criteria for MCI
Not normal, not demented (Does not meet criteria (DSM IV, ICD 10) for a dementia syndrome)
Self and/or informant report and impairment on objective cognitive tasks
Evidence of decline over time on objective cognitive tasks and / or
Preserved basic activities of daily living / minimal impairment in complex instrumental functions
Which medications are most likely to cause delirium?
Anticholinergic drugs (tricyclic antidepressants)
Sedative hypnotics (benzodiazepines)
Corticosteroids
Anti-Parkinson drugs (benztropine, trihexyphenidyl)
Histamine-2 (H2) blockers (cimetidine, ranitidine)
Centrally acting antihypertensives (methyldopa, reserpine)
Pain medication (opiates)
Memory in FTD Vs Alzheimer’s
Compared to Alzheimer’s recent memory is preserved better than remote memory
Risk factors for delirum
Age 65 years or older
Cognitive impairment (e.g. dementia)
Coexistent severe medical illness (e.g. infection)
Current hip fracture
Medications
Which findings on a PET scan would be most indicative of Alzheimer’s dementia?
Temporoparietal hypometabolism
MRI findings for Alzheimer’s
mesial temporal lobe atrophy (particularly hippocampus and entorhinal cortex)
temporoparietal cortical atrophy
Ventricular enlargement is also seen which is a consequence of atrophy
Useful radiological marker for initial diagnosis of Alzheimer’s?
Dilatation of the perihippocampal fissure is a useful radiologic marker for the initial diagnosis of Alzheimer’s disease, with a predictive accuracy of 91%.
Imaging results for vascular dementia
Structural changes - CT and MRI demonstrate atrophy, infarcts, and extensive deep white matter lesions.
Functional changes - SPECT shows a patchy multi-focal pattern of hypoperfusion.
Imaging findings for lewy body dementia
Structural changes - Changes tend to be non-specific and subtle on structural imaging (hence functional imaging SPECT and PET often used). On CT and MRI ventricular enlargement is seen with relative preservation of medial lobe structures. White matter changes similar to Alzheimer’s disease are also seen.
Functional changes - SPECT shows posterior deficits and reduced D2 receptor density.
Imaging findings for FTD
Structural changes - CT and MRI show frontal lobe atrophy
Functional changes - SPECT shows anterior perfusion deficits.
characteristic features of normal pressure hydrocephalus?
Incontinence
Ataxia
Dementia
Which medication has been proven to increase the risk of stroke in elderly patients with dementia?
Olanzapine
An infarct in which region has been shown to lead to an increased risk of depression?
Basal ganglia
Prevalence of post stroke depression
30-40%
Types of Frontotemporal lobar degeneration
Frontotemporal dementia (Pick’s)
Progressive non fluent aphasia (chronic progressive aphasia, CPA)
Semantic dementia
Corticobasal degeneration
Which antipsychotic drugs is least likely to worsen movement problems in Parkinson’s disease?
Quetiapine
Which deficits are less pronounced in dementia due to Parkinsons?
Cognitive deficits such as alexia, dyspraxia, and anomia are less pronounced in dementia due to Parkinson’s
Compared to the general population, how many times higher is the suicide rate in people with Huntington’s disease?
4-6x
Prevalence of CADASIL
The prevalence is about 2 per 100 000.
Initial presentation of CADASIL
The initial presentation is primarily with neurological features of stroke (1/3 of cases) or migraine (1/3 of cases). Psychiatric manifestations are the initial presentation in 15% of cases.
Psychiatric presentation of CADASIL
Mood disorders and subcortical dementia are the most frequent form of psychiatric presentation.
Which way do people with PSP tend to fall?
People with PSP usually stand straight or occasionally even tilt their heads backward (and tend to fall backward),
How long after remission should People over 65 should continue antidepressant?
People over 65 should continue antidepressant medication for at least 2 years following remission
Which medication is licensed for the the treatment of agitation in patients with dementia?
Risperidone
appropriate treatment in a man with advanced multiple sclerosis who develops pathological crying who has failed to respond to citalopram?
Dextromethorphan and quinidine
risk factors for paraphrenia?
It is much more common in women than men
It is associated with hearing and visual impairment
Paraphrenic patients are less likely to be married
Paraphrenia patients are less likely to have children
It is associated with imaging changes consistent with CVAs
It is associated with social isolation
What is most commonly seen in people with Huntington’s disease?
Lack of initiative
What is the estimated total population prevalence of dementia among the entire UK population?
1.3%
score of 7 or more on the Hachinski Ischaemic Score supports a diagnosis of this
Vascular dementia
Tools for assessing MCI
CAMCog (part of the CAMDEX)20 and the SISCO (part of the SIDAM).
in which of the following patient groups is HMPAO SPECT not considered helpful when trying to differentiate Alzheimer’s disease, vascular dementia and frontotemporal dementia?
Downs
No of UK population aged over 65
10 million
No of UK population aged over 80
3 million
Proportion of patients with Parkinsons disease who have depression
40-50%
Proportion of patients with Parkinsons disease who have dementia
40%
Symptoms of vCJD
Early anxiety an depressive symptoms, personality change, and fnally progressive dementia
What is pulvinar sign?
Symmetric high signal intensity changes affecting pulvinar and medial aspects of thalamus - seen on MRI in 70% of confirmed cases
Whats the worldwide prevalence of sporadic CJD?
0.1 cases per 100 000
Hoe does sporadic CJD present?
Non specific symptoms such as lethargy, depression and fatigue
What are the EEG findings in sporadic CJD?
periodic bi or triphasic discharges against slighth low voltage background
Prevalence of paraphrenia in >65 is?
1-2%
Proportion of late onset schizophrenia that are female?
60-69%
Characteristic sleep changes that take place in ageing?
- decreased durtation of slow wave sleep
- decreased sleep efficiency
- decreased total sleep time
- increased sleep latency
In older adults with sleep onset problems which drugs should be avoided?
Long acting Benzodiazepines like Diazepam and Chlordiazepoxide
What is the maximum recommended total daily dose of Lithium in the elderly based on the current treatment guidelines?
600mg/day
What’s the incidence of mania in the elderly?
5%
What are the common clinical features found in mania in elderly people?
- More circumstantial speech
- More paranoid ideation
- Less hyperactivity
- More cognitive impairment
What % of elderly people suffer from major depressive disorder?
3%
What is the approximate incidence of delirium amongst old people who are hopsitalised?
10%
What is the process by which all neuroanatomical areas in the brain show significant loss of neurons?
Ageing
What % of people with delirium have abnormal EEG?
90%
What’s the relapse rate of depression in elderly patients?
up to 60%
How long after remission should elderly patients continue to take antidepressants?
2 years
Do elderly patients take longer to repsond to antidepressants than younger patients?
Yes
What are the risk factors for delirium?
- Age 65 years or older
- Cognitive impairment (e.g. dementia)
- Coexistent severe medical illness (e.g. infection)
- Current hip fracture
- Medications
What’s the annual incidence of Diogenes Syndrome?
0.5 per 1 000
What are some of the symptoms of Diogenes Syndrome?
- extreme neglected physical state
- social isolation
- domestic squalor
- tendency to hoard excessively (syllogomania)
What % of Diogenes Syndrome patients have no history of psychiatric illness?
50%
What’s the most important precipitating factor in developing Diogenes syndrome?
loss of a close relative who was caring for the patient
What is another name for Diogenes syndrome?
Senile squalor syndrome
What are the features of Charles Bonnet syndrome?
persistent or recurrent complex hallucinations (usually visual or auditory) occurring in CLEAR CONSCIOUSNESS
What are the most common opthalmological conditions associated with this Charles Bonnet syndrome?
- macular degeneration
- glaucoma
- cataracts
Charles Bonnet syndrome is most commonly associated with what impairment?
Visual
Which psychotropics are most likely to cause gastrointestinal bleeding in the elderly?
SSRIs
Can antidepressants enhance post stroke motor recovery?
Yes
Which antidepressants are recommended if a patient is on warfarin post storke?
Citalopram or Escitalopram
Which antidepressant is indicated post stroke?
- SSRIs, mirtazapine, and nortriptyline are recommended for post CVA depression
- FLUOXETINE has the strongest evidence base
What are the main risk factors for suicide in the elderly?
- Past history of an attempt
- Depressive disorder
- Access to lethal means
- Physical illness or disability
- Chronic pain
- Recent losses
- Social isolation
Is late onset schizophrenia (aged>60 years) more common in men or women?
Women
What’s the one year prevalence of late onset schizophrenia (aged>60 years)?
0.4%
Genetics of Alzheimer’s Disease
Presenilin 2 gene on Chromosome 1 - early onset
Presenilin 1 gene on Chromosome 14 - early onset
Beta amyloid precursor protein gene on Chromosome 21 - early onset
Apolipoprotein E4 on Chromosome 19 (1 copy = 3x more lilely, 2 copies =8x more likely)
Poor prognostic factors in Alzheimer’s
Being male onset before 65 years prominent behavioural problems observed depression absence of misidtentification syndrome parietal lobe damage
Prevalence of psychosis in Alzheimer’s
30-50%
Commmon misidentification syndromes in Alzheimer’s
Capgras - belief that familair people have been repplaced with unfamiliar
Phantom boarder - guests are living in the house
mirror sign - indentifies own image as someone else
tv sign - identfies tv image as real
magazine sign - identifies magazine imageas real and exisiting in 3d
Subtypesof vascular dementia
- Cognitive deficit after single stroke - more common after thalamic/midbrain stroke
- multi-infarct dementia - stepwise deterioration
- progressive small vessel disease (Binswangers disease) - psychomotor slowness, memory loss and gradual intellectual declinene
What’s the inheritnce pattern of CADASIL?
autosomal dominant - with high penetrance
Difference between LBD and Parkinson’s with dementia?
motor symptoms and demetia develop within 12 months = DLB
Parkinsons for 12 months then dementia = Parkinson’s with dementia
*On SPECT scan DLB shows grater caudate inolvement
% people with DLB that experience lifethretening adverse effects to anipsychotics?
50%
% people with DLB that experience recurrent visual hallcinations?
60-80%
% people with DLB that experience paranoid delusions?
60%
% people with DLB that experience auditory hallucinations?
20%
Pathway implictaed in delirium?
dorsal tegmental (mesencephalic reticular formation -> tectum + thalamus) nuerotransmitter involved = Acetylcholine
EEG in delirium
gneralised slowing of activity
prevalence of depression in >65years
10-15%
Periodic Sharp Wave Complexes (PSWC) on EEG is typical of middle and late stages of which disease?
CJD
Theory of link between vascular disease and depression
- increased platelet aggregration
- depression and ischaemia may be 2ndary to atherosclerosis
- recurrent depression may increase risk of vascular pathology
What are some of the Psychiatric presentations of Huntington’s?
- Depression
- Dementia
- Psychosis
- Anxiety
- Mania
- Sexual dysfunction
- Suicide
What is Huntington’s disease is characterised by?
triad of motor, cognitive and psychiatric symptoms
What’s the inheritance patttern on Wilson’s disease?
Autosomal recessive
What is the minimum duration SSRI should be continued for post stroke depression?
6 months
Among the following neuropathological changes in Alzheimer’s Disease, which changes occurs prior to onset of cognitive deficits?
Build-up of amyloid plaque
Which drug is recommended by NICE for the management of distress in patients with delirium?
Olanzapine
Which tool can reliably discriminate normal ageing from MCI?
Montreal cognitive assessment
As part of normal ageing at what age do memory and verbal fluency start to decline?
45 years
% of patients with vascular origin MCI who develop demntia in 2 years according to Canadian cohort study?
40%
Which medication has been shown to be of prophylactic benefit in reducing the duration and severity of post operative delirium?
Haloperidol
What percentage of patients with Parkinson’s Disease experience psychiatric symptoms?
70%
What percentage of patients with Parkinson’s Disease experience anxiety?
50 - 65%
What percentage of patients with Parkinson’s Disease experience psychosis?
40% (mostly drug related)
What are the RFs for depression in Parkinson’s?
- female gender
- younger onset
- R sided lesions
- rapid disease progression
- bradykinaesia
What is the genetic basis of Huntington’s disease?
- Mutation = serial CAG repeats (>41 repeats causes ‘fully penetrant’ disease)
- Mutated protein is called ‘Huntingtin’
- Gene locus = short arm Chromasome 4
What percentage of patients with Wilson’s disease present with psychiatric symptoms exclusively?
20%
These include: personality disturbances, mood abnormalities, cognitive dysfunction
Kaiser-fleischer rings are present in what percentage of patients with Wilson’s disease?
95% of those with neurological Sx
50-60% of those without neurological Sx
10% of those who are asymptomatic (screened)
What is seen on MRI in Wilson’s disease?
Giant Panda sign = hyperintensity of midbrain with relative sparing of red nucleus, superior colliculus and part of the pars reticulata
The sudden withdrawal of antiparkinsonian drugs could cause
NMS
