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Y4 OPIC > Older persons mental health > Flashcards

Older persons mental health Flashcards

1
Q

Early stages of dementia

A
  • Poor memory
  • Subtle changes in mood- change in interest
  • Limited intrusion into day to day activities
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2
Q

Mid stage of dementia

A
  • Memory problems more prominent- difficulty with language, can’t remember pen but say pea instead.
  • Wandering, irritability, confusion
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3
Q

Severe

A
  • Remembering children/family member names
  • ‘Want to go home’ may be referring to a childhood home
  • Asking for mum and dad
  • Agitated, disinhibition- sexually, severe apathy (mis-labelled as depression)
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4
Q

Behavioural and psychological symptoms of dementia (BPSD)

A
  • Increased anxiety
  • Feeling low
  • Hallucinations
  • Sun downing
  • Symptoms

4 main clusters
- Affective (changes in mood)
- Apathetic
- Psychotic (hallucinations)
- Hyperactive (wandering)

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5
Q

Management for BPSD (Behavioural and psychological symptoms of dementia)

A

Reduce patient distress
- Keep ABC charts in acute hospital
- Music therapy
- Antipsychotic medication, caution with LBD

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6
Q

Purpose of CT in dementia

A

To sub categorise dementia
NOT to diagnose it

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7
Q

What is the definition of delirium

A

Transient and global impairment of cognition, disturbances of attention and conscious level, abnormal psychomotor behaviour, disturbed sleep-wake cycle and emotional disturbance

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8
Q

Three things delirium gets misdiagnosed as

A
  • Dementia
  • Depression if hypoactive (need to have symptoms for at least two weeks)
  • Manic disorders/schizophrenia if hyperactive
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9
Q

Most common cause of delirium

A

Infection- UTI or pneumonia

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10
Q

What is a characteristic of delirium rather than dementia?

A

Impairment of consciousness

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11
Q

ACE III

A

5 domains
- Attention
- Memory
- Verbal fluency
- Language
- Visual-spatial

There is a 30 point version if the patient is significantly confused or anxious

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12
Q

Investigations for dementia

A
  • FBC, U&E, TFT, LFT, Glucose, B12 and folate
  • ECG- safety before prescribing
  • CT/MRI brain- dementia subtype

Try and rule out any other medical cause that may be causing confusion, memory loss?

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13
Q

If subtype remains unclear

A
  • Consider neuropsychology referral
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14
Q

Can you still drive if you have been diagnosed with dementia?

A

Yes
But you must inform the DVLA

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15
Q

Acetylcholinesterase inhibitors

A
  • Donepezil
  • Rivastigmine
  • Galantamine

Side effects
- GI symptoms, reduced appetite, dizziness and agitation

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16
Q

What are types of dementia?

A

Neurodegenerative- AD, vascular, FTD, parkinson’s, Korsakoff, parkinson’s

Infective- HIV, herpes, syphyllis

Prion- kuru, CJD

Inflammatory- vasculopathies, sarcoid

Metabolic- poorly controlled endocrine disease

Genetic- downs syndrome, CADASIL (rare form of vascular dementia)

17
Q

How can you quantitatively assess frailty?

A

PRISMA7 questionnaire

A score of >3 means you are frail

18
Q

What are the clinical features of hyperactive delirium?

A

Agitation
Delusions
Hallucinations
Wandering
Aggression

19
Q

What are the clinical features of hypoactive delirium?

A

Hypoactive delirium is less well known and as a result, often missed or confused with depression.

Clinical features of hypoactive delirium include:

Lethargy
Slowness with everyday tasks
Excessive sleeping
Inattention

20
Q

What tests can you do for a cognitive assessment?

A

AMTS
ACE-III
MMSE

21
Q

What is part of the confusion screen?

A

Blood tests:

FBC (e.g. infection, anaemia, malignancy)
U&Es (e.g. hyponatraemia, hypernatraemia)
LFTs (e.g. liver failure with secondary encephalopathy)
Coagulation/INR (e.g. intracranial bleeding)
TFTs (e.g. hypothyroidism)
Calcium (e.g. hypercalcaemia)
B12 + folate/haematinics (e.g. B12/folate deficiency)
Glucose (e.g. hypoglycaemia/hyperglycaemia)
Blood cultures (e.g. sepsis)

CT head: if there is concern about intracranial pathology (bleeding, ischaemic stroke, abscess)
Chest X-ray: may be performed if there is concern about lung pathology (e.g. pneumonia, pulmonary oedema

22
Q

Non-pharmacological management of delirium

A
  • Keep a consistent nursing and medical team
  • Gentle re-orientation, calm and consistent care
  • Keep patients independent
  • Bright lighting
  • Involve the family and friends
23
Q

What medication should you use for uncontrollable agitation and delirium?

A

0.5mg of Lorazepam due to it’s rapid onset and short half-life

24
Q

How do you die from Alzheimer’s?

A
  • Aspiration pneumonia
  • Severe malnutrition and dehydration
  • Sepsis
  • Falls and injuries
25
Q

What symptoms of fronto-temporal dementia come from the frontal lobe and temporal?

A

Frontal
- Disinhibition
- Apathy
- Loss of sympathy
- Impulsive behaviour
- Planning, problem solving problems

Temporal
- Altered food preferences, increased consumption of cigarettes- where the reward center is
- Loss of sympathy/empathy

Y4 OPIC (15 decks)

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