Older Persons Mental Health Flashcards
How can cognitive impairment be categorised?
Single/ multiple/ static/ progressive
Define cognitive impairment.
Disturbance of higher cortical functions including memory, thinking, judgement, language, perception and awareness
Define dementia.
Cognitive impairment: decline in both memory and thinking sufficient to impair personal ADLs present for >6 months
Define delirium.
Impairment of cognition; disturbances of attention and conscious level; abnormal psychomotor behaviour and affect; disturbed sleep-wake cycle
Describe how a patient with the hyperactive subtype of delirium would present.
heightened arousal, restlessness, irritability, wandering, carphologia (picking at clothing)
Describe how a patient with the hypoactive subtype of delirium would present.
Quiet, sleepy, inactive, unmotivated and EASILY OVERLOOKED
Describe the perceptual disturbances experienced by patients with delirium.
- Visual
- Transient
- Tacile
Name some causes of delirium.
- Hypoxia
- Abdominal
- Drugs
- Endocrine
- Infections
- Electrolyte disturbances
- Hepatic/renal
- Stroke
- Nutritional
Name some drug types that can induce delirium.
Psychotropic drugs - Antidepressants - Antipsychotics - Benzodiazepines Antiparkinsonian drugs Anticholinergic drugs Opiates Diuretics (recreational drug intoxication and withdrawal)
Why is it important to diagnose memory abnormalities early?
Optimising medical management Relief gained Maximising decision making autonomy Access to care and services Risk reduction Clinical and cost effectiveness A human right?
Describe some behavioural and Psychological Symptoms of Dementia (BPSD).
Aggression / agitation Restlessness Psychotic symptoms Depressive symptoms Anxiety symptoms Sexual disinhibition Sleep disturbance Wandering
Describe some effect of dementia on carers.
Changing relationships
Financial difficulties
Social isolation
Psychological and physical strain
Describe the epidemiology of dementia.
The total population prevalence of dementia among over 65s is 7.1% (based on 2013 population data). This equals one in every 79 (1.3%) of the entire UK population, and 1 in every 14 of the population aged 65 years and over.
Describe the aetiology of dementia.
Dementia is a term used to describe the symptoms that occur when there’s a decline in brain function. Several different diseases can cause dementia. Many of these diseases are associated with an abnormal build-up of proteins in the brain. This build-up causes nerve cells to function less well and ultimately die.
Describe the epidemiology of delerium.
Delirium is a common syndrome that affects up to 30% of hospitalised adults. The prevalence varies significantly depending on the patient population, as patients with advanced age, cognitive decline, and more severe medical illness are at higher risk.
Describe the aetiology of delerium.
Delirium occurs when the normal sending and receiving of signals in the brain become impaired. This impairment is most likely caused by a combination of factors that make the brain vulnerable and trigger a malfunction in brain activity.
Describe how to assess the Activities of Daily Living skills of patients presenting with cognitive impairment.
Comment on:
Ambulating: The extent of an individual’s ability to move from one position to another and walk independently.
Feeding: The ability of a person to feed oneself.
Dressing: The ability to select appropriate clothes and to put the clothes on.
Personal hygiene: The ability to bathe and groom oneself and to maintaining dental hygiene, nail and hair care.
Continence: The ability to control bladder and bowel function
Toileting: The ability to get to and from the toilet, using it appropriately, and cleaning oneself.
Describe the side effects of psychiatric medication prescribed to older persons for their mental health.
- Oversedation
- Memory and psychomotor impairment
- Poor functional autonomy
- Addiction;
Name some organisations available in primary, secondary health care, social services and voluntary organisations in the provision of the care for older people presenting with cognitive impairment, and the needs of their carers.
- Age UK
- Contact the elderly
Describe how patients experiencing changes in executive and frontal lobe function relating to dementia would present.
- Letter and category fluency
- Impulsivity, congative estimates, perseveration, proverbs
- Personality change, appetite
- Primitive reflexes – e.g. palmar-mental reflex, glabelar reflex, etc
Describe how patients experiencing changes in apraxia relating to dementia would present.
Meaningless gestures, miming tasks ‘brush your teeth, comb hair’, sequencing e.g. luria or alternating hand/fist
Describe how patients experiencing changes visuospacial ability relating to dementia would present.
- Topographic disorientation
- Neglect
- Dressing dyspraxia
- Copying wire cube, pentagons, clock face
- Prosopagnosia
Name some common cognitive assessment scales.
AMT 6-CIT GP-COG MMSE MoCA ACEiii Formal neuropsychological assessment
Name some neuroimaging you could request in patients presenting with dementia symptoms.
- CT/MRI
- SPECT, FDG-PET, Amyloid-PET
Describe the specific drug treatment options for patients with Alzheimers disease.
Donepezil, rivastigmine, galantamine (cholinesterase inhibitors)
Memantine (NMDA receptor antagonist)
Describe the specific drug treatment options for patients with Parkinson’s disease dementia.
Rivastigmine
What types of dementia should not be offered anti-dementia medication?
- Vascular dementia – unless mixed dementia suspected
- Frontotemporal dementia
- Cognitive impairment secondary to multiple sclerosis
