Psychiatric disorders across a lifetime Flashcards
pathophysiology of dementia
- amyloid plaques (insoluble protein deposits in the hippocampus, amygdala, cerebral cortex) - HACC PLAQUES
- Neurofibrillary tangles (phosphorylated tau protein - found in cortex, hippocampus, substantia nigra)
which chromosome codes for amyloid precursor protein
C21 -> implicated in down syndrome also
which chromosome codes for apoliprotein E4
C19 -> increase risk of AD
what is the cholinergic hypothesis?
pathological changes lead to degeneration of cholinergic nuclei in the basal forebrain -> reduced cortical ACh
medications for issues caused by cholinergic hypothesis
acetylcholinesterase inhib - Donepezil
NMDA (glutamate) receptor antagonist - Memantine
BPSD meaning
behavioural and psychological symptoms of dementia
memory loss pattern dementia
retain older memories more than new memories
important questions to ask for short term memory
hazards
- > paying bills, leaving oven on
- > may indicate she needs a guardian (power of attorney when they still have capacity as hard to do afterwards)
- > are they driving –> can be so dangerous
dysphasia
problems with recognising and expressing the right words
progressive disease can lead to emergence of what phenomena? (1 + extra info)
- > psychotic
- > also decline in ADLs and social skills
catastrophic reaction?
where the patient becomes very frustrated and angry with their inability to understand and lash out
features of advanced AD
- monosyllabic speech
- psychotic symptoms
at which locations are up to 50% of neurons and synapses lost in the brain in dementia?
the cortex and hippocampus
Which chromosome codes for presenilin 1 (implicated in B-amyloid peptide).
C14
Which chromosome codes for presenilin 11 (implicated in B-amyloid peptide).
C1
early symptoms of dementia (5)
- Absent-mindedness
- Difficulty recalling names and words
- Difficulty learning new information
- Disorientation in unfamiliar surroundings
- Reduced social engagement
progressive disease features of dementia (6)
- Marked memory impairment
- Reduced vocabulary
- Loss of less complex speech patterns.
- Mood swings and/or apathy
- Decline in ADL’s & social skills
- Emergence of psychotic phenomena.
advanced dementia features (5)
- Monosyllabic speech
- Psychotic symptoms
- Behavioural disturbance
- Loss of bladder and bowel control
- Reduced mobility
psychiatric changes symptoms of dementia (3)
- Delusions (15%)—usually of a paranoid nature.
- Auditory and/or visual hallucinations (10–15%)—which may be simple misidentification, and indicate rapid cognitive decline.
- Depression is common, requiring treatment in up to 20% of patients.
behavioural disturbances in dementia (7)
- aggression,
- wandering,
- explosive temper,
- sexual disinhibition,
- incontinence,
- excessive eating,
- searching behaviour.
personality change in dementia features
often reflects an exaggeration of premorbid traits with coarsening of affect and egocentricity.
what type of diagnosis is given for AD?
probable diagnosis
“probable AD”
-> based off of deterioration from baseline, and reviews other potential causes e.g. other causes of dementia
what tool is used to assess a patient for AD?
MMSE
onset of delirium vs dementia vs depression
delirium -> acute
dementia -> insidious
depression -> acute or insidious
course of delirium vs dementia vs depression
delirium -> fluctuating
dementia -> progressive
depresion -> chronic
duration of delirium vs dementia vs depression
delirium -> hours/weeks
dementia -> months/years
depression -> motnhs/years
consciousness of delirium vs dementia vs depression
delirium -> altered
dementia -> usually clear
depression -> clear
attention of delirium vs dementia vs depression
delirium -> impaired
dementia -> normal except in severe dementia
depression -> may be decreased
psychomotor changes of delirium vs dementia vs depression
delirium -> inc/dec
dementia -> often normal
depression -> slowed in severe cases
reversibility of delirium vs dementia vs depression
delirium -> usually
dementia -> irreversible
depression -> usually
routine dementia investigations primary purpose
to exclude reversible causes of cognitive deterioration
routine dementia investigations bloods examples (7)
- FBC, ESR, CRP - anaemia, vasculitis
- T4 and TSH - hypothyroidism
- biochemical screen - hypercalcaemia or hypocalcaemia
- urea and creatinine - renal failure, dialysis dementia
- glucose
- B12 and folate - vitamin deficiency dementia
- clotting and albumin - liver function
- > midstream urine if delirium is a possibility
routine dementia imaging
- MRI to assist with early diagnosis and detect subcortical vasc changes
- > CT scanning could also be used
imaging dementia purpose
imaging may help to identify treatable causes such as subdural haematoma, normal pressure hydrocephalus, cerebral tumours
-> also help establish subtype of dementia
