Psychiatry of Old Age Flashcards
def: dementia
- decline in memory and thinking
- of a degree to impair functioning in daily living
- present for 6+ months
- associated with changes in behaviour, motivation and personality
- acquired progressive illness
- no reversile cause
- clear consciousness
- clinical diagnosis
presentation: dementia
cognitive symptoms:
* memory (recent)
* language (understanding, can’t get words etc)
* visuospatial defecits (driving, appliances)
* calculation (money)
neuropsychiatric:
* personality
* behaviour
* mood
* psychotic (visual hallucinations)
* sleep
ADLs:
* personal care
* driving
* shopping
cognitive examination
orientation - time and place
attention - serial 7s, months of year backwards
visuospatial - object recognition, prospagnosia, overlapping pentagon, clock face drawing
execuive fnx - problem solving, reasoning, verbala dn category fluency
language - naming, comprehencsion, reading, writing
ix: alzheimer’s dementia
biological:
* bloods dementia screen - U+E, FBC, LFT, TFT, B12 and folate, CRP, blood glucose, VDRL/TPHA
* neuroimaging - CT/MRI (cerebral atrophy, exclude CVA, SOL, NPH0
* ECG if resting pulse <60
social:
* socail hx from family.carers
* OT assessment
rx: alzheimers tx
biological:
* treat reversible causes of confusion
* acetylcholinesterase inhibitor: 1st line donepazil 2nd line memantine
* CI - cardiac conduction problems, peptic ulcer disease, severe respiratory disease then give memantine
social:
* review social needs - housing suitable? finances? fit to drive? day centre?
psycholoigcal:
* assessment of behavioural symptoms - diversion, avoiding confrontation, adjusting to impaired communication
* signpost patients and carers to support groups
clinical fx: lewy body dementia
- parkinsonism
- recurrent visual hallucinations
- preserved memory
- attention and visuospatial impairment
- fluctuation
- REM sleep problems
