Old age psychiatry Flashcards
Define dementia
Dementia is an acquired, progressive, degenerative disorder giving a global impairment of all mental functions in clear consciousness.
What is the epidemiology of dementia?
Affects 5-10% >65s and 20% of >80s
Affects more females than males
Number of people w Dementia is increasing in UK
What are the clinical features of dementia?
Cognitive decline - language, visuo-spatial, abstract thinking, judgement, problems with finances, affair management
Reversion to mother tongue
Gradual memory decline (especially recent)
Behavioural and Psychological Sx of Dementia (BPSD) Mood changes Abnormal behaviour Aggression Wandering off - appearing lost/disorientated Agitation Psychosis Depression Apathy
What are the different types of Dementia?
Alzheimer's in 60-80% Vascular Dementia 5-10% Lewy Body Dementia 5-10% Fronto-temporal Dementia 5-10% Parkinson's Dementia Huntingdon's Mixed Dementia
What are the Ix for Dementia?
Bedside: Thorough Hx, Collateral Hx, Neuro exam
Bloods: Dementia screen: FBC, U&E, TFT, B12, folate, Ca, fasting glucose + lipids, VDRL, HIV
Imaging: MRI brain/CT brain
Special tests: AMTS, GP-COG, 6 CTT, ACE-III, MoCA
What is a +ve result for Dementia on an MRICT brain?
Hippocampal atrophy
Medial temporal lobe atrophy
What is the tx for Dementia?
BIO: Cholinesterase inhibitors (AChEIs BUT not for fronto-temporal dementia): Donepezil, Galantamine, Rivastigmine (Parkinsonian Dementia)
-> may need medication for BPSD (last resort)
PSYCHO-SOCIAL: social services, occupational therapy, telecare, neuropsychology, LPA (health and finances), carer’s support - Alzheimer’s society/Admiral’s Nurses, benefits, convince pt to notify DVLA of diagnosis
What are standout features of Parkinsonian dementia?
Alongside standard Dementia sx, also movement disorder: chorea, speech/swallowing, dystonia, gait
Stepwise gradual progression
What are standout features of Fronto-temporal dementia?
Personality change, behaviour problems, early loss of insight, hyperorality
What are standout features of Lewy body dementia?
Similar to Parkinson’s + visual disturbances
What are the differentials for a Dementia picture?
Depression Hypercalcaemia - malignancy Hypothyroid Hypoglycaemia Vitamin D deficiency Iron deficiency anaemia Mild cognitive defect
What is transient global amnesia?
Transient global amnesia is a neurological condition characterised by a temporary but total disruption of both short and long term memory. Other cognitive functions are preserved.
