Old Age Psychiatry

Question 1

describe the ABCD of assessing in old age psychiatry

Answer 1

Activities of daily living
Behavioural and psychiatric symptoms
Cognitive impairment
Decline

Question 2

what symptoms are you assessing for when assessing behavioural and psychiatric symptoms of dementia?

Answer 2

> psychosis
> anxiety
> agitation
> depression
> altered circadian rhythm

Question 3

what are you assessing when looking at the patients cognitive impairment?

Answer 3

> memory
 - dyspraxia
 - dysphasia
> dysgnosia
> dysexecutive functioning

Question 4

how is dementia diagnosed?

Answer 4

case findings of symptoms suggesting cognitive impairment then a clinical assessment is carried out.
then they are referred to a specialist who confirms. (can do brain scanning)

Question 5

what is the differential diagnosis with dementia?

Answer 5

> delirium
depression
dementia

Question 6

describe how delirium may present

Answer 6

> acute and precise onset
> disorientation early
> fluctuating consciousness
> short attention span
> disturbed sleep wake cycle
> early psychomotor changes

Question 7

describe how depression may present in the elderly

Answer 7

> abrupt onset
> "don't know answers"
> fluctuating cognitive loss
> short and long term memory loss
> insomnia
> suicide
> agitation
> hypochondriasis

Question 8

how does Alzheimer’s present?

Answer 8

> dysmenesia
> dysexecutive functioning
> functional impairment
> no focal neurological signs
> no vascular risk factors

Question 9

how does dementia with lewy bodies present?

Answer 9

> REM sleep disorder
> deficits
 - attention
 - frontal executive thinking
 - visuospatial
> fluctuation of symptoms
> visual hallucinations

Question 10

how is Alzheimer’s diagnosed?

Answer 10

T1 weighted MRI if young or an unusual history

> atrophy in the medial temporal lobes

Question 11

how does frontotemporal dementia present?

Answer 11

> change in behaviour
 - messy
 - apathetic
 - appearance
> speech
 - mutism
 - echolalia
 - steryotypy
- altered output
> neuropsychology
 - frontal dysexecutive function
 - memory not severely impaired
> neurological signs
 - Parkinson's later
 - incontinence
 - MND
 - autonomic

Question 12

what is seen on an MRI in frontotemporal dementia?

Answer 12

cerebral atrophy of the frontotemporal regions (increase in sulci size)

Question 13

what dementia presents in a stepwise progression?

Answer 13

stepwise progression

Question 14

how does subcortical dementia?

Answer 14

> gradual deterioration in executive function
> mood changes 
 - apathy
 - irritability
> neurological features
 - falls
 - seizures
 > memory stays

Question 15

what classes of drugs can be used to treat dementia?

Answer 15

> antipsychotics
> antidepressants
> anxiolytics
> hypnotics
> anticonvulsants
> acetylcholinesterase inhibitors
> narcoleptics (controversial)

Question 16

name some antipsychotics

Answer 16

> risperidone
quetiapine
amisulpride

Question 17

name some antidepressants used in dementia

Answer 17

> mirtazapine

> setraline

Question 18

name some anxiolytics used in dementia

Answer 18

> lorazepam

Question 19

name some hypnotics used in dementia

Answer 19

> zolpidem
zopiclone
clonazepam

Question 20

name some anticonvulsants used in dementia

Answer 20

> valproate

> carbamazepine

Question 21

name some acetylcholinesterase inhibitors

Answer 21

> donepezil
rivastigimine
galantamine

Question 22

what are the side effects of acetylcholinesterase inhibitors?

Answer 22

> fatigue
> headache
> muscle cramps
> syncope
> nausea