Old Age Flashcards
Treatment of psychotic depression in older people
According to Maudsley TCA probably first line SSRI seoond Should probably add olanzapine or quetiapine to 1 or 2 ECT considered
Routine tests in dementia investigation
NICE guidelines suggest the following investigations in people with dementia:-
routine haematology
biochemistry tests (including electrolytes, calcium, glucose, and renal and liver function)
thyroid function tests
serum vitamin B 12 and folate levels
Imaging: Magnetic resonance imaging (MRI) is the preferred modality to assist with early diagnosis and detect subcortical vascular changes, although computed tomography (CT) scanning could be used. Imaging may not always be needed in those presenting with moderate to severe dementia, if the diagnosis is already clear.
What extra areas of imaging are suggested for dementia workup?
HMPAO SPECT: differentiates AD, FTD, VD
If above not available, then FDGPET
Above not helpful in DOWNS as they have HMPAO SPECT abnormalities throughout life
FP CIT SPECT: to confirm LBD
How to treat psychosis in dementia?
What is the only licensed treatment/
The Maudsley Guidelines recommend risperidone for use in behavioural and psychological (BPSD) symptoms in dementia (e.g. psychosis and agitation) as is the only drug licensed in the UK for BPSD. They recommend short term use only (6 weeks).
The most recent data suggest that risperidone and olanzapine are the treatments of choice. This comes from the CATIE-AD trial which showed minor advantages (as per effectiveness) for olanzapine and risperidone (but not Quetiapine) over placebo.
What four domains are classically hit in cortical dementia?
Impaired memory
Impaired visuospatial ability
Impaired executive function
Impaired language
What domains are classically hit in subcortical dementia?
Generalised slowing of mental processes
Personality change
Mood disorders
Presence of abnormal movements
Name 6 subcortical dementias
Binswanger’s disease
Dementia associated Huntington’s disease
Dementia associated AIDS
Dementia associated with Parkinson’s disease
Dementia associated with Wilson’s disease
Dementia associated with progressive supranuclear palsy
How is Huntingdons passed and what is the classical age of onset?
Early onset 35-44
Associated with abnormal movements (chorea)
Autosomal dominant
MMSE severity scores?
Early onset 35-44
Associated with abnormal movements (chorea)
Autosomal dominant
Post stroke depression What rates? What areas? What drugs safe? What drugs for those on warfarin?
30-40%
L frontal lobe and L basal ganglia
Safe: SSRIs (paroxetine first), nortryptyline
Citalopgram or escitalopram if on warfarin
Prophylaxis is effective with nortryptyline, fluoxetine, escitalopram, duloxetine, sertraline, mirtazapien
What is the risk of people developing alzheimers if family members had it?
3-4 fold increase
if their family member had it up to any age of 85 years
Huntingdons suicide risk compared to gen pop
Increased by 4-6x
Dementia epidemiology What % under 65? How often does prevalence double? Duration after diagnosis? In UK, relation with M:F? What % in private households? Distribution of severity in %?
2% under 65
Prevalence doubles every 5 years after 65y
Duration: 5-7y
M>F in early onset, F>M in late onset
60% in private households
Mild 55%, Mod 30% Severe 15%
Dementia prevalence overall?
Dementia prevalence in over 65s
- 3%
7. 1%
