Aged Psychiatry Flashcards
MMSE Severity Classification
24-30: Normal
20-23: Mild cognitive impairment
10-19: Moderate
0-9: Severe
Alzheimer’s Disease criteria
A. Criteria met for major/mild neurocog disorder
B. insidious onset and gradual progression of impairment in 1 or more cognitive domains (major is 2)
C. Criteria met for either probable/possible AD
1. evidence of a causative AD mutation from family history/genetic testing
2. All 3 of
- clear evidence in decline of memory and learning and at least 1 other domain
- steadily progressive, gradual decline in cognition w extended plateaus
- no evidence of mixed etiology
D. disturbance not better explained by brain disease/other neurodegenerative/substance/mental/neuro/systemic disorder
5 A of alzheimer’s
amnesia, agnosia, aphasia, anomia, apraxia
Pharmaco Management of Alzheimer’s
Mild-mod: ACh inhibitors: donepezil, rivastigmine, galantamine. need to do ECG, weight, falls risk assessment before prescribing Mod-severe: NMDA antagonist Memantine BPSD: antipsychotics, SSRI Sleep disturbance: Melatonin
Other management of alzheimer’s
Promoting functional independence
- communication strategy, ADL skills training, assistive tech, exercise, rehab, recreational activity
Occupational therapy
- environmental assessment and mods, driving assessment, sensory
Cognition-oriented approach
Reality-oriented therapy
Reminiscence therapy
Validation therapy
Sensory enhancement
Support families and caters
Planning for future: advanced directive, will, power of attorney
Vascular dementia criteria
A. as others
B. Clinical features consistent with a vascular aetiology
- onset is temporally related to at least 1 cerebrovascular event
- evidence for decline is prominent in complex attention and frontal-executive function
C. Evidence of presence of cerebrovascular disease from history/PE/neuroimaging
D. Not better explained by another disorder
Assessment of vascular dementia
Brain imaging, blood tests, Hachinski Ischemic Score, Global Deterioration Scale, Cornell Depression scale for dementia
Frontotemporal dementia criteria
A. as others
B. Disturbance has insidious onset and gradual progression
C. Either 1/2
1. Behavioural variant: 3 or more of
- behavioural disinhibition
- apathy/inertia
- loss of empathy/sympathy
- perseveration/stereotyped/ritualistic behaviour
- hyperorality and dietary change
2. Language variant: persistent decline in language; speech production, word finding, object naming, grammar, word comprehension
D. Relative sparing of learning and memory and perceptual motor-function
E. as others
Assessment and treatment for Frontotemporal dementia
Assessment: frontal assessment battery
Treatment: symptom-focused, serotonergic meds for behavioural issues
Lewy Body dementia criteria
A. as others
B. Disorder has insidious onset and gradual progression
C. Core diagnostic features
- fluctuating cognition with pronounced variation in attention and alertness
- recurrent visual hallucinations that are well-formed and detailed
- spontaneous features of parkinsonism with onset after cog decline
Suggestive diagnostic features
- meet criteria for REM behaviour disorder
- severe neuroleptic sensitivity
D. as others
Management of Lewy Body dementia
- need to identify comorbids and existing visual impairment
- review conflicting prescriptions like antiparkinsonism meds
- don’t use antichokinergic PD meds
- avoid antipsychotics, best is clozapine
- avoid tricyclics
- ACh inhibitors
Difference between dementia and pseudo dementia
Sudden onset and rapid progression No night changes Presence of insight Frequent vegetative symptoms Doesn’t try to answer questions Suicidal thoughts More somatic symptoms like insomnia, anorexia, fatigue, psychomotor retardation
Managing pseudo dementia
Need to be careful with SSRIs and benzos due to risk of falls, delirium, constipation, hyponatremia, renal impairment, comorbids
