old age psych

Question 1

DSM V dementia criteria?

Answer 1

1. multiple cog defects
2. memory impairment
3. at least one of : aphasia, apraxia, agnosia, executive fxn prob
4. impaired social or occupational function
5. decline from a previously better level of fxn
6. can’t attribute to anything else and are not just delirium

Question 2

most common dementia?

Answer 2

alzheimers

Question 3

proven RFs for alzheimer’s dementia?

Answer 3

1. age
2. DS
3. apolipoprotein e4 allele

Question 4

likely RFs for alzheimer’s dementia?

Answer 4

1. females
2. head injury
3. post menopause

Question 5

possible RFs for alzheimer’s dementia?

Answer 5

fhx parkinsons, vascular, DS

Question 6

proven protective factors alzheimers?

Answer 6

apolipoprotein e2 allele

Question 7

possible protective factors AD?

Answer 7

1. smoking
2. NSAIDs
3. oestrogen
4. premorbid personality + education

Question 8

genes associated with early onset AD?

Answer 8

presenilin

beta amyloid precursor

Question 9

1st degree relative risk of AD?

Answer 9

15-19%

Question 10

neuropathology of AD?

Answer 10

1. diffuse atrophy
2. flat sulci
3. enlarged ventricles
4. plaques, NF tangles, neuronal loss, synaptic loss,

Question 11

where else do you see plaques>

Answer 11

Down’s syndrome

Question 12

Neuroimaging in AD?

Answer 12

1. CT - cortical atrophy (parietal and temporal) + 3rd ventricle dilation
2. MRI - less grey matter, and reduced volume in hippocampus, amygdala and temporal lobes
3. PET - reduced blood flow and metabolism in parietal and temporal

Question 13

what is lexical anomia?

Answer 13

seen in AD

problem finding the words

Question 14

what is apraxia?

Answer 14

prob with learned motor tasks

Question 15

what is agnosia?

Answer 15

can’t recognise peripheral sensory stimulation and parts of body

Question 16

behavioural features of AD?

Answer 16

1. wandering
2. aggression
3. sexual disinhibition
4. incontinence
5. searching
6. eating

Question 17

psych features of AD?

Answer 17

1. delusions
2. auditory and visual hallucinations
3. depression
4. psychotic = rapid decline - survival 8yrs

Question 18

signs of progression in AD?

Answer 18

increasing agitation
emotional outbursts
night pacing, poor sleep, wandering

Question 19

terminal phase AD?

Answer 19

profound disorientation
double incontinent
amnestic

Question 20

what are the anti AD drugs?

Answer 20

1. donezepil, rivastigmine, galantamine - cholinesterase inhibs
2. memantine - NMDA agonist - protects neurons from glutamate - may augment donezepil

Question 21

_______ is useful in parkinsons dementia

Answer 21

rivastigmine

Question 22

______ is used in vasc and mixed dementia.

Answer 22

memantine

Question 23

_____ is hepatotoxic

Answer 23

tacrine

Question 24

ginkgo biloba is ______

Answer 24

useless

Question 25

poor px factors in AD

Answer 25

1. male | 2. onset

Question 26

what are some cognitive tests

Answer 26

``` MMSE CAPE AMTS CAMCOG Clock drawing ```

Question 27

cut off in MMSE is ___

Answer 27

24/30

Question 28

MMSE screens for _____

Answer 28

``` cog dysfunction orientation memory concentration language praxis gnosis ```

Question 29

MMSE varies due to _______

Answer 29

age SE education verbal performance

Question 30

cutoff in AMTS is ______

Answer 30

7-8/10

Question 31

AMTS covers ______

Answer 31

memory | orientation

Question 32

clock drawing tests _____

Answer 32

praxis

Question 33

types of vascular dementia?

Answer 33

1. post stroke deficits 2. multi-infarct dementia 3. progressive small vessel disease (binswangers)

Question 34

key features of vascular dementia?

Answer 34

1. uneven cognitive impairment 2. abrupt onset, stepwise deterioration 3. focal signs 4. can coexist with alzheimers

Question 35

key features multi infarct dementia?

Answer 35

1. gradual onset | 2. minor ischaemic episode hx

Question 36

key features subcortical dementia?

Answer 36

1. hx of HTN 2. deep white matter ischaemia 3. well preserved white cortex

Question 37

insight in vascular dementia is ______

Answer 37

retained

Question 38

somatic complaints in vascular dementia are _______

Answer 38

common eg headache and dizzy

Question 39

what is lewy body dementia?

Answer 39

1. progressive w/ parkinsonism 2. fluctuating cognition with profound variations in alertness and attention 3. detailed visual hallucinations 4. parkinsonism 5. falls, faints, loss of consciousness 6. delusions 7. spared short term memory and medial temporal lobes

Question 40

histology of LBD?

Answer 40

eosinophilic intracytoplasmic inclusions

Question 41

define parkinsons dementia?

Answer 41

where parkinsons sx >12 months before the dmenentia

Question 42

define frontotemporal dementia?

Answer 42

1. slow onset 2. frontal lobe 3. emotioanlly blunt 4. disinhibited 5. apathy 6. restless 7. aphasia 8. personality change

Question 43

onset of FTD is _____

Answer 43

45-65

Question 44

dementia in CJD is _____

Answer 44

``` fast myoclonus cerebellar and EPS signs visual probs death in 1yr ```

Question 45

on EEG in dementia of CJD?

Answer 45

periodic complexes

Question 46

what is pseudodementia?

Answer 46

1. cognitive impairment seen in psych disorders - mostly depression

Question 47

what are the caine criteria for pseudodementia?

Answer 47

1. ID in pt with 1y psych prob 2. similar to features of impairment in CNS disorders 3. reversible deficits 4. no neurological condition