Old Age psychiatry Flashcards
(65 cards)
1
Q
ABCD of dementia
A
A - ADLs
B - behavioural and psychiatric symptoms of dementia
C - cognitive impairment
D - decline
2
Q
What does ADLs stand for?
A
Activities of daily living
3
Q
What do you need when taking a history in dementia?
A
A collateral history
4
Q
Cognitive features of dementia
A
Memory (dysmenesia/amnesia) PLUS one or more of - dysphagia (communication) - expressive - receptive - dyspraxia - dysgnosia - dysexecutive functioning Functional decline - ADLs basic and instrumental
5
Q
Which type of dysphasia is more obvious in dementia?
A
Expressive dysphagia
6
Q
What is expressive dysphagia?
A
Difficulty in finding words, tip of the tongue phenomena
7
Q
What is dyspraxia?
A
Inability to carry out motor skills (despite an intact motor system)
8
Q
What is dysgnosia?
A
Not recognising objects e.g. razor, toilet
9
Q
What is basic ADLs?
A
What you did in the morning and what you did in the evening
10
Q
What are examples of instrumental ADLs?
A
keyboard
phone
appointments
buses
11
Q
What type of functional decline occurs first in dementia?
A
Instrumental ADLs
12
Q
Neuropsychiatric disturbance in dementia
A
Psychosis Depression Anxiety Altered circadian rhythms Agitation
13
Q
Types of dementia
A
Alzheimer’s
Vascular (step wise progression)
Lewy body (parkinsons)
Mixed Alzheimer’s and vascular
14
Q
Course of dementia
A
Symptoms diagnosis loss of functional independence behavioural problems nursing home placement death
15
Q
Features of dementia
A
INSIDIOUS ONSET WITH UNKNOWN DATE slow, gradual, progressive decline generally irreversible disorientation in late illness SLIGHT DAY TO DAY VARIATION LESS PROMINENT PHYSIOLOGICAL CHANGES consciousness clouded only in late stage normal attention span disturbed sleep - wake cycle Psychomotor changes late in illness
16
Q
Features of delirium
A
ABRUPT, PRECISE ONSET, KNOWN DATE Acute illness, lasting days or weeks Usually reversible Disorientation early in illness VARIABLE, HOUR BY HOUR PROMINENT PHYSIOLOGICAL CHANGES Fluctuating levels of consciousness short attention span disturbed sleep wake cycle; hour to hour variation n Marked early psychomotor changes
17
Q
Features of depression
A
Abrupt onset history of depression HIGHLIGHTS DISABILITIES dont know answers diurnal variation in mood fluctuating cognitive loss tries less hard to perform and gets distressed by losses short and long term memory loss depressed mood coincides with memory loss associated with anxiety
18
Q
What does a brain scan tell you about dementia?
A
The aetiology
NOT THE DIAGNOSIS
19
Q
Criteria for dementia with lewy bodies (DLB)
A
Dementia Amnesia not prominent - deficits of attention - frontal executive - visuospatial Two of these factors = probable, one = possible - fluctuation (marked, important feature) - visual hallucinations - parkinsonism Suggestive features - REM sleep disorder - severe antipsych severity - abnormal DAT scan supportive by - falls, syncope, loss of consciousness - other psychiatric symptoms - autonomic dysfunction - scans
20
Q
Diagnosis of LBD is less likely if
A
stroke disease
other brain / systemic illness
21
Q
What does a DAT scan look at?
A
Dopamine receptors
22
Q
LBD on a DAT scan
A
reuptake of dopamine transporter in the head of the caudate nucleus and putamen is reduced in the putamen, leading to the “full stop sign” instead of the “comma sign”
23
Q
Signs of Alzheimer’s on MRI
A
Brain atrophy
Gyri more obvious
24
Q
Presentation of frontotemporal dementia (FTD)
A
Behavioural disorder - personality change Can be early onset Early emotional blunting Speech disorder - altered output - sterotypy - echolalia - preservation - mutism Frontal dysexecutive syndrome Neuroimaging abnormalities in frontotemporal lobes Neurological signs commonly absent early, parkinsonism later, autonomic; incontinence, primitive reflexes Picks disease
25
Features of frontal dysexecutive syndrome
Memory
Praxis
Visuospatial function not severely impaired
26
Presentation of subcortical vascular dementia
gradual deterioration in executive function
mood changes such as apathy or irritability
memory often relatively spared
may have additional neurological features
- falls
- incontinence
- seizures
27
Why is memory often relatively spared in subcortical vascular dementia?
Due to the preservation of cortical grey matter
28
Drug treatment of dementia
```
Acetylcholinesterase inhibitors (AChl) for mild to moderate SDAT
- donepezil
```
Memantine for moderate to severe SDAT
Antipsychotics (e.g. risperidone) to manage behavioural problems and psychosis
Antidepressants (e.g. sertraline)
- to enable sleep, and to deal with mood problems and anxiety
Anxiolytics e.g. lorazepam
Hypnotics e.g. zolpidem
Anticonvulsants e.g. valproate for behavioural disturbance but not much used
29
What is there a risk of in the use of hypnotics to treat dementia?
Falls
30
What do cholinesterase inhibitors do?
```
Improve cognitive function
Slow decline
Improve non cognitive symptoms
- ADL
- longer at home
- reduce carer stress
```
31
S/Es of cholinesterase inhibitors
```
nausea, vomiting
diarrhoea
fatigue
insomnia
muscle cramps
headaches
dizziness
syncope
breathing problems
```
32
What is capacity?
Abilities relevant to competence
- understanding
- manipulating
- approaching the situation and its consequences
- communicating choices
33
When is guardianship used?
When the patient no longer has the capacity to get a power of attorney
34
What are the two types of power of attorney?
Finance
| Welfare
35
In old age psychiatry, who is most associated with suicide?
Elderly males - associations with alcohol and widowed etc
36
Normal symptoms of grief, mourning and bereavement
```
alarm
numbness
pining - illusions or hallucinations may occur
depression
recovery and reorganisation
```
37
Abnormal symptoms of grief, mourning and bereavement
```
Persisted beyond 2 months
guilt
thoughts of death
worthlessness
psychomotor retardation
prolonged or marked functional impairment
psychosis
```
38
Suicide rate for the elderly has the same rate as what age group?
< 25 y/o
39
Presentation of late onset schizophrenia like psychosis
Spectrum from circumscribed persecutory delusions to full schizophrenia like psychosis
40
Causes of late onset schizophrenia like psychosis
Sensory loss
social isolation
genetic - possible minor abnormalities
41
Treatment of late onset schizophrenia like psychosis
often needs compulsory admission
neuroepileptics
social contact
42
Prognosis of late onset schizophrenia like psychosis
May fail to regain insight
| high relapse rate if stop neuroepileptics
43
Who should not drive in dementia?
Those with poor short term memory, disorientation or lack of insight
44
Simple definition for dementia
Cognitive and functional decline > 6 months
45
Definition of dyspnogia
Poor recognition
46
Definition of dyspraxia
Motor skills
47
What makes up executive function?
```
Initiation of tasks
Inhibition (knowing when to stop)
Set shifting
Abstraction
Problem solving
```
48
What is set shifting?
Multi-tasking
49
What do you look at to see if the person is functioning?
ADLs
50
What is "reversible" dementia?
Not actually dementia, another condition causing the symptoms
51
Causes of reversible dementia
```
Normal pressure hydrocephalus
Subdural haematoma
Tumours
Neurosyphillis / HIV
Vitamin deficiencies - B12, folate
Hypothyroidism
```
52
Types of dementia
```
Alzheimers
Vascular
Mixed AD + VD
Lewy Body
Frontotemporal
Alcohol
Subcortical
Prion protein
```
53
Pathology of alzheimers dementia
Atrophy of key brain regions
54
Type of progression of alzheimers
Progressive
55
Type of progression of VD
Step wise (up and down)
56
Features of lewy body dementia
Dementia
Parkinsonism
Hallucinations
Fluctuation
57
What type of hallucinations tend to be seen in lewy body dementia?
Visual
58
Features of FTD
Behavioura
DNFA
Progressive non fluent aphasia
Semantic
59
Examples of subcortical dementia
Parkinsons
Huntingtons
HIV
60
What indicates LBD? (motor and cognitive decline)
Onset of motor and cognitive decline within 1 year
61
What indicates parkinsons dementia (motor and cogntivie decline)?
Onset of cognitive decline 1 year after motor symptoms
62
Differential diagnosis for confusion
```
Normal
Dementia
Depression
Delerium / acute confusional state
Mild cognitive impairement (mild memory impairment)
```
63
What does BPSD stand for?
Behavioural and psychological symptoms in dementia
64
Presentation of BPSD
```
Agitation
Psychosis
Affective
Disinhibition
Behaviour
```
65
How can depression be differentiated from dementia?
Depression - short history and rapid onset
