Old age psychiatry Flashcards
(27 cards)
3 Big D’s in elderly
dementia
delirium
depression
ABCD of dementia
Activities of daily living
Behavioural and psychiatric symptoms of dementia
Cognitive impairment
Decline
What else in needed in the ABCD of dementia?
collateral history
flexible cognitive testing
Cognitive features of dementia
memory plus 1 of - dysphasia -dysgnosia - dyspraxia - dysexecutive function functional decline - ADL
Neuropsychiatric disturbance of dementia
depression anxiety circadian rhythm altered agitation psychosis
BPSD of dementia
paranoia
aggression
anxiety
hallucinations etc
Ockham’s razor of dementia
Alzheimer's = 50% Vascular = 25% 15% - mixture of both DLB = 5% other = 5%
Course of dementia
symptoms diagnosis loss of functional independence behavioural problems nursing home placement death
Diagnosing AD in primary care
symptoms suggesting cognitive impairment
history and collateral, MSE, physical and bloods, cognitive assessment
exclude delirium, depression
brain scan, neuropsychology
Best view to assess atrophy of medial temporal lobes
T1 weighted MRI scans
SPECT
helps to determine aetiology by looking at blood flow
Dementia with Lewy bodies
attention, frontal executive, visuospatial
visual hallucinations, parkinsonism, fluctuation
DAT scan abnormal
syncope, falls
DAT scan use
DLB
dopamine - comma with caudate nucleus and putamen
“full stop” sign
Pick’s disease
fronto-temporal dementia
knife blade gyri
Fronto-temporal dementia
behavioural disorder - personality change
speech disorder
frontal dysexecutive syndrome
brain scan
Subcortical vascular dementia
gradual deterioration in executive function, mood (apathy)
memory relatively spared
falls, incontinence, seizures
Drug treatment of dementia
Acholinesterase inhibitors memantine antipsychotics anxiolytics antidepressants anticonvulsants hypnotics
Cholinesterase inhibitors
improve cognitive function
slow decline
SE = N&, syncope, muscle cramps, fatigue
Neuroleptics
controversial - efficacy, death
Capacity
decision specific
act, make, communicate, remember and understand
Power of attorney
finance
welfare
Guardianship
finance or welfare
lack capacity to grant POA
GP and psychiatrist certificate
detailed MHO report
What else apart from dementia?
depressive symptoms or illness anxiety disorders mania schizophrenia alcohol suicide
Abnormal grief
> 2 months
guilt
thoughts of death
psychosis
