Organic Psych Flashcards
(34 cards)
Define dementia
Acquired progressive degenerative disorder giving global impairment of all mental functions and significant enough to impact ADLs, with normal consciousness lasting for >6 months
Define dementia to a lay person/patient
Dementia refers to a group of conditions that cause a decline in brain functioning that gets worse over time. People with dementia often have difficulties with memory and doing their normal daily activities like dressing + cooking.
What are the features of dementia?
- Cognitive decline: memory, spatial skills, language, abstract thinking
- Mood changes
- Abnormal behaviour eg. disinhibition
- Hallucinations and delusions
Describe the typical clinical course of dementia
- Forgetfulness
- > Disorientation
- > decreased ability to do ADLs
- > BPSD (mood change, abnormal behaviour, hallucinations + delusions)
How common in dementia?
5-10% of >65s
20% of >80s
What are the different types of dementia? Which is most common?
Alzheimer's disease: most Vascular dementia Dementia with Lewy Bodies Pick's disease/fronto-temporal dementia \+ Huntington's, CJD, Korsakoff, HIV
What is the pathophysiology of Alzheimer’s disease?
Accumulation of intracellular neurofibrillary tangles (hyperphosphorylated Tau) and extracellular beta-amyloid plaques
- > neuronal loss, especially cholinergic cells
- > generalised cortical atrophy
Describe the classic clinical presentation of Alzheimer’s
Amnesia: forgetfulness
Apraxia: difficulty with ADLs
Aphasia: loss of speech
Agnosia: poor recognition
Describe the presentation of vascular dementia
- Stepwise, rapid decrease in cognitive function
- Associated with a history of vascular disease, RFs
- Symptoms variable, include emotional lability with preserved personality and insight
Describe the presentation of dementia with Lewy bodies
- Fluctuating confusion
- Visual hallucinations eg Lilliputian hallucinations
- Falls, Parkinsonism
What is the pathophysiology of dementia with Lewy bodies?
Intracellular alpha-synuclein and ubiquitin accumulation, in the cyngulate gyrus
Describe the presentation of fronto-temporal dementia
- Marked changes in behaviour (disinhibition) and personality
- Dysexecutive syndrome: difficulties in planning, organisation, judgement
- Loss of insight
Describe the presentation of Huntington’s
In 40s-60s
- Chorea and athetosis
- Difficulties with speech + swallowing
- Dementia
What are some differential diagnoses for dementia?
Delirium Pseudodementia Korsakoff HIV, syphilis Vitamin deficiency Cushing's Hypothyroidism CJD
What is presentation of normal pressure hydrocephalus?
Triad of:
- Dementia
- Incontinence
- Ataxia
What investigations would you do for someone with suspected dementia?
- Collateral history
- Cognitive testing eg. 10-CS
- Bloods: FBC, U+Es, CRP, LFTs, bone profile, TFTs, cortisol, glucose, B12, syphilis + HIV serology
- Consider septic screen eg urine dip, CXR
- Consider CT/MRI if neuro symptoms, starting medication, psychotic symptoms
You speak to a patient in the GP and suspect they may have dementia. What would you do next?
- Collateral history
- Investigate any reversible causes eg blood tests, urine dip, hearing test, review medications
- Cognitive testing
- > refer to memory clinic
What can be used to differentiate delirium and dementia?
CAM- confusion assessment method
OSLA- observational scale of level of arousal
Which medications are used in the management of dementia and their uses.
Cholinesterase inhibitors: donepezil, rivastigmine, galantamine. Used in mild-mod Alzheimer’s, DLB
Memantine: severe Alzheimer’s, DLB when CEi are contraindicated
Describe the management of dementia
MDT approach! GP, memory clinic eg old age psych, neuro, specialist nurses, OT
Biopsychosocial approach:
-Education including driving (inform DVLA + regular assessment)
-Involvement in decision making, creating a care plan (and advance care planning)
-Medical: cholinesterase inhibitors, memantine
-Psych: group cognitive stimulation, group reminiscence therapy.
-Social: cognitive rehabilitation with OT to improve independence, carer support, activities
-Carer support: group training sessions, Carers Needs Assessment, respite. Refer to charities eg Dementia UK
What is the management of sleep problems in dementia? Depression?
Sleep: no melatonin. Recommend sleep hygiene, sunlight, activities, exercise
Depression: psychological therapies
Agitation, psychosis: antipsychotics (be careful in Parkinsons or DLB)
What are some important questions to ask when assessing risk in someone with dementia?
Risk to self: leaving the hob on, getting lost, wandering on roads. DSL if depressed.
Risk from others: victim of fraud/scams
Neglect: living alone, ability to do ADLs
Define delirium
Acute confusional state or
Transient impairment in cognition with altered consciousness
How does delirium present?
Rapid onset decline in cognitive function with altered consciousness
- Fluctuating with diurnal variation: worse at night
- Impaired concentration and attention
- Disturbed cognition (memory, thinking, orientation) and perception (delusions + hallucinations)
- Motor agitation or retardation
