Old Age Psychiatry

Question 1

What is the ABCD of dementia?

Answer 1

A - affect on activities of daily living (ADLs)

B - behavioural and psychiatric symptoms

C - cognitive impairment

D - decline

Question 2

What are the behavioural symptoms (B)?

Answer 2

Agitation

Altered circadian rhythm

Personality change

Question 3

What are the psychiatric changes in dementia?

Answer 3

Anxiety
Depression
Psychosis

Question 4

What are the 4 D’s of cognitive impairment in dementia?

Answer 4

Dysphasia
Dyspraxia
Dysgnosia
Dysexecutive function

Question 5

What is dysphasia?

Answer 5

Loss of ability to express/understand

Question 6

What is dysgnosia?

Answer 6

Loss of sense of “whereness”

Question 7

What other part of cognition is impaired in dementia apart from dysphasia, dyspraxia, dysgnosia and dysexecutive function?

Answer 7

Memory

Question 8

What is the course of alzheimers disease?

Answer 8

Symptoms –> diagnosis –> loss of ADL’s –> Behavioural decline –> moved to a home –> death

Question 9

What are the main differences between alzheimers and delerium?

Answer 9

Alzheimers

• Gradual onset
• Day to day variability
• Normal attention span
• Disturbed sleep wake cycle
• Disorientation, psychomotor changes and consciousness changes only occur late in disease

Delerium

• Very acute illness with abrupt onset
• Presents with hourly variation and reduced attention spans
• Disorientation/psychomotor and consciousness changes occur earlier on

Question 10

What is a typical difference between depression and delerium/dementia?

Answer 10

Depression presents with a lot of “don’t know” answers as apposed to the others where the patient tries to remember but can’t

Also associated with anxiety more than the other two

Question 11

What are investigations for older people presenting with symptoms of dementia?

Answer 11

Collateral history most important

MMSE
MOCA
Addenbrookes clinical assessment (ACE)

Bloods

Specialist referral

Question 12

What is the MOCA good for?

Answer 12

Delerium

Question 13

What bloods should be tested?

Answer 13

B12

Thiamine

Question 14

What imaging should be done?

Answer 14

MRI head - alzheimers

DATscan

Question 15

What will be seen on MRI in alzheimers?

Answer 15

Marked temporal atrophy in early

General atrophy later

Question 16

What does a DATscan test for?

Answer 16

Lewy body dementia

Question 17

What does a DATscan show normally and in lewy body?

Answer 17

Normal - comma like uptake of dopamine

Lewy body - marked loss of dopamine uptake

Question 18

What must never be forgotten in delerium?

Answer 18

SEPSIS

Question 19

What score is used for sepsis?

Answer 19

SOFA score

Sequential organ failure score

Question 20

Treatment of sepsis?

Answer 20

Sepsis 6

Question 21

What is the SEPSIS 6?

Answer 21

All must occur within 1hr of presentation

• Fluid challenge
• O2 therapy
• Broad spectrums
• Blood cultures
• Lactate
• Urine output

Question 22

Treatment of alzheimers?

Answer 22

Cholinesterase inhibitors

• Rivastigmine
• Donepezil

NMDA receptor antagonists
- Memantine

Question 23

What psych drugs are helpful in alzheimers?

Answer 23

Antipsychotics
- Risperidone

Antidepressants
- SSRIs