• Symptom of depression
• Cognitive impairment, with loss of interest and concentration
• Distinguishing features:
• Won't even bother trying in MMSE
• Can specific exactly when it started (cf gradual decline in dementia)

ECT

• 80% improve
• 1/50,000 risk of injury or death (anaesthetic)
• Immediate(ish) effect
• Side effects: Headache, Short-term amnesia (can do unilaterally to reduce)

Delirium

• 50% 1-year mortality
• Pharmacological management
• Only AFTER you've tried everything else
• Haloperidol, olanzapine, lorazepam

Dementia

• Definition
• Aquired global deficit of intellect, memory, personality
• In clear consciousness
• ICD10
• Deficit in memory, cognition, executive function, personality
• For 6 months
• Epidemiology
• 5% at age 65
• Doubles every 5 years
• Types
• Alzheimers: 60%, Slow gradual decline, Predominantly cholinergic loss, Beta-amyloid, Hyperphosphorylated tau
  
• Vascular: 20%, Multiple steps down
• Lewy body: 10%, Fluctuating course
• Screen
• FBC, U+Es, LFT, ESR, TFTs, B12, Folate, Glucose, Syphilis, MSU, HIV, Heavy metals, CT, CXR, MRI
• Management
• ACh esterase inhibitors: Donepezil, Rivastigmine, Galantamine
• Antidepressants: Sertraline is very safe (cf Long QT with citalopram)
• Statins, BP control etc for vascular dementia

• Old people are like crisps: High fat, Low water, Low protein