Pseudodementia
- 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
Notes- Old people are like crisps: High fat, Low water, Low protein
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