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13.05.10 Old age psychiatry

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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