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