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