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53 Cards in this Set
- Front
- Back
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What are some Neurobiology changes that accoru w/ aging?
-Brain? |
Atrophy (13% volume loss) and leukoariosis
Neuron loss and shrinkage Astrocytes increase in size and number Pigment accumulation (lipofuscin, melanin) -Increase in pathologic entities (beta amyloid, abnormal T, alpha-synuclein |
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What are some Neurobiology changes that accoru w/ aging?
-Sensory? |
Receptor strcutres
Loss of receptors Decline in acuity |
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What are some Neurobiology changes that accoru w/ aging?
-Motor change |
-loss of anterior horn cells
-loss of muscle fiber (50% by age 80) -loss of strength |
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During normal cognitive aging, what is the one area that increases (as opposed to decreasing w/ time)?
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Verbal knowledge
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What are some things that decrease of Normal congnitive aging?
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WOrking memory
Short term memory Long-term memory Speed of processing |
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Why might it be difficult to do a psychiatric evaluation of someone w/ geriatric psychiatric disorders?
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-less likely to offer mental health complaint or endorse symptoms on inquiry (stigma, stoic, vocabulary)
-Might need to turn to collateral source to see if having problems |
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What are the levels of memory coming from environmental input?
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environmental input ->
Sensory memory -> Primary Memory -> Secondary Memory -> Tertiary memory |
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What is the syndrome?
+ Primary memory (immediate, working) - Secondary memory (recent) + Tertriary (remote) |
Amnesia
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What is the syndrome?
+ Primary memory (immediate, working) - Secondary memory (recent) - Tertriary (remote) |
Dementia
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What is the syndrome?
- Primary memory (immediate, working) - Secondary memory (recent) +/- Tertriary (remote) |
Delirium
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What are common Geriatric psychiatric disorders?
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-Mild congnitive impairment
-Dementia -Confusional State -Depression -Schizophrenia |
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-Alzheimer DZ
-Vascular -Lewy body DZ - Fronto-temporal DZ may all cause? |
Dementia
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MILD COGNITIVE IMPAIRMENT diagnostic criteria?
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-Subjective complaint (paitent or informant-reported abnormal decline in congition); OR
-Physician detected abnormal decline in congnition; AND -One or more cognitive test scores 1.5 SD below the mean of same age peers; AND -Normal activities of daily living |
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What can Mild Cognitive Impairment become over time?
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Can REVERT
-Be STABLE -Convert to DEMENTIA |
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What are some clinical features of Mild Cognitive Impairment?
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-5-25% prevalence (varies w/ criteria and sample)
-Multiple subtypes (4) single vs multi-domain amnestic vs non-amnestic -Multiple causes AD, LBD, FTD, Stroke, TBI, MS -Heterogeneous outcome -Treatment/mangagment dependent on presumed etiology |
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Diagnostic Criters (DSM-IV) Dementia
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-memory impairment
-impairment in oantoehr area of cognition (aphasia, apraxia, agnosia, executive dysfunction) -interferes w/ work/social fx and represents DECLINE -NOT due to delirium -Evidence of specific medical factor -Specific criteria for suspected causes |
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What are some suspected causes fo dementia?
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-Alzheimer
Frontotemporal Lew Body Vascular Etc |
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about what % persons age 65+ affected by dementia?
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8%
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about what % persons age 85+ affected by dementia?
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33%
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4.5 million americans affected in 2000
-4th leading cause of death in developed countries |
Dementia
*huge economic consts - $67 billion in 1991 |
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Alzheimer DZ: clinical feature:
-age of onset? |
mid-70's
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Alzheimer DZ: clinical feature:
Presentation? |
-insidious onset and slowly progressive memory loss
-personality preserved early on -awareness variable, usually declines over time -anxiety (10%) and depression (16%) can occur at any time -Hallucinations (6%) and delusions (12%) late features -Normal PE and NE |
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Alzheimer DZ: clinical feature:
Diagnosis occurs? |
1-2 years after onset
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Alzheimer DZ: clinical feature:
Lifespan? |
median survival 3-5 years after diagnosis
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Alzheimer DZ Pathology:
Brain size? |
brain atrophy due to synapse and neuron loss
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Alzheimer DZ Pathology:
-plaque? |
Senile plaque containing beta-amyloid
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Alzheimer DZ Pathology:
-neurofibrillary tangles? |
Neurofibrillary tangles composed of abnormal tau
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Vascular Dementia
Age? |
older adult
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Vascular Dementia
Prevalence? |
10-15%
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Vascular Dementia
Presentations? |
Stepwise
Single strategic Progressive |
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Vascular Dementia
Criteria NINDS/AIRENS |
-focal signs
-brain imaging CVD -Time lock |
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Vascular Dementia
Pathology? |
infarction, hemorrhage
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Vascular Dementia
Tx? |
HTN, DM, Statins, Folic acid, antithrombotics, Donepezil
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Vascular Dementia Subtypes?
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-Multi-infarct dementia (MID)
-Strategic single infarct -Small vessel DZ (lacunar state or Binswanger DZ) |
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What are some parts of the brain that Strategic single infarct can affect to cause vascular dementia?
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-Angular gyrus
-Caudate -Globus pallidus -Thalamus |
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Diffuse Lewy Body DZ:
-onset? |
50-83 years
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Diffuse Lewy Body DZ:
-Prevalence? |
10%
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Diffuse Lewy Body DZ:
Clinical features? |
-Gradual onset and progression
-Visuospatial worse than memory -Fluctuating consciousness -Hallucinations (usually VISUAL) -Falls (parkinsonism) |
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Diffuse Lewy Body DZ:
Pathology? |
-Lewy body
-Alpha-synuclein -ubiquitin |
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Fronto-temporal dementia:
-Age? |
30-75 years
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Fronto-temporal dementia:
-Prevalence |
<5% (higher if onset <65 y)
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Fronto-temporal dementia:
Onset? |
Insidious onset, gradually progressive
-marked personaliy change -disturbance to language -executive deficits>memory loss (early) |
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Fronto-temporal dementia:
Pathology? |
Tau-positive incluions (pick bodies)
-F-T neuon loss, no U+ or T+ inclusions (DLDH) -F-T neuron loss, U+/T- inclusions (MND) |
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-Alteration in consciousness and attention
-Cognition and perceptual distrubances -acute or subacute onset -Fluctuating course -Associated w/ medical illness, toxic or metabolic state, substance w/drawal |
Confusional State (delirium)
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Compared to patients w/ typical-onset depression, patients w/ LLD have
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-less frequent family Hx of depression
-Higher prevalence of dementia -More impairment on cognitive tests -Higher rates of dementia on follow-up -larger ventricles -more white matter hyperintensities |
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Because of the characteristics of Late-life depression, it is thought that LLD is due to
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Neurological brain disorder
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How do suicide rates in the elderly compare w/ normal population?
-men/women? |
Higher
-Higher for older MEN than for older women -Higher for WHITES than NON-WHITES |
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What usually causes secodary psychoses (Late-life psychosis)
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-Dementia
-Brain disorder |
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What usually causes Primary psychoses (Late-life psychosis)
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Schizophrenia
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What are some of the characteristics of Psychosis associated w/ dementia as opposed to Primary psychosis (due to Schizophrenia)?
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Dementia-
Hallucinations more frequently VISUAL -Auditory hallucinations tend NOT to be COMMAND -Delusions often involve THEFT, NOT Grandiosity |
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Late-onset schizophrenia is usually characterized by what age?
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first onset after age 40, sometimes 45
-3% of hospitalized schizo patient first presented after age 60 -women affected 2-10 times more often than men |
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With late-onset schizophrenia, are cognitive deficits progressive?
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NO, they are present but non-progressive
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What is some of the Tx options for Late-onset schizophrenia?
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Pharmacotherapy
ECT Psychotherapy Inpatient and Partial hopsitalization C-L Psychiatry |
