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Medicine Notes Psychiatry Notes

Dementia Notes

Updated Dementia Notes

Psychiatry Notes

Psychiatry

Approximately 43 pages

Clinically-relevant notes for medical finals. Includes all the common psychiatric conditions along with notes on dementia and child psychiatry. Colour coded per topic. Easy to follow and breaks down the main presenting features and treatments (both drugs, psychological therapies and ECT)
Very useful for finals revision....

Available here

The following is a more accessible plain text extract of the PDF sample above, taken from our Psychiatry Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Dementia

Global impairment of cognition with a normal level of consciousness

Epidemiology

  • 5% prevalence in >65

  • 20% prevalence >85

Clinical features

  • Early

    • Loss of short term episodic memory

      • Autobiographical e.g times, places, events

  • Middle

    • Pervasive memory loss

    • Confabulation

    • Alterations in personality, affect and behaviour

    • Distorted interpretation of senses

      • E.g unable to recognize people’s faces

  • Late

    • Profound memory loss

    • Poor attention

    • Language deficits

    • Behaviour abnormalities

Memory and cognitive impairment

Common in all types

Memory problems Cognitive problems 3 subdivisions:

  • Short term memory is affected

  • Inability to recall information

  • Difficulty learning new skills

  • Live more in past as disease progresses

  • Disorientation to time and place=early sign

EXECUTIVE FUNCTION

  • Problem solving

  • Abstract and reasoning

  • Decision-making and judgement (e.g. do they want rx, making Will, capacity assessment by Dr needed??)

  • Planning, organising

  • Processing

VISUOSPATIAL ABILITY

  • Getting lost

  • Driving impaired

  • Copying figures

LANGUAGE

  • Reduced conversation

  • Difficulty finding words

  • Reduced vocab

  • Perseveration – shows organic cause

  • Global aphasia

Non-cognitive symptoms

Altered:

  1. Perception - hallucinate, illusions

  2. Thought - delusions

Types of Dementia

IRREVERSIBLE REVERSIBLE

Alzheimer’s

Vascular

Lewy body

Mixed (e.g. alzheimer’s +vascular)

Fronto-parietal, others including CJD, AIDS

Chronic alcohol

Metabolic – hypothyroid

Neoplastic – frontal lobe tumour

Infection -syphilis

Deficiencies – B12, Thiamine (B1), T4

Normal pressure hydrocephalus

Alzheimer’s Disease

Gradual decline in episodic memory

Mainly loss of short-term memory

Childhood memories stay intact

Aetiology

  • 5% of cases are familial

  • Earlier onset

  • Mutations on chr. 21 (amyloid precursor gene – accounts for amyloid deposition in brain. Hence Down Syndrome have earlier onset – 3x2)

Pathology

  • Progressive atrophy of cortical + subcortical structures

  • Neurofibrillary tangles

  • Amyloid senile plaques (seen in normal aging people but more in AD)

  • MRI shows specific disproportionate atrophy of the hippocampus

Treatment

  • Anticholinesterase inhibitors

    • Delay progression

    • Used because of widespread loss of neurons containing Ach

Patients usually die from pneumonia or inanition (exhaustion due to lack of nutrients)

Vascular dementia

Epidemiology:

Men>women

Usually in 60’s, pts tend to be younger than AD.

More sudden onset than Alzheimer’s

Risk factors

CV risk factors all play a role (e.g. heart disease, HF,HTN,carotid bruits, smoking etc.)

Pathogenesis

  • Step-wise progression in memory loss

  • Atherosclerosis – higher risk of MI, stroke, hypertension

  • May have focal neurological signs

Associated with multiple small infarcts in main brain vessels. Causes of this are:

  • Arteriosclerosis of main vessels

  • Thromboembolism from extracranial vessels (e.g.carotids)

  • Vasculitis

  • Haemorrhage (stroke)

Brain atrophies and ventricles enlarge.

Usually affects white matter more

Clinical features

  • Memory & cognition impairment

  • Emotional and behavioural disorders

  • Symptoms fluctuate. Confusion is common

  • Fits indicate cerebral ischaemia.

  • Emotional and personality changes can be seen before the common memory and intellect changes in some patients. Insight and personality...

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