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The 3 D’s of geriatric psychopathology
Dementia Work-Up
Thorough H and P, Neuro exam for focality, vital signs
ETOH Hx***
B12 or Homocysteine level, Folate
CBC and Diff, Chem Screen
HIV Risk?
?Imaging of the brain
Dementia Types
60 % Alzheimer’s Disease
15% Multi-infarct dementia
25% mix of degenerative diseases, alcohol, metabolic and infectious etiologies
Alzheimer’s Disease
Plaques & tangles
Plaques: beta amyloid w inflammation
Tangles: pleated sheets of abnl. Tau Protein
Alzheimer’s Disease genes
AP0 E4 risk genes
Differentiation of Dimentia
-Lewy body dementia
AD: slow progressive
MI: rapid, stepwise
P: 35% get dementia
LB: visual hal, parkinsons
FT: personality change
Dementia Meds
Class and examples
Anticholinesterase Inhibitors
- donepezil (Aricept)
- Rivastigmine (Exelon)
- Galantamine (Reminyl)
NMDA (N-methyl-D-Aspartate) receptor blocker
- Memantine (Namenda)
Dementia Meds efficacy
Delays NH placement by 6 months
Risks for Depression in elderly
Loss of spouse
Functional disability
Low perceived support
Female sex
Cerebrovascular changes in late onset depression
Late onset mania is usually associated with brain disease or drugs
White males over age 65 account for ____ of all completed suicides in U.S.A.
Correlates of Elderly Suicide
Social Isolation
Stressful life events
Physical Illness
Personality and Coping Style
Substance Abuse
Suicide Completers
_____ saw their PCP during the week prior
Anxiety in Late-Life
muscle tension, restlessness, fatigue, difficulty concentrating, irritability, and insomnia
most cases are secondary to Major Depression(70% of GAD)
20-40% of Late-Life MDD have GAD
resolves with Rx of the depression
Delirium: Acute Brain Failure
Decreased attention: focus, sustain or shift
Altered memory, orientation, language, mood, perception or reality testing

Waxing and waning

Onset over hours to days
Suspicion of medical cause: commonly UTI, alcohol/sedative withdrawal or drug toxicity
Delirium EEG
shows generalized slowing
_____ of elders who present with delirium in the hospital are Dx’d w dementia in 6 mo.
Treating Delirium
Treat the underlying cause
Protect the patient and others from harm
haloperidol for psychosis/agitation (may give IV)
Monitor fluids and electrolytes
Usually takes days to resolve

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