+ All Categories
Home > Documents > Old Age Psychiatry: Principles and Assessment

Old Age Psychiatry: Principles and Assessment

Date post: 30-Jan-2022
Author: others
View: 0 times
Download: 0 times
Share this document with a friend
Embed Size (px)
of 43 /43
Old Age Psychiatry: Principles and Assessment George Tadros Clinical Director of Urgent Care pathway, BSMHFT Professor of Liaison Psychiatry and Dementia, Aston Medical School Professor of Dementia Care in Acute Hospitals, University of Chester
Cognition and AgingMedical School
of Chester
• Diseases
• Medications
• Frail body, reduced BMI
Crystallized Vs Fluid intelligence
– Crystallized intelligence (e.g. knowledge)
– Fluid intelligence (native wit)
• Tested by IQ test.
Bridge and chess
• Strong correlation; sensory abilities & intellectual skills
• Visual & auditory acuity account for 49% of the recorded variance of the difference in intelligence in the elderly.
– Impaired metabolic and cardiovascular systems.
– Decline in CNS transmission speed, cell loss & increased neural noise.
Psychological effect
– What are the possible problematic confounders?
• Different generations
• Materialistic differences
• Effect of education
• How to control??!!
The peak of intellectual performance is around 25 years of age, and gradually decline thereafter.
Longitudinal Studies
– Drop out effect (less well more likely to drop out)
– Still cohort study.
Intellectual functions remain static till about the age of 53, then start to decline.
60-80 years; great individual variations, 60- 80% remain stable or improving.
80-100 decline in all subtests
Ageing and cognitive decline
Age related cognitive can occur in the healthiest elderly person.
The normal elderly less frequently experience impairment in cognitive areas other than memory.
Not universal but variable
Slowing of intellectual and physical performance but maintain reasonable level of functioning.
Other factors associated with age: • Illness
• Medications
Slowed neuronal processing
Accentuation of personality traits • Decreased flexibility and tolerance to change
• Decreased excitability & impulsivity; more cautious
Ageing and intelligence: • Preserved crystalized intelligence
• Decreased fluid intelligence
Decrease in naming ability
Decreased retrieval of stored memory
Language relatively well spared
What is Cognition?
basic capacities such as perception,
language, behaviour, actions, memory and
thoughts in order to interact appropriately
with the world.
Assessment of Cognition
Attention and Concentration
3. RETRIEVAL - locate and retrieve on request
Forgetting – Loss and decay
Where is memory based?
system (Hippocampus, Parahippocampal
temporal neocortex.
100% of all individuals over ??
50% of all individuals in nursing homes.
820,000 persons in the UK.
People with/without dementia
Census 2001 : 20% above the age of 65. • How many in Birmingham?
750,000 in UK today with dementia.
More with cognitive impairment …!!
37% in institutional care
13% live alone, usually supported by a carer.
Size and cost of Dementia It is estimated that 35.6 million people living with
dementia worldwide in 2010, – increasing to 65.7 million by 2030 and 115.4 million by
– The total estimated worldwide costs of dementia are US$604 billion in 2010.
– The United Dementia Republic • What if dementia was a republic in terms of population economy? • It would have ranked 18th Largest economy in the world
About 70% of the costs occur in Western Europe and North America.
Approximately 30% of the total annual cost of AD is invested in the direct management of BPSD.
820,000 people with dementia in the UK – The cost of dementia care exceeds that of cancer, heart
disease and stroke combined. – £17 billions/ year – Triple to £50 billions/ year over the next 30 years
Definition of dementia
multiple areas of intellectual function, not
due to delirium.
three or more of the following nine
spheres of mental activities:
– Memory, language, perception, praxis,
calculation, conceptual or semantic
knowledge, executive functions, personality,
– Memory (STM & LTM)
– Visiuo-special awareness.
In mid-frontal area, superior temporal area, parietal area and hippocampus.
Limbic system is primarily affected.
cell loss in nucleus basalis of Meynert reduce acetyl- transferase reduce acetyl choline. NFT
Intracellular structures.
particularly in hippocampus.
of the tangles.
Plaques not seen in white matter
No. of plaques = impairment of
cognitive functions.
Causes and types of dementia
Not just due to aging but increased risk with age. – Alzheimer’s disease
– Vascular dementia (multiple infarctions)
– Dementia of Lewy Body
1. Parkinsonian signs
2. Speech impairment
3. Cognitive impairment
Behavioural and Psychological
• Agitation, pacing,
Daily burden
Infections e.g. AIDS, Syphilis.
Wilson’s disease.
I. Causes Psychological
Biological Disease (vascular pathology, Parkinson, Degeneration)
Medication (Hypotensives, antibiotics .... Etc)
Older people tend not to complain about depression
More somatic symptoms
Psychomotor retardation
Memory impairment
Poor concentration
is different from younger
is different from younger
Psychological symptoms CBT
Difficulty with accessibility
ECT Severe depression
• Late onset Psychosis
Late Onset Psychosis
?? Charles Bonnett Syndrome
Physical symptoms