Summary: Geriatric Psychiatry
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1 Neurocognitive Disorder/Dementia
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Non Modifiable Risk factor of Dementia
- Advancing Age: The risk for any type of dementia increases significantly for those aged 65 years and older.
- Gender: Females have a higher risk of developing dementia, particularly Alzheimer’s Disease.
- Genetics: Dementia is caused by a combination of genetic and environmental factors
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Modifiable Risk factor of Dementia
- Cardiovascular Disease: Conditions that affect heart and blood vessel health, such as hypertension, diabetes mellitus, high serum cholesterol, and obesity.
- Psychiatric Illness: Depression is identified as a major risk factor.
- Lifestyle Factors: Habits that increase risk include smoking, alcohol consumption, and physical inactivity. A lack of social engagement is also a contributing factor.
- Other Health Factors:
- Hearing impairment.
- Traumatic brain injury.
- Low levels of early-life education.
- Environmental Factors: General environmental conditions also play a role in dementia risk.
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1.1 Alzheimer's Dementia
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Cardinal signs of Alzheimer's Dementia
Progressively worsening memory loss (especially for recent events), impaired reasoning, and difficulty performing everyday tasks. -
Pathophysiology of Alzheimer's Disease
Buildup of amyloid and tau proteins -
Progression of Alzheimer's Dementia
Chronic and gradual decline -
Imaging in Alzheimer's Dementia
Hippocampal atrophy Posterior gradient atrophy -posterior (parietal ) worse thananterior (frontal ) -
Treatment of Alzheimer's Dementia
Cholinesterase inhibitor
Memantine (BPSD)
Aducanumab (treat underlying cause) -
1.2 Vascular Dementia
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Cardinal sign of Vascular Dementia
Impaired judgment, confusion, and difficulty following instructions or organizing tasks. Symptoms may appear suddenly after a stroke. -
Aetiology of Vascular Dementia
Acquired – vascular events, chr ischemia -
Progression of Vascular Dementia
- Step-wise: recurrent strokes
- Chronic progressive: chronic small vessel ischemia
- Mixture of above
Can be static if no stroke recurrence
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