Health Whats Normal and When to Seek Professional Assessment Maria Margarita Reyes MD Facts vs Myths Older patients are more likely than younger cohorts to be referred to mental health specialists false ID: 549929
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Aging and Mental Health: What’s Normal and When to Seek Professional Assessment
Maria Margarita Reyes, MDSlide2
Facts vs Myths
Older patients are more likely than younger cohorts to be referred to mental health
specialists (false)
Major depression in later life is closely correlated with poorer self-perceived
health (true)
Men ages 65 and older have twice the rate of completed suicide than men ages 15-24 years of
age (true)
Memory loss and
significant cognitive
decline are a normal and expected part of
aging (false)
The general approach to treating depression and anxiety in the older population
should mirror
that of treating younger
adults (false)Slide3
Depression: Normal vs Abnormal
Normal
Feeling sad or irritable from time to time
Grief
Occasional insomnia
Abnormal
Feeling sad or irritable most of the time
Losing interest in people/activities
Pervasive, self deprecating thoughts
Change
in cognitive function (concentration, planning, memory
)
Change in appetite and/or
sleep patterns
Suicidal
thoughtsSlide4
Anxiety: Normal vs Abnormal
Normal
Worrying from time to time
Fear
of things that present an eminent danger
Mild nervousness when meeting new people, public speaking,
etc
Abnormal
“Fear
of
fear”
-avoidance
of situations/activities because you’re afraid of appearing anxious/having a panic attack
“Worrying
yourself
sick”
(somatization)Slide5
Cognitive decline: Normal vs abnormal
Normal
Forgetting names of people or an appointment and remembering it later
Occasional difficulty finding the right word
Occasional fender bender
Misplacing items
but
being able to retrace stepsGetting lost in unfamiliar places
Abnormal
Forgetting recent conversations
Forgetting appointments w/o any recollection
of having made
them
Forgetting common words (
eg
watch
= “hand clock”)
Inability/difficulty performing IADLs (pay bills, cooking meals, grocery shopping, using the phone)
Frequent car accidents or
“near misses”
Frequently misplacing items
w/o ability to retrace steps
Getting lost in familiar placesSlide6
Types of Major Neurocognitive Impairment
Alzheimer’s
Vascular
Lewy
body
Parkinson’s plus dementia
Frontotemporal lobular dementiaHuntington’s, Creuzfield-Jacob, HIV, AlcoholismMixed Slide7
Mild Cognitive Impairment vs Major Neurocognitive Disorder (aka dementia)
Minor Neurocognitive Impairment
Modest
cognitive decline in
>
1
domains
Domains = memory, executive function, language, visual/special reasoning
Cognitive
deficits do not interfere with independence in daily activities
Independent Activities of Daily Living (IADLS) are
preserved but may require greater effort, compensatory strategies or accommodation
No
severity specifier
Major Neurocognitive Impairment
Significant
cognitive
decline
in ≥
1
domains
Cognitive deficits interfere with independence in daily
activities
Requires assistance with
IADL’s
Severity
specifier (mild, moderate, severe)Slide8
Prevalence of Major Neurocognitive Impairment (aka dementia) with Advanced Age
Krasuski
, 2016Slide9
Medical Contributions to Dementia
Infection
(HIV/AIDS, even a bladder infection!)
Medication toxicity/unintended drug effects/ interactions
Over/under active thyroid
Vitamin deficiencies
Uncontrolled diabetesCancerStroke, heart attack,
high blood pressure, high cholesterolSlide10
Is it depression or dementia?
Krasuski
, 2016Slide11
Geriatric Psychiatry Evaluation
Review of medications
Review of health history
Basic labs
MMSE/
MoCA
(cognitive screening)+/- Brain imaging+/- Psychometric testing