Abstract
AKT Answer Relating to Parkinson's Disease
Answer D. This is a common side effect of L Dopa preparations (and also Lewy body disease). This patient is likely to need an alternative — seek expert advice.
Answer D. After exclusion of simple physical causes (e.g. infection and constipation). Haloperidol would make Parkinson's disease (PD) worse.
Answer B. Depression is commonly associated with PD — as is dementia.
Answer F. End of dose deterioration is usual if L Dopa preparations are given over a number of years. While F is a reasonable short-term alternative, seek expert advice since he may benefit from other therapy (e.g. COMT inhibitors or selegeline).
AKT Answer Relating to Epilepsy and the Quality and Outcomes Framework
Answer 5. Medication review. Anticonvulsant level strongly discouraged in the well patient (i.e. no fits and no side effects).
AKT Answers Relating to Diagnosis of Dementia
The crossover between depression and dementia can be very subtle — indeed the two conditions commonly coexist. However, in the elderly depressive clues include
Unexplained or aggravated aches and pains Hopelessness Helplessness Anxiety and worries Memory problems Loss of feeling of pleasure Slowed movement Irritability Lack of interest in personal care (skipping meals, forgetting medications, neglecting personal hygiene) Dementia requires a triad of memory loss, loss of another aspect of cognitive function (as in this example) and impairment of everyday life
Recognition of dementia depends on the triad of patient report, informant history and assessment of cognitive function. Blood tests will pick up the occasional treatable cause such as B12 deficiency. CT scanning is certainly desirable and multi-infarct dementia and Alzheimer's both have suggestive appearances. It is not, however, usually diagnostic. Delirium is a more acute process commonly triggered by co-morbidity or drugs. The mini mental state is one of many tests of cognitive function — but is often favoured by specialists.