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Psych CASC / OSCEOld age psychiatry — neurocognitive disorders

Psych CASC / OSCE · Old age psychiatry — neurocognitive disorders

Explain vascular cognitive impairment and risk-factor plan to patient and son — CASC communication station

MRCPsych/FRANZCP-style communication station: explain VCI phenotype, secondary prevention as the main lever, modest drug evidence, safety-net for delirium/new stroke, and check understanding.

communication2 min readVerification in progress

Target exams

FRANZCPMRCPsychABPNMD-DNB
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Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
A 76-year-old man with stepwise cognitive decline after strokes and his adult son want a plain-language explanation of vascular cognitive impairment versus Alzheimer disease, why blood pressure and smoking matter more than expecting a miracle tablet, and what monitoring looks like if a cholinesterase inhibitor is trialled.

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the old-age/memory clinic. [1][4]

Candidate instructions. Explain vascular cognitive impairment in plain language; contrast with typical Alzheimer disease without overwhelming jargon; explain why controlling blood pressure, diabetes, smoking, and preventing further strokes is the main treatment; outline that memory tablets may give only modest benefit if used; safety-net acute confusion or new stroke symptoms; address driving/finances at a high level; check understanding with teach-back. Examiner plays the patient; a second role-player may be the son. [1][2][3]

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You have read the opening of this CASC / OSCE. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship library.

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References5ShowHide
  1. [1]O'Brien JT, Thomas A Vascular dementia Lancet, 2015.PMID 26595643
  2. [2]Williamson JD, Pajewski NM, Auchus AP, et al. Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial JAMA, 2019.PMID 30688979
  3. [3]Kavirajan H, Schneider LS Efficacy and adverse effects of cholinesterase inhibitors and memantine in vascular dementia: a meta-analysis of randomised controlled trials Lancet Neurol, 2007.PMID 17689146
  4. [4]Gorelick PB, Scuteri A, Black SE, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association Stroke, 2011.PMID 21778438
  5. [5]Appelbaum PS, Grisso T Assessing patients' capacities to consent to treatment N Engl J Med, 1988.PMID 3200278
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