From the Guidelines
Angiograms are indicated for psych-geriatric patients when there is a strong suspicion of vascular pathology contributing to or causing psychiatric symptoms, particularly in cases of late-onset psychiatric symptoms with cognitive decline, focal neurological deficits, or atypical presentation of psychiatric disorders. The primary indications for angiography in this population include:
- Evaluation of cerebrovascular disease in patients with late-onset psychiatric symptoms
- Suspected vascular dementia, especially with stepwise deterioration or history of transient ischemic attacks
- Treatment-resistant depression or psychosis emerging after age 65, where vascular lesions affecting mood-regulating brain regions may be present
- Neuroimaging (CT or MRI) revealing abnormalities suggesting vascular malformations or stenosis According to the 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update on the diagnosis and management of patients with stable ischemic heart disease 1, coronary angiography is useful in patients with presumed stable ischemic heart disease who have unacceptable ischemic symptoms despite guideline-directed medical therapy and who are amenable to, and candidates for, coronary revascularization. However, in the context of psych-geriatric patients, the decision to proceed with angiography should be guided by a thorough risk assessment, considering the patient's cardiovascular status, renal function, and bleeding risk 1. Patients should fast for 6 hours prior to the procedure, and those on anticoagulants may need medication adjustment. The risks of contrast-induced nephropathy and radiation exposure must be weighed against potential diagnostic benefits, particularly in frail elderly patients with multiple comorbidities.
From the Research
Indications for Angiogram in Psych-Geriatric Patients
There are no direct research papers that provide indications for angiogram specifically in psych-geriatric patients. However, the following information can be gathered from the available studies:
- The studies primarily focus on patients with transient ischemic attack (TIA) or stroke, and the use of angiography in these patients.
- According to 2, CT-angiography is recommended for TIA patients to assess extra- and intracranial arteries for vascular pathologies.
- The study 3 suggests that noninvasive imaging of the cervical vessels should be performed, and noninvasive imaging of intracranial vessels is reasonable in TIA patients.
- In terms of geriatric patients, the study 4 provides guidance on the management of geriatric patients, including those with delirium, dementia, and depression, but does not specifically address the use of angiography in these patients.
- The studies 5 and 6 discuss the prognosis and outcomes of patients with TIA or stroke, including those with vascular risk factors and cerebral amyloid angiopathy, but do not provide specific indications for angiogram in psych-geriatric patients.
Key Points to Consider
- The decision to perform an angiogram in psych-geriatric patients should be based on individual patient needs and medical history.
- Patients with a history of TIA or stroke may benefit from angiography to assess vascular pathologies.
- Geriatric patients with cognitive impairment or dementia may require careful consideration before undergoing angiography.
- The presence of vascular risk factors, such as hypertension, diabetes, and hypercholesterolemia, may increase the likelihood of vascular disease and the need for angiography.
Vascular Risk Factors and Angiography
- The studies suggest that patients with multiple vascular risk factors are at higher risk of vascular disease and may benefit from angiography.
- The presence of cerebral amyloid angiopathy may also increase the risk of vascular disease and the need for angiography.
- However, the decision to perform an angiogram should be based on individual patient needs and medical history, rather than solely on the presence of vascular risk factors.