from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.util import Inches, Pt
from io import BytesIO

# ─── Colour palette ───────────────────────────────────────────────────────────
NAVY      = RGBColor(0x0D, 0x2B, 0x55)   # dark navy – header bg
TEAL      = RGBColor(0x00, 0x7B, 0x8A)   # teal accent
LIGHT_BG  = RGBColor(0xF0, 0xF4, 0xF8)   # very light blue-grey slide bg
WHITE     = RGBColor(0xFF, 0xFF, 0xFF)
DARK_TXT  = RGBColor(0x1A, 0x1A, 0x2E)
ACCENT    = RGBColor(0xE8, 0x6C, 0x2A)   # orange accent for highlights
GREY      = RGBColor(0x5A, 0x5A, 0x6A)

prs = Presentation()
prs.slide_width  = Inches(13.333)
prs.slide_height = Inches(7.5)
blank = prs.slide_layouts[6]


# ─── Helper functions ─────────────────────────────────────────────────────────
def add_rect(slide, x, y, w, h, fill_color=None, line_color=None, line_width_pt=0):
    from pptx.util import Pt as _Pt
    shape = slide.shapes.add_shape(
        1,  # MSO_SHAPE_TYPE.RECTANGLE
        Inches(x), Inches(y), Inches(w), Inches(h)
    )
    shape.line.fill.background()  # transparent line by default
    if fill_color:
        shape.fill.solid()
        shape.fill.fore_color.rgb = fill_color
    else:
        shape.fill.background()
    if line_color:
        shape.line.color.rgb = line_color
        shape.line.width = _Pt(line_width_pt)
    return shape


def add_text(slide, text, x, y, w, h,
             font_name="Calibri", size=18, bold=False, italic=False,
             color=DARK_TXT, align=PP_ALIGN.LEFT, valign=MSO_ANCHOR.TOP,
             wrap=True):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.vertical_anchor = valign
    tf.margin_left  = Pt(4)
    tf.margin_right = Pt(4)
    tf.margin_top   = Pt(4)
    tf.margin_bottom= Pt(4)
    p = tf.paragraphs[0]
    p.alignment = align
    r = p.add_run()
    r.text = text
    r.font.name  = font_name
    r.font.size  = Pt(size)
    r.font.bold  = bold
    r.font.italic= italic
    r.font.color.rgb = color
    return tb


def add_bullet_slide(slide, title_text, bullets, subtitle=None):
    """Standard content slide with header bar and bullet list."""
    # Background
    add_rect(slide, 0, 0, 13.333, 7.5, fill_color=LIGHT_BG)
    # Header bar
    add_rect(slide, 0, 0, 13.333, 1.1, fill_color=NAVY)
    # Accent strip
    add_rect(slide, 0, 1.1, 13.333, 0.06, fill_color=TEAL)
    # Title text
    add_text(slide, title_text, 0.25, 0.08, 12.5, 0.95,
             size=28, bold=True, color=WHITE, valign=MSO_ANCHOR.MIDDLE,
             align=PP_ALIGN.LEFT)
    if subtitle:
        add_text(slide, subtitle, 0.25, 1.2, 12.5, 0.4,
                 size=14, italic=True, color=TEAL)
    # Bullets
    y_start = 1.65 if subtitle else 1.35
    tb = slide.shapes.add_textbox(Inches(0.5), Inches(y_start),
                                  Inches(12.5), Inches(7.5 - y_start - 0.3))
    tf = tb.text_frame
    tf.word_wrap = True
    for i, (indent, text) in enumerate(bullets):
        p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
        p.level = indent
        p.space_before = Pt(4 if indent == 0 else 2)
        r = p.add_run()
        r.text = ("• " if indent == 0 else "  ‒ ") + text
        r.font.name = "Calibri"
        r.font.size = Pt(16 if indent == 0 else 14)
        r.font.bold = (indent == 0)
        r.font.color.rgb = DARK_TXT if indent == 0 else GREY
    return slide


def add_two_col_slide(slide, title_text, left_title, left_bullets,
                      right_title, right_bullets):
    """Two-column layout slide."""
    add_rect(slide, 0, 0, 13.333, 7.5, fill_color=LIGHT_BG)
    add_rect(slide, 0, 0, 13.333, 1.1, fill_color=NAVY)
    add_rect(slide, 0, 1.1, 13.333, 0.06, fill_color=TEAL)
    add_text(slide, title_text, 0.25, 0.08, 12.5, 0.95,
             size=28, bold=True, color=WHITE, valign=MSO_ANCHOR.MIDDLE)

    # Divider line
    add_rect(slide, 6.55, 1.25, 0.04, 6.0, fill_color=TEAL)

    for col, (col_title, col_bullets) in enumerate([
            (left_title, left_bullets), (right_title, right_bullets)]):
        x = 0.4 if col == 0 else 6.75
        add_text(slide, col_title, x, 1.3, 5.8, 0.45,
                 size=17, bold=True, color=TEAL)
        tb = slide.shapes.add_textbox(
            Inches(x), Inches(1.85), Inches(5.9), Inches(5.4))
        tf = tb.text_frame
        tf.word_wrap = True
        for i, (ind, text) in enumerate(col_bullets):
            p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
            r = p.add_run()
            r.text = ("• " if ind == 0 else "  ‒ ") + text
            r.font.name  = "Calibri"
            r.font.size  = Pt(14 if ind == 0 else 13)
            r.font.bold  = (ind == 0)
            r.font.color.rgb = DARK_TXT if ind == 0 else GREY
            p.space_before = Pt(3)


# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 1 – Title slide
# ══════════════════════════════════════════════════════════════════════════════
s1 = prs.slides.add_slide(blank)
add_rect(s1, 0, 0, 13.333, 7.5, fill_color=NAVY)
add_rect(s1, 0, 5.5, 13.333, 2.0, fill_color=TEAL)
add_rect(s1, 0, 5.45, 13.333, 0.1, fill_color=ACCENT)

add_text(s1,
    "PERSONALITY CHANGES IN THE ELDERLY",
    0.5, 1.2, 12.3, 1.5,
    size=38, bold=True, color=WHITE,
    align=PP_ALIGN.CENTER, valign=MSO_ANCHOR.MIDDLE)

add_text(s1,
    "Aetiopathogenesis  •  Clinical Presentation  •  Identification  •  Functional Changes\n"
    "Acute Care  •  Stabilization  •  Management  •  Rehabilitation",
    0.5, 2.8, 12.3, 1.4,
    size=18, color=RGBColor(0xCC, 0xE8, 0xFF),
    align=PP_ALIGN.CENTER, valign=MSO_ANCHOR.MIDDLE)

add_text(s1,
    "General Medicine  |  4th Year UG",
    0.5, 5.7, 12.3, 0.6,
    size=16, bold=True, color=WHITE,
    align=PP_ALIGN.CENTER)

add_text(s1,
    "Presented by: ________________________________\n"
    "Department of General Medicine",
    0.5, 6.35, 12.3, 0.8,
    size=13, italic=True, color=RGBColor(0xCC, 0xE8, 0xFF),
    align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 2 – Overview / Outline
# ══════════════════════════════════════════════════════════════════════════════
s2 = prs.slides.add_slide(blank)
add_rect(s2, 0, 0, 13.333, 7.5, fill_color=LIGHT_BG)
add_rect(s2, 0, 0, 13.333, 1.1, fill_color=NAVY)
add_rect(s2, 0, 1.1, 13.333, 0.06, fill_color=TEAL)
add_text(s2, "Overview", 0.25, 0.08, 12.5, 0.95,
         size=28, bold=True, color=WHITE, valign=MSO_ANCHOR.MIDDLE)

topics = [
    "1.  Introduction & Epidemiology",
    "2.  Normal Aging vs Pathological Personality Change",
    "3.  Aetiopathogenesis",
    "4.  Clinical Presentation",
    "5.  Identification & Diagnostic Tools",
    "6.  Functional Changes",
    "7.  Acute Care & Stabilization",
    "8.  Management",
    "9.  Rehabilitation",
    "10. Summary & Take-Home Points",
]
for i, topic in enumerate(topics):
    col = i % 2
    row = i // 2
    x = 0.6 + col * 6.5
    y = 1.4 + row * 1.1
    add_rect(s2, x, y, 6.0, 0.9,
             fill_color=TEAL if col == 0 else NAVY,
             line_color=None)
    add_text(s2, topic, x + 0.15, y + 0.05, 5.7, 0.8,
             size=14, bold=False, color=WHITE,
             valign=MSO_ANCHOR.MIDDLE)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 3 – Introduction & Epidemiology
# ══════════════════════════════════════════════════════════════════════════════
s3 = prs.slides.add_slide(blank)
add_bullet_slide(s3,
    "Introduction & Epidemiology",
    [
        (0, "Definition"),
        (1, "Personality = the stable, enduring pattern of thinking, feeling, and behaving that defines an individual"),
        (1, "Personality CHANGE = a significant deviation from previous baseline patterns – new onset in older age"),
        (0, "Epidemiology"),
        (1, "Global population ≥ 65 years projected to reach 1.5 billion by 2050 (WHO)"),
        (1, "Personality disorders prevalent in 6–33% of older adults depending on setting"),
        (1, "Organic personality changes seen in up to 40–60% of dementia patients"),
        (1, "Behavioural and psychological symptoms of dementia (BPSD) affect ~90% at some point"),
        (0, "Why it matters"),
        (1, "Leading cause of caregiver burden, institutionalisation, and reduced quality of life"),
        (1, "Often the earliest or most prominent presenting symptom of underlying organic disease"),
        (1, "Treatable – early identification changes outcome"),
    ]
)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 4 – Normal vs Pathological
# ══════════════════════════════════════════════════════════════════════════════
s4 = prs.slides.add_slide(blank)
add_two_col_slide(s4,
    "Normal Aging vs Pathological Change",
    "Normal / Expected Changes",
    [
        (0, "Increased agreeableness & conscientiousness"),
        (0, "Decreased neuroticism with advancing age"),
        (0, "Reduced novelty-seeking / risk-taking"),
        (0, "Gradual slowing of cognitive processing speed"),
        (0, "Greater emotional regulation & equanimity"),
        (0, "Use of mature coping mechanisms"),
        (0, "Increased reflection and life review"),
    ],
    "Pathological / Alarming Changes",
    [
        (0, "Sudden or rapid personality shift from baseline"),
        (0, "Disinhibition, impulsivity, inappropriate behaviour"),
        (0, "Marked apathy – loss of initiative & motivation"),
        (0, "New aggression, suspiciousness, paranoia"),
        (0, "Emotional dysregulation – lability, rage episodes"),
        (0, "Social withdrawal + functional decline"),
        (0, "Interferes with ADLs or causes safety concerns"),
    ]
)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 5 – Aetiopathogenesis (Part 1 – Organic)
# ══════════════════════════════════════════════════════════════════════════════
s5 = prs.slides.add_slide(blank)
add_bullet_slide(s5,
    "Aetiopathogenesis – Organic Causes",
    subtitle="Neurological, Metabolic & Systemic",
    bullets=[
        (0, "Neurodegenerative Disorders (most common)"),
        (1, "Alzheimer's disease – depression, anxiety, apathy; paranoid delusions in moderate stage; personality change may precede memory loss"),
        (1, "Frontotemporal Dementia (Pick's) – frontal lobe disinhibition → dramatic behavioural change, social inappropriateness, loss of empathy"),
        (1, "Parkinson's disease – apathy, depression, psychosis; DLB associated with vivid visual hallucinations"),
        (1, "Huntington's disease – irritability, impulsivity, obsessive features"),
        (0, "Cerebrovascular Disease"),
        (1, "Vascular dementia – stepwise decline; lacunar infarcts in frontosubcortical circuits → emotional lability, pseudobulbar affect"),
        (1, "Strategic infarct (thalamus, basal ganglia, cingulate, orbitofrontal cortex) → personality change"),
        (0, "Metabolic & Endocrine"),
        (1, "Hypothyroidism – depression, apathy, slow cognition"),
        (1, "Hyperthyroidism – anxiety, agitation, emotional lability"),
        (1, "Hypo/hyperglycaemia, hypo/hypernatraemia, uraemia, hepatic encephalopathy"),
        (1, "Vitamin B12 / folate deficiency – personality change, mania, paranoid delusions"),
        (0, "CNS Lesions"),
        (1, "Frontal/temporal lobe tumours, subdural haematoma, normal pressure hydrocephalus"),
        (1, "CNS infections: neurosyphilis, HIV encephalopathy, herpes encephalitis, prion disease"),
    ]
)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 6 – Aetiopathogenesis (Part 2 – Psychosocial + Pathophysiology)
# ══════════════════════════════════════════════════════════════════════════════
s6 = prs.slides.add_slide(blank)
add_two_col_slide(s6,
    "Aetiopathogenesis – Psychosocial & Pathophysiology",
    "Psychosocial Factors",
    [
        (0, "Bereavement & loss of spouse"),
        (0, "Retirement – loss of identity and purpose"),
        (0, "Social isolation and loneliness"),
        (0, "Caregiver stress and role reversal"),
        (0, "Financial insecurity / relocation"),
        (0, "Pre-existing personality disorder – exacerbated by stressors of aging"),
        (0, "Polypharmacy – steroids, benzodiazepines, anticholinergics, opioids, levodopa"),
        (0, "Substance use – alcohol most common"),
        (0, "Sensory deficits (hearing/vision loss) → social withdrawal, misinterpretation"),
    ],
    "Pathophysiology",
    [
        (0, "Frontosubcortical circuit disruption"),
        (1, "Orbitofrontal → disinhibition"),
        (1, "Anterior cingulate → apathy"),
        (1, "Dorsolateral PFC → cognitive dysexecutive"),
        (0, "Neurotransmitter changes with aging"),
        (1, "↓ Dopamine – anhedonia, apathy"),
        (1, "↓ Serotonin – depression, aggression"),
        (1, "↓ Acetylcholine – cognitive & behavioural"),
        (1, "↑ MAO activity – depressive change"),
        (0, "Amyloid / tau pathology in limbic system"),
        (0, "White matter hyperintensities → emotional dysregulation"),
        (0, "HPA axis dysregulation → chronic cortisol → hippocampal damage"),
    ]
)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 7 – Clinical Presentation
# ══════════════════════════════════════════════════════════════════════════════
s7 = prs.slides.add_slide(blank)
add_bullet_slide(s7,
    "Clinical Presentation",
    subtitle="Spectrum of Behavioural & Psychological Symptoms",
    bullets=[
        (0, "Affective Symptoms"),
        (1, "Depression (most common) – dysphoria, tearfulness, early morning waking, loss of interest"),
        (1, "Anxiety – excessive worry, restlessness, somatic complaints"),
        (1, "Emotional lability – abrupt mood swings, crying, laughter without cause"),
        (0, "Behavioural Symptoms"),
        (1, "Agitation – verbal aggression, pacing, resistiveness to care"),
        (1, "Disinhibition – sexual, social, verbal (frontal release)"),
        (1, "Apathy – flat affect, loss of motivation (most common in FTD, Parkinson's)"),
        (1, "Impulsivity – reckless decisions, wandering, self-neglect"),
        (0, "Psychotic Symptoms"),
        (1, "Paranoid delusions – 'people are stealing from me', misidentification syndromes (Capgras)"),
        (1, "Hallucinations – visual > auditory; VH especially in DLB and Parkinson's"),
        (0, "Neurovegetative Changes"),
        (1, "Insomnia / hypersomnia, appetite change, weight loss, reduced libido"),
        (0, "Social Symptoms"),
        (1, "Withdrawal from family, hobbies; refusal to eat; caregiver conflict"),
        (1, "Early: patient may compensate by avoiding challenging situations (Rosen's EM)"),
    ]
)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 8 – Identification & Diagnostic Tools
# ══════════════════════════════════════════════════════════════════════════════
s8 = prs.slides.add_slide(blank)
add_bullet_slide(s8,
    "Identification & Diagnostic Tools",
    subtitle="ICD-11 / DSM-5 Criteria + Validated Scales",
    bullets=[
        (0, "Clinical History (cornerstone)"),
        (1, "Establish baseline personality from family / informant (NEVER rely on patient alone in advanced disease)"),
        (1, "Onset (acute = organic), tempo, associated cognitive or neurological symptoms"),
        (1, "Medication review, substance history, medical comorbidities"),
        (0, "DSM-5 / ICD-11 Organic Personality Disorder Criteria"),
        (1, "Significant change from prior personality in ≥ 2 domains (affect, behaviour, cognition, impulse control)"),
        (1, "Evidence of direct physiological cause (organic lesion / disease)"),
        (1, "Not better explained by another mental disorder"),
        (0, "Cognitive & Behavioural Scales"),
        (1, "MMSE / MoCA – baseline cognitive screening"),
        (1, "Neuropsychiatric Inventory (NPI) – gold standard for BPSD; rates 12 domains of frequency × severity"),
        (1, "GDS (Geriatric Depression Scale) – 15-item version; > 5 = depression"),
        (1, "CMAI (Cohen-Mansfield Agitation Inventory) – agitation severity"),
        (1, "Bristol ADL scale – functional impact assessment"),
        (0, "Investigations"),
        (1, "Blood: FBC, TFT, B12/folate, RFT, LFT, glucose, calcium, syphilis serology, HIV"),
        (1, "Neuroimaging: CT/MRI brain – structural cause, white matter changes, atrophy pattern"),
        (1, "EEG – if delirium / seizures suspected"),
        (1, "CSF analysis – if infectious or prion disease suspected"),
    ]
)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 9 – Functional Changes
# ══════════════════════════════════════════════════════════════════════════════
s9 = prs.slides.add_slide(blank)
add_two_col_slide(s9,
    "Functional Changes",
    "Impact on ADLs",
    [
        (0, "Basic ADLs affected"),
        (1, "Bathing, dressing, grooming – apathy / depression"),
        (1, "Feeding – refusal, forgetting to eat"),
        (1, "Toileting – agitation around personal care"),
        (1, "Mobility – fearfulness, falls risk ↑"),
        (0, "Instrumental ADLs affected"),
        (1, "Medication management – non-compliance"),
        (1, "Financial decisions – impulsivity, exploitation risk"),
        (1, "Driving – impulsive, disinhibited behaviour"),
        (1, "Telephone / social communication"),
    ],
    "Psychosocial & Systemic Impact",
    [
        (0, "Caregiver burden – depression in 40–50% of carers"),
        (0, "Social isolation → accelerated cognitive decline"),
        (0, "Increased hospitalisation and healthcare utilisation"),
        (0, "Medication non-compliance → complications of comorbidities"),
        (0, "Risk of elder abuse – both as victim and perpetrator"),
        (0, "Nutritional compromise – weight loss, sarcopenia"),
        (0, "Sleep disruption → sundowning phenomenon"),
        (0, "Loss of driving licence → further isolation"),
        (0, "Premature institutionalisation if support inadequate"),
    ]
)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 10 – Acute Care & Stabilization
# ══════════════════════════════════════════════════════════════════════════════
s10 = prs.slides.add_slide(blank)
add_bullet_slide(s10,
    "Acute Care & Stabilization",
    subtitle="Emergency Assessment and Immediate Interventions",
    bullets=[
        (0, "Immediate Safety Assessment (ABC + D)"),
        (1, "Airway, breathing, circulation; check for delirium (CONFUSION with acute onset → medical emergency)"),
        (1, "Rule out acute reversible causes: hypoglycaemia, hyponatraemia, hypoxia, sepsis, intracranial event"),
        (1, "Assess suicide / homicide / self-neglect risk"),
        (0, "De-escalation (non-pharmacological – first line)"),
        (1, "Calm, well-lit, familiar environment – minimise noise/strangers"),
        (1, "Reassurance, orientation cues (clocks, family photos, familiar objects)"),
        (1, "Therapeutic communication – slow speech, simple sentences, eye contact"),
        (1, "Involve a trusted family member if available"),
        (0, "Pharmacological Stabilization (when non-pharm fails or patient/others at risk)"),
        (1, "Acute Agitation: Haloperidol 0.5–1 mg PO/IM (lowest effective dose; caution in DLB – avoid antipsychotics)"),
        (1, "Benzodiazepines (short-acting lorazepam 0.5 mg) – only if haloperidol contraindicated; risk of paradoxical disinhibition"),
        (1, "Treat underlying cause: antibiotics for UTI/sepsis, levothyroxine for hypothyroidism"),
        (0, "Monitoring"),
        (1, "Vital signs, O₂ saturation, fluid status, medication reconciliation"),
        (1, "Repeat cognitive assessment after stabilization (MMSE / CAM for delirium)"),
    ]
)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 11 – Management (Pharmacological)
# ══════════════════════════════════════════════════════════════════════════════
s11 = prs.slides.add_slide(blank)
add_bullet_slide(s11,
    "Management – Pharmacological",
    subtitle="Target-Symptom Approach | Use Lowest Effective Dose | Review Regularly",
    bullets=[
        (0, "Depression"),
        (1, "SSRIs: Sertraline 25–50 mg OD or Escitalopram 5–10 mg (preferred in elderly – fewer drug interactions)"),
        (1, "Avoid TCAs (anticholinergic, QT prolongation, fall risk)"),
        (1, "Mirtazapine useful if poor appetite / sleep disturbance"),
        (0, "Anxiety / Agitation"),
        (1, "SSRIs / SNRIs first-line for chronic anxiety"),
        (1, "Buspirone – useful anxiolytic without dependence"),
        (1, "Avoid long-term benzodiazepines (fall, sedation, paradoxical disinhibition)"),
        (0, "Psychosis / Aggression in Dementia (BPSD)"),
        (1, "Atypical antipsychotics – Risperidone 0.25–0.5 mg; Quetiapine 12.5–25 mg (safer for DLB)"),
        (1, "Black box warning: ↑ mortality in elderly dementia (cerebrovascular events)"),
        (1, "Time-limited trials; regular reassessment and discontinuation when safe"),
        (0, "Cognitive Enhancers (modify BPSD secondarily)"),
        (1, "Cholinesterase inhibitors (Donepezil, Rivastigmine) – reduce apathy and psychosis in AD"),
        (1, "Memantine – reduces agitation in moderate-severe AD"),
        (0, "Mood Stabilisers (if bipolar or FTD disinhibition)"),
        (1, "Valproate, Lamotrigine – use cautiously; avoid carbamazepine (drug interactions, hyponatraemia)"),
    ]
)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 12 – Management (Non-Pharmacological)
# ══════════════════════════════════════════════════════════════════════════════
s12 = prs.slides.add_slide(blank)
add_bullet_slide(s12,
    "Management – Non-Pharmacological",
    subtitle="Should ALWAYS precede or accompany pharmacological treatment",
    bullets=[
        (0, "Person-Centred Care"),
        (1, "Understand the patient's life history, preferences, and values"),
        (1, "Dignity-preserving communication; avoid arguing about delusions"),
        (0, "Psychotherapeutic Approaches"),
        (1, "Cognitive Behavioural Therapy (CBT) – effective for anxiety and depression (adapted for cognitive level)"),
        (1, "Reminiscence therapy – enhances mood and identity in early–moderate dementia"),
        (1, "Validation therapy – for advanced dementia; accepts patient's subjective reality"),
        (1, "Problem Adaptation Therapy (PATH) – modified CBT for MCI and mild dementia"),
        (0, "Behavioural Management"),
        (1, "ABC approach: identify Antecedents → Behaviour → Consequences"),
        (1, "Eliminate triggers (pain, constipation, noise, over-stimulation)"),
        (1, "Structured daily routines reduce agitation and wandering"),
        (0, "Environmental Modifications"),
        (1, "Safe wandering areas, adequate lighting, orientation boards"),
        (1, "Music therapy – reduces agitation and improves mood (evidence-based)"),
        (1, "Pet therapy, aroma therapy, bright-light therapy for circadian rhythm"),
        (0, "Caregiver Support"),
        (1, "Psychoeducation about the disease and behavioural symptoms"),
        (1, "Respite care, support groups, coping strategy training"),
        (1, "Screen carers for depression and burnout"),
    ]
)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 13 – Rehabilitation
# ══════════════════════════════════════════════════════════════════════════════
s13 = prs.slides.add_slide(blank)
add_two_col_slide(s13,
    "Rehabilitation",
    "Goals of Rehabilitation",
    [
        (0, "Maximize functional independence"),
        (0, "Slow further deterioration"),
        (0, "Improve quality of life for patient AND carer"),
        (0, "Facilitate community reintegration"),
        (0, "Prevent secondary complications"),
        (0, "Components"),
        (1, "Physiotherapy – mobility, balance, fall prevention"),
        (1, "Occupational Therapy – ADL retraining, environmental adaptation, assistive devices"),
        (1, "Speech therapy – communication strategies, dysphagia if present"),
        (1, "Neuropsychological rehabilitation – cognitive stimulation therapy (CST)"),
        (1, "Social work – care coordination, housing, legal issues (PoA, guardianship)"),
    ],
    "Cognitive Stimulation & Exercise",
    [
        (0, "Cognitive Stimulation Therapy (CST)"),
        (1, "Group-based structured activities 2x/week"),
        (1, "Proven to improve cognition and quality of life in mild-moderate dementia"),
        (0, "Physical Exercise"),
        (1, "Aerobic exercise ↑ BDNF, reduces depression, ↓ fall risk"),
        (1, "Strength + balance training (Tai chi, yoga)"),
        (0, "Social Engagement"),
        (1, "Day centres, senior activity groups"),
        (1, "Volunteer programmes, intergenerational activities"),
        (0, "Technology & Digital Tools"),
        (1, "Memory aids, reminders, GPS for wanderers"),
        (1, "Video calls to reduce social isolation"),
        (0, "Palliative Phase"),
        (1, "When rehabilitation goals shift – comfort, dignity, family support"),
    ]
)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 14 – Multidisciplinary Team
# ══════════════════════════════════════════════════════════════════════════════
s14 = prs.slides.add_slide(blank)
add_rect(s14, 0, 0, 13.333, 7.5, fill_color=LIGHT_BG)
add_rect(s14, 0, 0, 13.333, 1.1, fill_color=NAVY)
add_rect(s14, 0, 1.1, 13.333, 0.06, fill_color=TEAL)
add_text(s14, "The Multidisciplinary Team (MDT)", 0.25, 0.08, 12.5, 0.95,
         size=28, bold=True, color=WHITE, valign=MSO_ANCHOR.MIDDLE)

roles = [
    ("Geriatrician / General Physician", "Overall medical assessment, comorbidity management, medication review"),
    ("Geriatric Psychiatrist", "Diagnosis of personality disorder, BPSD, prescribing psychiatric medications"),
    ("Neurologist", "Neurodegenerative workup, imaging interpretation, cognitive assessment"),
    ("Clinical Psychologist", "Psychotherapy, neuropsychological testing, behavioural analysis"),
    ("Occupational Therapist", "ADL assessment, environmental modification, assistive technology"),
    ("Physiotherapist", "Mobility, fall prevention, exercise prescription"),
    ("Social Worker", "Carer support, community resources, legal/ethical matters"),
    ("Specialist Nurse / CPN", "Day-to-day monitoring, medication adherence, family liaison"),
]

for i, (role, task) in enumerate(roles):
    col = i % 2
    row = i // 2
    x = 0.3 + col * 6.55
    y = 1.3 + row * 1.48
    add_rect(s14, x, y, 6.2, 1.3,
             fill_color=TEAL if col == 0 else NAVY)
    add_text(s14, role, x + 0.12, y + 0.06, 5.95, 0.45,
             size=13, bold=True, color=WHITE)
    add_text(s14, task, x + 0.12, y + 0.52, 5.95, 0.65,
             size=11, color=RGBColor(0xCC, 0xE8, 0xFF))

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 15 – Summary & Take-Home Points
# ══════════════════════════════════════════════════════════════════════════════
s15 = prs.slides.add_slide(blank)
add_rect(s15, 0, 0, 13.333, 7.5, fill_color=NAVY)
add_rect(s15, 0, 1.05, 13.333, 0.08, fill_color=ACCENT)

add_text(s15, "Summary & Take-Home Points", 0.4, 0.1, 12.5, 0.9,
         size=30, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

points = [
    "Personality change in the elderly is NEVER simply 'old age' – always look for an underlying cause",
    "Frontotemporal dementia and vascular dementia often present with personality change BEFORE memory loss",
    "Always obtain informant history; patient insight may be impaired",
    "Organic causes must be excluded systematically: metabolic, endocrine, structural, infective, toxic",
    "Non-pharmacological management is FIRST-LINE; pharmacological treatment should be target-symptom, low-dose, time-limited",
    "Antipsychotics carry a black-box warning in elderly dementia – use with caution and informed consent",
    "Rehabilitation aims to preserve function, dignity, and quality of life – not cure",
    "The MDT approach is essential; caregiver support is as important as patient care",
    "Screen ALL elderly with behavioural change: GDS for depression, NPI for BPSD, MoCA for cognition",
]

for i, point in enumerate(points):
    y = 1.25 + i * 0.67
    bg = TEAL if i % 2 == 0 else RGBColor(0x1B, 0x48, 0x7A)
    add_rect(s15, 0.4, y, 12.5, 0.58, fill_color=bg)
    add_text(s15, f"  {i+1}.  {point}", 0.42, y + 0.03, 12.45, 0.52,
             size=13, color=WHITE, valign=MSO_ANCHOR.MIDDLE)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 16 – References
# ══════════════════════════════════════════════════════════════════════════════
s16 = prs.slides.add_slide(blank)
add_rect(s16, 0, 0, 13.333, 7.5, fill_color=LIGHT_BG)
add_rect(s16, 0, 0, 13.333, 1.1, fill_color=NAVY)
add_rect(s16, 0, 1.1, 13.333, 0.06, fill_color=TEAL)
add_text(s16, "References", 0.25, 0.08, 12.5, 0.95,
         size=28, bold=True, color=WHITE, valign=MSO_ANCHOR.MIDDLE)

refs = [
    "1. Daroff RB, et al. Bradley and Daroff's Neurology in Clinical Practice, 8th ed. Elsevier, 2022 – Chapter 9: Behavior and Personality Disturbances",
    "2. Marx J, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice, 9th ed. Elsevier, 2023 – Chapter 90: Dementia",
    "3. Sadock BJ, et al. Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 10th ed. LWW, 2022 – Geriatric Psychiatry chapters",
    "4. Loscalzo J, et al. Harrison's Principles of Internal Medicine, 22nd ed. McGraw-Hill, 2025 – Chapter 489: Dementia",
    "5. Jeste DV, et al. Mental health care for older adults: recent advances. World Psychiatry 2022; 21(3):336–363. [PMC9453913]",
    "6. Aging & Mental Health 2022 Geriatric Psychiatry Review Course – AAGP",
    "7. DSM-5-TR: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Text Revision. APA, 2022",
    "8. ICD-11: International Classification of Diseases, 11th Revision. WHO, 2022",
    "9. Cohen-Mansfield J. Nonpharmacologic interventions for BPSD. Int Psychogeriatr 2001;13(S1):209–218",
    "10. Orgeta V, et al. Cognitive training interventions for dementia. Cochrane Database 2014;(2):CD010150",
]

tb = s16.shapes.add_textbox(Inches(0.4), Inches(1.25), Inches(12.5), Inches(5.9))
tf = tb.text_frame
tf.word_wrap = True
for i, ref in enumerate(refs):
    p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
    r = p.add_run()
    r.text = ref
    r.font.name = "Calibri"
    r.font.size = Pt(12)
    r.font.color.rgb = DARK_TXT
    p.space_before = Pt(5)


# ══════════════════════════════════════════════════════════════════════════════
# SAVE
# ══════════════════════════════════════════════════════════════════════════════
out_path = "/tmp/workspace/personality-changes-elderly/Personality_Changes_Elderly.pptx"
buf = BytesIO()
prs.save(buf)
with open(out_path, "wb") as f:
    f.write(buf.getvalue())

print(f"Saved: {out_path}")
print(f"Slides: {len(prs.slides)}")