7. Aging (Perspective on aging 1, 2)

Question 1

What are the 2 biological theories of aging?

Answer 1

• Programmed Aging (Aging is genetically programmed to occur with time)
• Damage or error theory

Question 2

What are the non-specific presentations in frail elderly?

Answer 2

Falls
Reduced mobility
Confusion
Weight loss
Not coping
Iatrogenic harm

Question 3

What are elderly likely to present with in Acute Coronary Syndrome?

Answer 3

Less likely: Chest pain

More likely: SOB

Question 4

What are elderly likely to present with in Pulmonary Embolism?

Answer 4

Less likely: Pleuritic chest pain, Haemoptysis

More likely: Syncope

Question 5

List some better ways of managing frail elderly?

Answer 5

• Comprehensive Geriatric Assessment (CGA)

- Rehabilitation

Question 6

What are the 2 changes in the aging brain?

Answer 6

• Atrophy

- Cerebrovascular disease

Question 7

What cognitive functions slow down in elderly?

Answer 7

Processing speed
Working memory
Divided attention ability
Executive functions

Question 8

Which cognitive functions remain unchanged in elderly?

Answer 8

Nondeclarative/implicit memory
Visuospatial ability
Language (some reduction in verbal fluency)

Question 9

What is the difference between ‘Alertness’ and ‘Cognition’?

Answer 9

Alertness - level of consciousness

Cognition - content of consciousness

Question 10

What is dementia?

Answer 10

• Progressive, degenerative, irreversible decline in all domains of cognition
• Not just memory impairment
  Loss of executive function
  Functional impairment
  Behavioural and psychological changes
  Lack of insight

Question 11

What is the most common cause of dementia?

Answer 11

1. Alzheimers
2. Vascular dementia
3. Mixed
4. Dementia with Lewy Bodies
   Others: Parkinson’s dementia, Frontotemporal dementia

Question 12

What is delirium?

Answer 12

Acute, global failure of higher brain function

Affecting level and content of consciousness (alertness and cognition)

Question 13

What are some differences between dementia and delirium?

Answer 13

DEMENTIA

• Chronic (months - years)
• Gradual progression
• No change in consciousness
• Irreversible

DELIRIUM

• Acute
• Fluctuating
• Main problem with alertness and attention
• Reversible

Question 14

What are the screening tests of cognition assessment?

Answer 14

• AMTS, 4AT
• MMSE – Mini Mental State Exam
• MOCA – Montreal Cognitive Assessment

Question 15

What are the diagnostic tests for cognition assessment?

Answer 15

• ACE- Addenbrooke’s Cognitive Examination

- Detailed neuropsychometric testing

Question 16

What score on 4AT indicates possible delirum +/- cognitive impairment?

Answer 16

4 or more

Question 17

What are the domains of cognitive function covered by MOCA?

Answer 17

• Visuospatial/Executive (drawing)
• Naming (animals)
• Memory & Delayed recall (List of words)
• Attention (backward order of words)
• Language (fluency)
• Abstraction (similarity between items)
• Orientation (Date, Year, City)

Question 18

What is aging?

Answer 18

Process of growing older

• Biological
• Psychological/ cognitive
• Social

Question 19

What is life expectancy?

Answer 19

A statistical measure of how long a person can expect to live

Question 20

What are the 5 difficulties in managing disease in older people?

Answer 20

• Multimorbidity
• Polypharmacy
• Iatrogenic harm
• Comprehensive geriatric assessment
• Rehabilitation

Question 21

What is frailty?

Answer 21

A physiologic syndrome characterized by decreased reserve and resistance to stressors, resulting from cumulative decline across multiple physiologic systems, and causing vulnerability to adverse outcomes

Question 22

What are the 2 components of higher brain function?

Answer 22

1. Level of consciousness (alertness)

2. Content of consciousness (Cognition)