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AGE > AGE REVISION PART 1 > Flashcards

AGE REVISION PART 1 Flashcards

1
Q

what is fragility/ fragility?

A

A physiological syndrome characterised by decreased reserve and diminished resistance to stressors, resulting from cumulative decline across multiple physiological systems, and causing vulnerability to adverse outcomes.

so basically you don’t respond well to stressors at all

Fragility is not the same as ageing you can be frail at any age.

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2
Q

according to strehler’s concept what are the 4 processes that must be present for true ageing.

A

• Universal
identifiable in all members of species

• Intrinsic
so shouldn’t require external stimulus

• Progressive
all changes continue progressively with time

• Deleterious
should be extremely harmful to the organism

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3
Q

what is the difference between ageing and disease.

A

ageing vs disease

universal - individual
intrinsic - intrinsic or extrinsic
progressive- progressive but may be halted or reversed
deleterious - deleterious but may be arrested or cured..

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4
Q

which lobe of the brain is responsible for memory and combining auditory and visual information?

-temporal lobe
-occipital lobe
-frontal lobe
parietal lobe

A

temporal lobe

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5
Q

which lobe of the brain is responsible for visual processing?

-temporal lobe
-occipital lobe
-frontal lobe
parietal lobe

A

occipital lobe

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6
Q

which lobe of the brain is responsible behaviour, is executive, impulsivity and emotion?

-temporal lobe
-occipital lobe
-frontal lobe
parietal lobe

A

frontal lobe
has the motor cortex
and also involved with behaviour and emotion remember phineas gage had the spear go through his prefrontal cortex.

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7
Q

which lobe of the brain responsible for processing, reading and writing and is sensory

-temporal lobe
-occipital lobe
-frontal lobe
parietal lobe

A

parietal, remember has the sensory cortex here.

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8
Q

which are the 3 physical/structural changes that happen to the brain as we age?

  • hypertrophy
  • Atrophy
  • Amyloid Plaques & Neurofibrillary Tangles
  • Increase in neuroplasticity
  • Cerebral blood flow & homeostatic regulation
A
  • Atrophy
  • Amyloid Plaques & Neurofibrillary Tangles
  • Cerebral blood flow & homeostatic regulation
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9
Q

As the brain ages there is more atrophy. Which are of the brain is most impacted by this? Also is there more white matter loss or more grey matter loss?

A
  • Pre-frontal cortex and striatum most affected

* White matter loss > grey matter loss

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10
Q

As we age Amyloid Plaques & Neurofibrillary Tangles develop in the brain what are they and what is the impact of this ?

A
  • Tangles are collections of hyperphosphorlyated protein inside neurons. Tangles form inside of neurons and interfere with the cellular machinery used to create and recycle proteins, which ultimately kills the cell.
  • Plaques are deposition of beta amyloid between neurons. The presence of plaques around a neuron causes them to die, possibly by triggering an immune response in the immediate area.
  • Both are present in ‘normal ageing’ but present in larger quantities in ‘abnormal ageing’ e.g. Alzheimer’s dementia
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11
Q

what are structural changes that happen to brain as we age in terms of cerebral blood flow & homeostatic regulation.

A

small vessel disease which shows as increased periventricular white imaging (like on both lobes of brain in the middle of both) this does not correlate with cognitive function but increases risk of stroke, dementia and increases risk of death.

oxidative stress- is a phenomenon caused by an imbalance between production and accumulation of oxygen reactive species in cells and tissues and the ability of a biological system to detoxify these reactive products.)

decreased BF to brain with age and decreases homeostasis

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12
Q

The two chemical changes that happen to the brain with age are changes in neurotransmitters and the blood brain barrier becomes more permeable also. match up what the pathophysiology will be with the decline of neurotransmitters as we age.

reduced:

  • acetycholine
  • dopamine
  • serotonin
  • depression and changes in circadian rhythm
  • cognitive impairment
  • reduced arm swing and increases rigidity
A

Reduced Acetylcholine
• Cognitive impairment

Reduced Dopamine
• Reduced arm swing
• Increased rigidity

Reduced Serotonin
• Depression
• Changes in circadian rhythm

Reduced availability and production of all

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13
Q

what are the changes that happen to the blood brain barrier as we age.

A
  • Altered transport of nutrients, metabolites and toxins
  • Increased permeability
  • Reduced transport of glucose, proteins and hormones
  • More susceptible to hypoglycaemia
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14
Q

answer true or false to these questions:

  1. Normal ageing can lead to cerebral atrophy
  2. Neurofibrillary targets and amyloid plaques can be found in both normal ageing and pathological disease e.g., dementia
  3. The blood brain barrier becomes more permeable with increasing susceptibility to side effects from neuromodulating drugs.
  4. Normal ageing can lead to forgetfulness that can affect normal function or daily activities.
  5. The extent of small vessel disease seen on neuroimaging correlates with the level of cognitive impairment.
A

T, T, T,F,F

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15
Q

what is delirium

A

Acute Confusional State’, ‘Acute Brain Failure’
A clinical syndrome characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course

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16
Q

what are the 3 types of delirium

A

hyperactive delirium- increased motor activity, loss of control of activity, restlessness, wandering

hypoactive delirium- decreased activity, action speed, speed or speech and amount of speech. reduced awareness of surroundings, listlessness, withdrawal.

mixed.- evidence of both subtypes in the previous 24 hours

17
Q

what is the most common type of delirium

A

hypoactive delirium

18
Q

Answer true or false to these statements

  1. Delirium only affects the elderly
  2. Delirium is easy to identify and treat
  3. Dementia has an acute and fluctuating course
A

Fff

19
Q

what is the difference between pharmacodynamics and pharmacokinetics?

A

pharmacokinetics: the movement of drugs within the body
pharmacodynamics: the response of the body to the drug

20
Q

As we age lean body mass and plasma albumin decreases. a.)what effect does this have on pharmacokinetics

b.) and what is the role of albumin in the body.

A

The reduction in lean body mass can result in the decreased volume distribution for drugs that bind to muscle.

Normal ageing shouldn’t have a huge impact on plasma albumin however if you acutely unwell or you have a chronic condition then the albumin levels will significantly decrease which will affect protein binding and can increase the number of free drugs.

Albumin is a protein made by your liver. Albumin helps keep fluid in your bloodstream so it doesn’t leak into other tissues. It is also carries various substances throughout your body, including hormones, vitamins, and enzymes. Low albumin levels can indicate a problem with your liver or kidneys

21
Q

what happens to the liver as we age?

A

decreased liver mass, decreased hepatic flow.

22
Q

what are some age related changes in pharmacodynamics of a drug

A

Age related changes include
• Increased sensitivity to sedation and psychomotor impairment
• Increased intensity and duration of effects of morphine / opiates
• Increased cardiac sensitivity to digoxin (irregluar hearbeat)

Due to reasons such as increased permeability of the blood brain barrier.

23
Q

List 5 drugs that shouldn’t be taken together

A

Most common interactions:
• cardiovascular drugs
• psychotropic drugs

Warfarin and Ibuprofen

24
Q

List 5 drugs that shouldn’t be taken together

A

Most common interactions:
• cardiovascular drugs
• psychotropic drugs

  • Warfarin (blood thinner) and Ibuprofen
  • Antidepressants and Painkillers
  • Any combo of ibuprofen, naproxen, and aspirin.
  • Tylenol and multi-symptom cold medicines.
25
Q

In Alzheimer’s where will the atrophy be in the brain on imaging

A

hippocampus

26
Q

what are the main diagnosis for dementia?

A

decline in memory and other cognitive abilities. not delerium present for more than 6 months

27
Q

match the 7 A’s of alzheimers to there meanings

  • Anosognosia
  • Aphasia
  • Altered perception
  • Apathy
  • Agnosia
  • Apraxia
  • Amnesia

loss of the ability to carry out purposeful movements.

when you misinterpret the information your senses are giving you

lack of ability to perceive the realities of one’s own condition.

loss of the ability to speak.

memory loss

not having drive or initiative

you can no longer recognise things through your senses

A
  • Anosognosia- lack of ability to perceive the realities of one’s own condition.
  • Aphasia- loss of ability to speak.
  • Altered perception- when you misinterpret the information your senses are giving you
  • Apathy- not having drive or initiative
  • Agnosia- you can no longer recognise things through your senses
  • Apraxia- loss of the ability to carry out purposeful movements.
  • Amnesia- memory loss
28
Q

what is the pathophysiology of Alzheimer’s?

A

• Neuronal cell death, particularly cholinergic.

• Amyloid plaques
– β amyloid

• Neurofibrillary tangles

• ApO E.
• Vascular pathology.
and Inflammation.

29
Q

what can be given to treat Alzheimer’s?

A 
Cholinesterase Inhibitors
–	Donepezil – OD tablet
–	Rivastigmine – patch or BD tablets
–	Galantamine
group of medicines that block the normal breakdown of acetylcholine. Acetylcholine is the main neurotransmitter found in the body and has functions in both the peripheral nervous system and the central nervous system.

NMDA receptor antagonist
• Memantine
Memantine blocks some NMDA receptors when they’re too active. The combination of memantine and a cholinesterase inhibitor leads to modest improvements in cognition and global outcomes in patients with advanced disease. It works by decreasing abnormal activity in the brain. Using it along with medications that focus on acetylcholine might make a bigger difference than those drugs would by themselves. It doesn’t work well for everyone.

30
Q

What are the different types of dementia?

A

Alzheimers- most prevalent due to neruonal degeneration in the brain can be seen as atrophy in the hippocampus.

Vascular dementia- caused by reduced blood flow to the brain usually after stroke and can be from small/large vessel disease.
Dementia with lewy body – when there is cognitive and motor decline within the same time. Patients with it often experience hallucinations. Avoid antipsychotics because they may cause severe reactions in more than one half of these patients and are associated with increased mortality.

Parkinsons Disease Dementia – when there is motor symptoms first which at least after 12 month leads to dementia. due to Parkinsons.

Frontotemporal dementia- atrophy of frontal and anterior temporal lobes

31
Q 
Which of these organs control thermoreguation? (Select one or more correct answer(s))
A.	Kidney
B.	Hypothalamus
C.	Skin
D.	Pancreas
E.	Skeletal muscle
A

b

32
Q 
Which of these problems can cause delirium? (Select one or more correct answer(s))
A.	Infection
B.	Change in environment
C.	Change in medication
D.	Constipation
E.	Ruptured Abdominal Aortic Aneurysm
A

all

33
Q 
What proportion of adults >65yrs have at least 1 fall per year? (Select one correct answer)
A.	¼
B.	⅓
C.	½
D.	⅔
E.	¾
A

b

34
Q 
Which of these are ‘Geriatric Giants’ (Select one or more correct answer(s))
A.	Immaturity
B.	Instability
C.	Intellectual impairment
D.	Immobility
E.	Illogical behaviour
A

B,C,D

35
Q 
Which of these are reversible causes of urinary incontinence? (Select one or more correct answer(s))
A.	Constipation
B.	Immobility
C.	Delirium
D.	Depression
E.	Heart failure
A

all

36
Q

What are the geriatric giants?

A

immobility

intelectual impairment

incontinence (not a normal part of ageing)

instability

Iatrogenic disorders
-relating to illness caused by medical examination or treatment.

37
Q

What are the reversible causes of incontinence?

A 
DIAPPERS
Delirium
Infection- urinary 
Atrophic urethritis and vaginitis
Pharmaceuticals 
Psychiatric disorders, especially depression
Excessive urine output 
Restricted mobility 
Stool impaction
38
Q

Pruritis affects around 50% of the elderly what is it?

A

itchy skin

39
Q

What are the ranges for hypothermia?

A

core temperature:
mild- 32-35
moderate- 28-32
severe- below 28

AGE (2 decks)

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