Ageing Flashcards
What questions should you ask when assessing a patient’s orientation to time/person/place during a 4AT assessment?
Their name and DOB, where they are, what year is it
How is Wernicke’s encephalopathy treated?
IV/IM thiamine for 2-7 days followed by oral thiamine indefinitely
What MMSE score is suggestive of mild cognitive impairment?
18-23
How is the orientation to time/person/place section of the 4AT scored?
No mistakes scores 0 points, one mistake scores 1 point, two or more mistakes score 2 points
What is the triad of Korsakoff’s syndrome?
Anterograde and retrograde amnesia, confabulation
What effect do drugs have for Alzheimer’s disease?
They can improve cognition for a few months-years
If all interventions for delirium fail, what medication can you prescribe?
0.5mg haloperidol orally
What are some medications that may be responsible for postural hypotension?
Diuretics, antihypertensives, antidepressants, sedatives, Levodopa
What questions should you ask in the ‘during’ section of a falls history?
Did they lose consciousness? Was there any tongue biting/incontinence? Did they injure themselves?
How is alertness ranked in the 4AT?
Normal or mild sleepiness for < 10 seconds after wakening scores 0 points, clearly abnormal scores 2 points
What are the second line drugs to be used for Alzheimer’s disease? Give an example.
NMDA receptor antagonist e.g. memantine
What are some examinations/interventions to consider after a falls history?
Cardio/MSK/neuro exam, blood pressure, medication review, ? visual acuity
What is the triad of Wernicke’s encephalopathy?
Ataxia, nystagmus/ophthalmoplegia, cognitive dysfunction
How is the attention section of the 4AT scored?
7 months or more correctly scores 0 points, starts but states < 7 months or refuses to start scores 1 point, not starting because they are unable to scores 2 points
When taking a falls history, what are some good things to clarify before moving onto the before/during/after of the fall?
When did it happen? Do they have any idea why it happened? Where were they when it happened? Who was there when it happened?
What is an important safety question to ask in a history of memory loss?
Have they ever put themselves at harm e.g. going out and getting lost or leaving the cooker on?
What drugs should you check for and stop in a patient with delirium?
Any neurotoxic drugs
A 4AT score of what suggests that delirium or severe cognitive impairment is unlikely?
0
What MMSE score is suggestive of no cognitive impairment?
24-30
A 4AT score of what is suggestive of possible cognitive impairment?
1-3
What is the management of vascular dementia?
Prevention of further episodes with antiplatelets, antihypertensives and lipid lowering drugs
What are the four sections of the 4AT for diagnosing delirium?
- Alertness, 2. Orientation to time/person/place, 3. Attention, 4. Acute change/fluctuating course
What questions should you ask in the ‘after’ section of a falls history?
What happened afterwards? How long did it take for them to come around? Did they get themselves up or did they need help? How did they feel afterwards?
What are some medical things you can do to make a patient with delirium more comfortable?
Ensure good hydration, treat any pain/constipation
How is the acute change/fluctuating course section of the 4AT scored?
If there has been an acute change or fluctuation in cognition in the last 2 weeks which is still evident in the last 24 hours, this scores 4 points. (If there is no evidence of acute change/fluctuating course, this scores 0 points)
How is a patient’s attention tested during the 4AT assessment?
Ask them to state the months of the year backwards
What is a really important thing to consider in the medication history of someone presenting with falls?
Has there been any changes to their medications recently?
What are some good things to do for all patients who present with falls?
Medication review, ensure vision is optimised, make any necessary footwear/environmental changes, consider strength and balance training
What are the first line drugs to be used for Alzheimer’s disease? Give examples.
Acetylcholinesterase inhibitors e.g. donepezil, rivastigmine, galantamine
What MMSE score is suggestive of severe cognitive impairment?
0-17
What are some investigations you should do for a patient with delirium?
Bloods (esp electrolytes and glucose), ECG, CXR, urine microscopy, culture and sensitivity
Describe the confusion assessment method (CAM) for diagnosing delirium?
Acute change/fluctuating course of mental status + inattention + one of disorganised thinking or altered level of consciousness
What is the definition of postural hypotension?
A fall in systolic BP of 20mmHg or more and/or diastolic BP of 10mmHg or more within 3 minutes of standing
What investigations would you want to do in someone presenting with memory loss?
Memory testing (MMSE, MOCA, Addenbrooke’s) and imaging (CT/MRI)
What questions should you ask in the ‘before’ section of a falls history?
What happened before the fall? Did they have any symptoms e.g. palpitations, dizziness, chest pain?
What are some specific examples you should ask about in somebody presenting with memory loss?
Forgetting names/dates/appointments, forgetting words, activities of daily living, disorientation to time/place
Other than medications, what are some potential causes of postural hypotension?
Diabetes, Parkinson’s, alcohol
A 4AT score of what is suggestive of possible delirium +/- cognitive impairment?
4 or more
What additional question should you always cover in a systemic enquiry of someone presenting with memory problems?
What is their mood like?
What are the two main reasons for not giving haloperidol to a patient with delirium?
If the delirium is related to alcohol withdrawal or if they have Parkinsonian symptoms
