Ageing Flashcards
Parkinson’s pathophysiology
Reduced motor cortex stimulation due to destruction of D2 receptors in the substantia nigra (nigrostriatal tract)
REM sleep disorder and micrographics
Parkinson’s
Treatment for Parkinson’s
Start with dopamine agonists or MOA inhibitor if not affecting QoL. The progress to levodopa combined with a peripheral decarboxylase inhibitor (carbidopa) to increase bioavailability. If getting symptoms or disk Ines is despite optimal levodopa, give MAO-B inhibitor, COMT inhibitor or dopamine agonists adjunct.
What to do if orthostatic hypotension occurs in Parkinson’s patients
Midodrine (peripheral alpha adrenergic receptors)
Benzhexol/ Benzatropine uses
Helps to reduce tremors and useful anti-cholinergic side effects (dry mouth)
Common side effects of levodopa
Diskinesia, on off effect, dry mouth, anorexia, postural hypotension
Side effects of dopamine agonists
Day time drowsiness, hallucinations, pulmonary retroperitoneal and cardiac fibrosis risk so perform ECG ESR and CXR prior to commencing bromocriptine or cabergoline
Neuroleptic malignant syndrome causes
Sudden stop of levodopa and mainly patients taking antipsychotics.
Presents with pyrexia, muscle rigidity, hypertension, tachycardia, tachypnoea, delirium and confusion and elevated CK
SPECT findings in Parkinson’s
Lewy bodies and alpha synuclein
What to give in delirium with Parkinson’s
Benzodiazepines - not antipsychotics due to their D2 antagonist effect.
DXA scan results in osteoporosis
If between -1 and -2.5 osteopenia
Below 2.5 is osteoporosis
Vascular dementia
Executive dysfunction, early motor and mood changes , stepwise decline in function. Often coexists with Alzheimer’s
Lewy body dementia
Pill rolling tremor, Parkinsonism, recurrent visual hallucinations (furry animals), cognitive fluctuations, REM sleep disorder
Frontotemporal dementia
Presents either as personality and social conduct issue or primary language disorder.
Behaviour includes early loss of empathy, emotional reactivity, hypoerorality, more sweet foods
Language deficits
Language deficits in frontotemporal dementia
Semantic : loss of knowledge of single words, surface dyslexia but spared speech production and repetition
Progressive non fluent is maintaining of single word knowledge but progressive loss of speech, agrammatism.
MRI in frontotemporal dementia
Shows focal atrophy in frontal and or anterior temporal lobe.
Alzheimer’s pathophysiology
A neurodegenerative disorder starting in hippocampus but affecting temporal lobe. Senile plaques and neurofibrkllary tangles are seen.
Genetic link in Alzheimer’s
ApoE 4 increases risk of disease, ApoE2 decreases risk but increased risk of CV disease.
APP and presenilin genes 1&2 usually early onset Alzheimer’s,
When to start bisphosphonates
Give if at medium or high risk of a fracture, or if had fracture. Complement with vit D and calcium if levels are low.
Calcium and phosphate levels in pagets, osteomalacia and osteoporosis
Osteoporosis: all usually normal
Osteomalacia: low vit d <25, low Ca, low Phosphate and high PTH (compensating)
Pagets: high ALP
Urethral stricture causes
Pelvic fracture, erethritis, infection (gonorrhoea lichen sclerosis)
Down syndrome associated disease
Alzheimer’s dementia
Clinical frailty scale 1-9
1-3 very fit to managing well
4- vulnerable but not dependent
5 - dependent for high order AODL
6- moderately frail
7- severely frail (need help with everything)
8-9 very bad usually hospital or care homes
Management of delirium
Reassure, isolate and reduce medical interventions as much as possible
Only if absolutely necessary, give haloperidol/lorazepam if Parkinson’s or seizures or elongated QT.
