Ageing Flashcards
ADL
IADL
Death: Activities of Daily Living
- Dressing
- Eating
- Ambulation
- Toilet
- Hygiene
Shaft: INSTRUMENTAL Activities of Daily Living
- Shopping
- Housekeeping
- Accounting - finance
- Food Prep
- Transport
What does a CGA include
- comprehensive geri assessment
Medical
Function - Physical, Cognitive
Psychosocial
Explain age-related change (most to be affected)
- what is ok
- what we expect
TOP 2 to be affected first
- psychomotor speed, executive function
- otherwise functioning should be ok
- memory loss is ok if inconsistent, non progressive
- in healthy elderly we expect longitudinal cognitive performance
Pathophysiology of AD
- explain genetic pathogenesis [2]
- abit o gross [3]
C21 for APP - autosomal dominant, early onset
C19 for phosphorylated tau protein - neurofibrillary tangles - late onset
– Note for APOE4 is bad APOE2 good;
- Temporal lobe, hippocampus atrophy
- ventricular enlargement as compensation
- sulci widening
Explain the reserve vs insult factors leading to neuro problems in elderly; like Dementia
- note is a balance between Cognitive reserve vs insult aka neuropathic, neurovascular changes;
Protective
- exercise
- education, increasing cognitive reserve
- hearing impairment pls FIX - HIGH DEMENTIA RISK
Insults, Putative
- smoking, HT, obesity
- these leads to neuropathic change
Dementia causes
- ‘reversible’
- non reversible causes - aka CNS diseases
Reversible "" Drugs Emotion - DEPRESSION Metab Eyes and ears isolation Normal pressure hydrocephalus TUMOR or SOL Infection - syphillis, HIV Anemia/ Alcohol
Irreversible – Neurodegens
- AD - tau and amyloid
- PD - apoptosis of dopaminergic neurons in nigrostriatal pathway; alpha synuclein Lewy bodies
- Huntingtons - Basal Ganglia + Cortical damage, Chorea; AD, CAG repeats, damage brain cells;
- Wilsons - presents as Parkinsonism; copper accumulation in brain
- note also Lewy body dementia, Frontotemporal dementia, PRIONS;
What if the Dementia px has myoclonus?
- What and how do you DDx
Myoclonus
14 3 3 Protein in CSF
EEG - periodic shockwaves
- Prion Disease
What are the clinical effects of Dementia!
think ABC
A: ADL //
- DEATH SHAFT
B: Behavior
C: Cognitive, STM loss then LTM loss; other cognitive function loss
Depression
- Pathophysiology
- Risk Factors
NOTE Dementia and Depression are risk factors for each other
- Deficiency in monoamine concentrations
RF spectrum
- medical - drugs
- psychosocial - loss, isolation; dementia drug abuse anxiety;
- genetic - family
- physical - chronic pain, diseases
What are the clinical effects of Depression!
- also think ABC
A: affective - mood
Behavioral
Cognitive - memory, concentration, decision making;
Delirium Definition
Neuropsychiatric MANIFESTATION of
- cerebral metab/ neurotransmission DISORDER
Whats the deal w delirium disease presentation
- give 2 properties
Disease affecting the organ of lowest reserve instead of organ of insult
- Pneumonia presenting as Headache
- AMI (low PO2) then Delirium
- Constipation (retention) then Delirium
Another property is
- high vulnerability px MINOR insult leads to delirium
- low vulnerability px MAJOR insult then delirium
Causes of delirium
Drugs Eyes Ears Low O2 Infections Retention of faces Ictal Underhydration, nutrition Metab Subdural Haemorrhage
Gimme the tests for DDD
Delirium
- CoNFUSION Assessment Method
- Course - acute change in mental state
- A - Inattention
- Mental - state of consciousness, disorganized thinking; 1 + 2 + 3/4
Depression
- Geriatric Depression Scale GDS 15
Dementia
- Abbreviated Mental Test
Health Strategies 4 areas
and Prevention stages
Preventive
Curative
Rehab
Supportive
Primary - stop risk factors in healthy population
Secondary - screening ppl at risk
Tertiary - rehab people to increase SOL
