Alcohol

Question 1

What are the DSM-V criteria for alcohol use disorder?

Answer 1

WITHDRAW THE alcohol

Withdrawal
Interpersonal or social problems
Tolerance
Hazardous physical situations
Desire to cutdown or unsuccessful
Recurrent use despite negative personal consequences
Activities given up
Work, school or home dysfunction

Time spent obtaining, using, recovering
Hankering/craving
Excess use or longer use

Question 2

What are two medications that can be used to treat alcohol use?

Answer 2

Naltrexone (Reduction and abstinence)
Acamprosate (support abstinence)

Question 3

What are two validated instruments to detect alcohol abuse in the elderly?

Answer 3

S-MAST-G (Shortened Michigan Alcohol Screening Test Geriatric Version)

SAMI (Senior Alcohol Misuse Indicator)

Question 4

Describe age related changes in the pharmacokinetic and pharmacodynamics of alcohol

Answer 4

PK
Absorption - possible inc risk gastritis, PUD
Distribution - inc conc
Metabolism - slower metabolism (dec gastric alcohol dehydrogenase and liver)
Elimination - small decline

PD
- Balance, judgement, orthostasis = falls
- Bone density = osteoporosis
- Nutrition = B12, folate, iron, Ca
- Neurologic = delirium, withdrawal seizures, dementia, peripheral neuropathy, Wenicke/Korsakoff

Question 5

What are recommended alcohol limit guidelines for older adults?

Answer 5

F 65+, max 1/day, max 5/wk
M 65+ max 1-2/day, max 7/wk
Non drinking days recommended every week

Question 6

What is Wernicke encephalopathy?

Answer 6

Acute encephalopathy caused by thiamine deficiency (usually related to alcohol overuse)
Triad of:
1. Cognitive changes
2. Oculomotor dysfunction
3. Gait ataxia

Question 7

What is Korsakoff syndrome?

Answer 7

Late neuropsych manifestation of WE

Question 8

What are the cognitive changes in Korsakoff?

Answer 8

Significant impairment in anterograde and retrograde memory
LTM usually preserved
Apathy
Confabulation sometimes

Question 9

What do you find on imaging in Korsakoff syndrome?

Answer 9

Atrophy of mamillary bodies (usually sign of previous WE)
Medial thalami
Corpus callosum

Question 10

What are age related physiological changes which decrease tolerance to alcohol?

Answer 10

1. Decrease body water to fat ratio
2. Decrease hepatic blood flow
3. Decrease liver enzyme efficiency
4. Inc permeability of BBB
5. Age related decrement in balance