Care of the Elderly Flashcards
Define dementia
Progressive global cognitive impairment with normal consciousness
Common types of dementia
Alzheimers Lewy body Frontotemporal Vascular Parkinsons Normal pressure hydrocephalus Depression Korsakoffs
Rare types of dementia
HIV CJD Syphilis Space occupying lesions Hypothyroid B12 deficiency Malnutrition
What to ask about for dementia
Age Onset Progression Memory Personality Thinking Planning Judgement Language Visuospatial skills Concentration Social behaviour Confusion Wandering Falls Head injury Tremor Mood Sleep Delusions Hearing Sight
PMH for Dementia
Seizures
CVA/TIA
DH for Dementia
Regular medications
Sleeping tablets
Anticholinergics
FH for Dementia
Dementia
Neurological problems
SH for Dementia
Effect on work, relationships and social activities
ADLs
Finances
Support at home
What tests would you do for Dementia
MMSE, Abbreviated mental test score, full exam
Investigations for Dementia
Full bloods
CXR, CT Brain
EEG, LP, ECG
Initial management for Dementia
Refer to neuro, rule out reversible/treatable causes, ensure MDT to support patient’s needs
Describe Alzheimers Dementia
Slowly progressive loss of memory, with later loss of language, executive or visuospatial functions
Which drug may benefit moderate AD
Anticholinesterase inhibitors (Donepezil)
Describe Vascular Dementia
Impairment of memory and at least one other cognitive domain. IN THE PRESENCE OF VASCULAR RISK FACTRS/ ISCHAEMIA ON IMAGING
Describe Lewy Body Dementia
Early loss of executive function with HALLUCINATIONS and fluctuating levels of consciousness. Memory loss is a later feature.
Describe Frontotemporal dementia
Prominent and early LANGUAGE LOSS and also loss of social functioning/disinhibition. May be a younger age group
Name three reversible causes of dementia
Sub dural haematoma
Normal pressure hydrocephalus
Korsakoff syndrom
What are the categories of the Mini Mental State Exam
Orientation Registration Attention and arithmetic Recall Language Executive function
Describe subdural haematoma dementia
Dementia and focal neurology. Elderly, atrophic brains. Trauma in history. Ix CT. Tx Evacuate
Describe normal pressure hydrocephalus dementia
Dementia, gait disturbance and urinary incontinence with hydrocephalus on CT and normal CSF opening pressure
Causes of normal pressure hydrocephalus
Idiopathic (50%)
Meningitis
Trauma
Subarachnoid haemorrhage
Normal pressure hydrocephalus treatment
ventriculo peritoneal shunt
Describe Korsakoffs syndrome dementia
Amnesia and confabulation seen in thiamine deficiency (eg alcoholism). Treatment thiamine (B1) replacement
Define delerium
Acute onset of disordered cognition with attentional deficits typically involvalves changes in arousal and may be associated with hallucinations
Clinical features of delerium
Globally impaired cognition, perception and consciousness
Marked memory
Disordered/ disorientated thinking
Sleep/wake cycle reversal
Describe hyperactive delerium
Restlessness
Mood lability
Agitation
Aggression
Describe hypoactive delerium
Patient becomes slow and withdrawn
What is the third type of delerium
Mixed
Risk factors for delerium
> 65yo, dementia, hip fracture, acute illness, psychological agitation eg pain
Causes of delerium
Sugery Systemic infection Intracranial infection or head injury Drug withdrawal Alcohol withdrawal Metabolic Hypoxia Vascular event Thiamine, B12 deficiency
Which drugs’ withdrawal causes delerium
Opiates
Levodopa
Sedatives
Recreational
Delerium differentials
Dementia
Anxiety
Epilepsy
Primary mental illness- schizophrenia
Delerium investigations
Bloods, ABG, Septic screen. ECG EEG LP CT
Delerium treatment
Reorientate Encourage visitors Monitor fluid balance and oral intake Sleep hygeine Avoid catheters Watch out for discomfort Review medications
Dementia vs delerium
Delerium is more inattention, distractability and disogranised thinking. Key thing is if there has been an acute decline from baseline
Define depression
Low mood that is not usual and persists for over 2 weeks
Symptoms of depression
Low mood Low energy Feeling worthless or guilty Poor concentration Recurrent thoughts of suicide or death Low self esteem Tearfulness Loss of interests Anhedonia
Somatic symptoms of depression
Weight/ appetite loss Sleep problems (early morning waking, insomnia or over sleeping) Loss of libido Psychomotor agitation or retardation Change in mood with time of day
Pyschotic symptoms of depression
Delusions
Hallucinations
Signs of depression
Neglect, agitation, slowed speech or movement, poor eye contact
Bereavement and depression
Dont diagnose depression within 2 months of bereavement. Be aware of cultural variations of grief. Depression likely if prolonged, sever functional impairment or psychomotor retardation
Treatment options for Depression
Psychotherapy- CBT
Antidepressants
Electroconvulsive therapy
When would you give electroconvulsive therapy
High risk (not eating or drinking) and or has failed to respond to medications
First line antidepressants
SSRIs citalopram or fluoxetine
Second line antidepressants
Venlafaxine
Complications of depression
Deliberate self harm Unemployment Relationship break down Recurrence Suicide
Antidepressant advice
2-3wks to start. up to 6 wks
Suicide risk may increase in first few weeks
Treatment should continue for 6 months after symptoms have stopped.
Should be weaned not stopped suddenly
Name 4 types of incontinence
Stress
Urge
Overflow
Functional
Define stress incontinence
Leakage on exercise/ coughing/ laughing
Define urge incontinence
Severe and sudden urgency (often due to detrusor instability)
Define overflow incontinence
Urine volume exceeds bladder capacity (e.g. in chronic retention)
Define functional incontinence
Restricted mobility so unable to get to the toilet in time
Causes of urinary incontinence
UTI, detrusor instability, MS, DM, diuretics + reduced mobility
F- uterine prolapse, weak pelvic muscles, pelvic mass
M- post prostate surgery
Investigations for incontinence
MSU, BM, Urinary diary, PSA
Treatment for general incontinence
Weight loss
Less caffeine
Stop smoking
Treat prolapse
Treatment for stress incontinence
Fluid restriction, pelvic floor exercises, transvaginal tape
Treatment for detrusor instablity
Bladder drill, tolterodine
Treatment for functional incontinence
Aid mobility
Treatment for overflow incontinence (chronic urinary retention)
TURP, Finasteride (5-alpha reductase inhibitor), Tamsulosin (alpha blocker)
Treatment for glaucoma
Prostaglandin eye drops
