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Care of the elderly > Conditions > Flashcards

Conditions Flashcards

1
Q

Define dementia

A

Syndrome caused by a number of brain disorders which cause memory loss, decline in cognition and intellect and difficulties with activities in daily living

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2
Q

Types of dementia

A

Alzheimer’s
Frontotemporal (Pick’s)
Lewi body dementia
Vascular

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3
Q

Clinical features necessary for the diagnosis of dementia/ memory impairment

A

Global
Memory problems ( short/ long) term
Progressive
Decline in function

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4
Q

Dementia and Driving. What is the the rules?

A

Legally obliged to inform the DVLA if driving

HGV licence is revoked

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5
Q

Pathophysiology of alzheimer’s

A

Macroscopic: Global atrophy ( starting at media temporal lobe)
Microscopic: B-amyloid plaques and neurofibrillary tangles

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6
Q

Clinical features and the time line in which they occur in Alzhemiers

A

EARLY

  • Forgetting names
  • Memory lapses
  • Difficulties in finding words

MIDDLE

  • Apraxia
  • Impaired decision making skills
  • Confusion

LONG

  • Wandering
  • Disorientation
  • Apathy
  • Behavioural problems
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7
Q

Management of Alzhemiers

A

A) Donepezil (AChE inhibitor)

B) Memantine (NMDA receptor antagonist)

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8
Q

Pathophysiology of vascular dementia

A

Macroscopic
Infracted grey and white matter

Group of syndromes of cognitive impairment caused by different mechanisms causing ischaemic haemorrhage secondary to CVD

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9
Q

Clinical features of vascular dementia

A

Sudden onset
Step wise detonation
Focal neuro deficits
Difficulty with attention and concentration

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10
Q

Pathophysiology of Lewy body dementia

A

Macroscopic: atrophy of the frontal, partial and occipital lobes
Lewi bodies in the occipo-partial cortex (intracellular aggregates of alpha-synuclein)

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11
Q

Clinical features of levy body dementia

A
  1. Parkinsonism
    - Tremor
    - Festinating gait
    - Rigidity
    - Bradykinesia
  2. Visual hallucinations
  3. Fluctuating levels of awareness and concentration
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12
Q

Management of Lewy-body dementia

A

Rivastigmine (6-12mg OD)

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13
Q

Pathophysiology of frontotemporal dementia

A 
Abnormal protein ( tau and progranulin)
Macroscopic = atrophy of F + T lobes 
Microscopic = intracellular aggregation of tau 
(Pick's disease and picks bodies)
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14
Q

Clinical features of frontotemporal dementia

A

Disinhibition
Personality change
Early memory preservation
Progressive aphasia

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15
Q

List the possible causes of falls in the elderly

A

Drugs (e.g. sedatives, alcohol)
MSK (e.g. OA of hip)
Syncope (e.g. vasovagal, cardiogenic, arrhythmias)
Stroke/TIA
Postural hypotension (secondary to antihypertensives, hypovolaemia, dopaminergic drugs)
Neurological: peripheral neuropathy, Parkinson’s
Hypoglycaemia
Visual impairment
Vertigo (e.g. BPV, meniere’s disease)
Poor environment (e.g. poor lighting, loose rugs)
Dementia

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16
Q

Main features of parkinson

A

Tremor
Bradykinesia
Rigidity (lead-pipe; cogwheel)

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17
Q

List differentiating features of parkinsonian tremor

A 
Slow (pill-rolling)
Worse at rest
Asymmetrical
Reduced on distraction
Reduced on movement
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18
Q

What class of drug is normally combined with L-dopa to prevent peripheral side-effects?

A

Dopa decarboxylase inhibitor (e.g. carbidopa or benserazide)

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19
Q

Name 3 complications of L-dopa therapy.

A

Postural hypotension on starting treatment

Confusion, hallucinations

L-dopa induced dyskinesias

On-off effect: fluctuations in motor performance between normal function (on) and restricted mobility (off).

Shortening duration of action of each dose (i.e. end-dose deterioration where dyskinesias become more prominent at the end of the duration of action)

Remember DOPAMINE

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20
Q

Pressure Ulcer Risk Factors

Name the scoring system

A 
Age > 70
Being bedridden
Paralysis (may be partial)
Obesity
Urinary or bowel incontinence
Poor nutrition
Medical conditions that affect blood supply: diabetes, peripheral arterial disease, renal failure, heart failure

Waterlow scoring system

21
Q

Pressure Sore Prevention

A

Barrier creams

Pressure redistribution and friction reduction (e.g. special foam mattresses, heel support, cushions)

Repositioning (every 6 hrs in normal risk; every 4 hrs in high risk)

Regular skin assessment:

  • Check for areas of pain or discomfort
  • Skin integrity at pressure areas
  • Colour changes
  • Variations in heat, firmness and moisture (e.g. incontinence, oedema, dry, inflammed skin)
22
Q

Name 4 cardiac conditions that may cause an embolic CVA

A 
Atrial fibrillation
MI causing mural thrombus
Infective endocarditis
Aortic or mitral valve disease
Patent foramen ovalee
23
Q

List 6 causes of delirium

A

Infection (commonly UTI and pneumonia)
Metabolic (hypoglycaemia, renal failure, liver failure, electrolyte imbalance e.g. hyponatriaemia, hypocalcaemia.)
Drugs: benzodiazepines, opiates, alcohol
Hypoxia
Nutritional deficiency (vitamin B12, thiamine)
MI
Intracranial lesion (incl. space-occupying, epilepsy, CVA, head injury)

24
Q

List 4 causes of hyponatriaemia.

A 
135-145 = Normal 
DILUTION EFFECT
- Heart failure 
- Hypoproteinaemia 
- SIADH 
- Hypervolaemia/fluid excess
- NSAIDs
- Oliguric renal failure

SODIUM LOSS

  • Addison’s disease
  • Diarrhoea & vomiting
  • Osmotic diuresis
  • Sever burns
  • Diuretic stage of acute renal failure

If you replace Na too quickly central pontine mylinolysis

25
Q

Name 4 symptoms of hypocalcaemia

A 
"SPASMODIC"
Spasms ( caropedal) 
Periodical parasthesia 
Anxious 
Seizures 
Muscle tone increase
Orientation reduced
Dermatitis
Impetigo hepaformis 
Chovesks sign +ve
26
Q

Name 4 symptoms of hypercalcaemia

A

Bone pain, fractures (hyperPTH or malignancy)

Renal stones (renal colic); renal impairment (renal calcinosis);

Polyuria, polydipsia, dehydration (nephrogenic diabetes insipidus)

Drowsiness, delirium, muscle weakness, impaired cognition, depression, coma

Nausea, vomiting,

Constipation, abdominal pain, weight loss, anorexia

HTN, shortened QT, arrhythmias

27
Q

What MMSE score supports a diagnosis of dementia?

A

MMSE <25 supports dementia.

  • 25-27 is borderline.
  • <10 severe;
  • 10-20 moderate;
  • 21-24 mild.
28
Q

What other cognitive assessment tools may be used?

A

Cognitive tests:

  • Addenbrookes cognitive examination-III (ACE-III)
  • Montreal cognitive assessment (MoCA)
  • Abbreviated mental test score (AMT)
  • 6-Item cognitive impairment test (6CIT)
  • General practitioner assessment of cognition (GPCOG)
29
Q

List 4 blood tests you would do to exclude treatable causes of dementia

A

Blood tests:

  • Thyroid function tests
  • Syphilis serology (neurosyphilis)
  • Liver function tests (hepatic encephalopathy; alcoholism)
  • Vitamin B12, thiamine (B1) and folate levels
30
Q

What is Donepezil and what types of dementia can it be used to treat?

A

Donepezil is an Acetylcholinesterase inhibitor; used only in Alzheimer’s disease. (Others ACh-ase inhibitors: rivastigmine and galantamine)

Alternative medication:
Memantine, a N-methyl-D-aspartate (NMDA)-receptor antagonist which blocks glutamate. (Only in moderate to severe Alzheimer’s)

31
Q

List the different types of delirium

A

“Acute fluctuating syndrome of disturbed consciousness, attention, cognition and perception”

Hyperactive  agitation, inappropriate behaviour, hallucinations

Hypoactive  lethargy, reduced concentration

32
Q

List the risk factors for delirium

A
  • Older age
  • Cognitive impairment
  • Frailty/multiple comorbidities
  • Significant injuries
  • Functional impairment
  • Hx of alcohol excess
  • Sensory impairment
  • Poor nutrition
  • Lack of stimulation
  • Terminal phase of illness
33
Q

Clinical features of delirium

A

Acute behavioural change (hours to days)

Altered social behaviour

Altered level of consciousness

Falling and loss of appetite

34
Q

Differential diagnosis of delirium

A

Depression

Dementia

Mental illness

Anxiety

Thyroid disease

Temporal lobe epilepsy

Charles Bonnet syndrome

35
Q

How do you deem if some has capacity

A

Assessment of capacity

  • Understand the information relevant to the decision
  • Retain the information
  • Weigh up the information
  • Communicate the decision
36
Q

How long should a patient be on bisphosphonates following a #

A

After a 5year period for oral bisphosphonates (3years for IV zoledronate), treatment should be re-assessed for ongoing treatment, with an updated FRAX score and DEXA scan.

If low risk/T score <2.5 stop and review in 2yrs

37
Q

List the patients who are at high risk of a future fractures

A 
Glucocorticoid therapy
Age >75
Previous hip/vertebral fractures
Further fractures on treatment
High risk on FRAX scoring
T score
38
Q

How do bisphosphonates work?

A

Bisphosphonates are analogues of pyrophosphate, a molecule which decreases demineralisation in bone. They inhibit osteoclasts by reducing recruitment and promoting apoptosis.

Clinical uses

  • Prevention and treatment of osteoporosis
  • Hypercalcaemia
  • Paget’s disease
  • Pain from bone metatases
39
Q

List 3 adverse effects of bisphosphonates.

A

Adverse effects

  • Oesophageal reactions: oesophagitis, oesophageal ulcers (especially alendronate)
  • Osteonecrosis of the jaw
  • Increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate
40
Q

How are DEXA scan scores interpreted?

A

Femoral neck T-score of > -2.5.

If T score is -2.5 < X < -1 == osteopenia

41
Q

Define malnutrition

A

State in which a deficiency of energy, protein, and/or other nutrients causes measurable adverse effects on the body’s form, composition, function and clinical outcome.

42
Q

List the causes of malnutrition

A

Decreased nutrient intake (starvation)

Increased nutrient requirements (sepsis or injury)

Inability to utilise ingested nutrients (malabsorption)

43
Q

List the criteria for diagnosing malnutrition

A

BMI<18.5kg/m2
Unintentional weight loss >10% last 3-6 months

Those at risk of malnutrition

  • Eaten little or nothing for > 5days
  • Poor absorptive capacity
  • High nutrient losses
  • Increased nutritional needs from causes such as catabolism
44
Q

List the factors increasing nutritional requirements

A 
Acute infection/pyrexia
Inflammatory condition
Trauma
Liver disease
Wound healing
Surgery
Malignancy
Chronic infection (e.g. HIV)
45
Q

List the consequences of malnutrition

A 
Impaired immunity
Impaired wound healing
Muscle mass loss
Respiratory function loss
Cardiac function loss
46
Q

Explain the pathophysiology behind refeeding syndrome

A

Prolonged starvation followed by provision of nutritional supplementation

Chronic malnutrition

  • Insulin levels decreased
  • Energy source switch to fats
  • Normal serum phosphate levels
  • Low intracellular phosphate levels

Refeeding syndrome

  • Insulin increased
  • Movement of electrolytes into cell result in decreased serum electrolyte levels
47
Q

List the blood results in referring syndrome

A 
Hypophosphataemia
Hypokalaemia
Hypomagnesaemia
Hyperglycaemia
Thiamine deficiency (erythryocyte transketolase or thiamine level)
Trace elements deficiencies
48
Q

Management of referring syndrome

A 
Replace electrolytes (P043-, K, Mg)
Monitor glucose and Na levels

Supportive care

Feeds, vitamins (B6,B12), folate

Refer to nutritional support team/dietician

49
Q

List the diagnostic criteria for delirium

A 
Clouding of consciousness
Disorientation, impaired memory 
Incoherent speech 
Perceptual changes 
Psychomotor changes 
Sleep is affected

Care of the elderly (1 decks)

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