deltamed

Question 1

Define frailty

Answer 1

multidimensional syndrome characterised by lack of physiological reserve
- present in 10% of those over 65

Question 2

Frailty scale

Answer 2

Rockwood scale
Fried scale

Question 3

What is frailty a risk factor for?

Answer 3

death
functional decline
requirement for care
falls
poor outcomes from surgery
poor outcomes from ICU

Question 4

MMSE
- score for dementia
- sens. and spec.

Answer 4

<24
specific but not sensitive

Question 5

AD prevention

Answer 5

physical activity, cognitive stimulation, social interaction
manage vascular risk factors

Question 6

AD pathophysiology

Answer 6

Amyloid plaques + Tau protein mediated neuronal injury
- shrinking of hippocampus

Question 7

Genetics of AD

Answer 7

Mutations:
Amyloid precursor protein - Chr 21
Presenilin 1 - Chr 14
Presenilin 2 - Chr 1
Down syndrome
Apolipoprotein E (E4 allele) (late onset)

Question 8

FTD subtypes

Answer 8

Behavioural subtype
Semantic dementia (fluent)
Primary progressive aphasia (nonfluent)
Motor subtypes (MND, PSP, CBD)

Question 9

FTD symptoms

Answer 9

personality and social conduct impairment
lose empathy
disinhibition, perseveration
abulia, apathy
Memory relatively well preserved

Question 10

Dementia with Lewy Bodies
- protein
- typical onset and progression
- typical features

Answer 10

alpha-synucleinopathy
rapid onset with progressive decline over 1-4 years
changes in attention, visual hallucination, REM sleep behaviour disorder, parkinsonism

Question 11

Vascular dementia
- diagnostic features, progression
- typical symptoms

Answer 11

Evidence of vascular disease on imaging, stepwise progress
inattention and poor executive function

Question 12

Cholinesterase inhibitors
- use
- NNT
- effects
- maximal response

Answer 12

use in mild-mod AD
NNT 10
maximal response at 6 months
may improve or delay onset of adverse behaviour and delay time to institutionalisation

Question 13

Cholinesterase inhibitors
- side effects

Answer 13

GIT - nausea, diarrhoea, anorexia
sleep disturbance
bradycardia
exacerbate asthma

Question 14

Memantine
- MOA
- target demographic, PBS
- precautions

Answer 14

NMDA receptor antagonist
moderate to severe AD or Vascular dementia
MMSE 10-14
- risk of epilepsy (dont use in previous seizure disorder)

Question 15

Aducanumab
- MOA
- adverse events

Answer 15

MAB to amyloid
cerebral oedema and microhaemorrhages

Question 16

Continence
- indications for urodynamic studies

Answer 16

unclear diagnosis that may help with further treatment
- e.g. underlying neurology or multiple sclerosis

Question 17

Continence
- medications

Answer 17

antimuscarinic agents (oxybutynin)
B3 receptor antagonists (mirabegron)
Botox
Topical oestrogens