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Aisha > Dunedin-Geriatrics > Flashcards

Dunedin-Geriatrics Flashcards

1
Q

What are the types of mild cognitive impairment?

A

amnestic subtype
non-amnestic subtype

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2
Q

Does amnestic MCI cover to alzheimers?

A

yes, 5-16% of them

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3
Q

Does MCI ever reverse?

A

Yes, 30-50%

factors associated with conversion
- single cognitive domain
- normal hippocampal volume
- depression
- anticholinergic burgen
- higher cognitive scores
- absence of apolipoprotein

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4
Q

What is the relationship between anticholinergic drugs and cognitive disorders?

A

Anticholinergic drug exposure associated with risk of dementia development OR 1.50

associated with increased cortical atrophy

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5
Q

Is there a role of cholinesterase inhibitors in MCI?

A

No

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6
Q

How to manage Mild cognitive impairment?

A

*blood pressure control
*dietary intervention- mediterranean *diet/DASH/vitamin B supplementation
*Cognitive training- inconclusive results

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7
Q

Describe the amyloid cascade hypothesis

A
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8
Q

Describe the genetics of alzheimers

A

Familial AD:
- autosomal dominant, <65 years
- APP (CH21), PSEN1, PSEN2 mutation account

Late-Onset AD
- APOE4 allele most common genetic risk factor

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9
Q

Is amyloid B burden associated with dementia severity?

A

no, but neurofibrillary tangles are

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10
Q

Describe biomarkers in alzeihmers

A

Core: Alpha Beta Proteinopathy, Tau
Biomarkers of non specific processes in AD: NFL, GFAP

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11
Q

What should you ALWAYS do before prescribing a cholinesterase inhibitor?

A

Get an ECG

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12
Q

Describe the role of cholinesterase inhibitor in Alzheimers disease

A

types: donepezil, galantamine, rivastimgine

Efficacy: symptomatic benefit only.

Adverse effects: contraindicated in bradycardia/conduction issues, long QTc
risk with syncope, falls, fractures
GI s/e common

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13
Q

What is the MOA of Memantine?

A

NMDA receptor blocker
block neurotoxicity from excess glutamine

may worsen delusions and hallucinations

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14
Q

What is Aducanumab? lecanemab? Donanemab?

A

Aducanumab: it is a amyloid beta-directed monoclonal antibody that were used in mild cognitive impairment (MCI) and early dementia

questionable benefit however caused amyloid-related imaging abnormalities (ARIA)

Lecanemab: Humanised IgG1 monoclonal Ab- binds to Alpha beta soluble protofils

Donaneman: monoclonal antibody that targets a modified form of deposited alpha beta

Solanezumab

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15
Q

what is post-stroke dementia?

A

10% develop new dementia soon after 1st stroke
>30% have dementia following recurrent stroke

increased risk of post-stroke dementia with:
- age
- previous stroke
- large volume stroke
- aphasia
- left hemisphere lesion
- hemorrhagic stroke

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16
Q

What is Binswanger disease?

A

extensive white matter lesion seen in cerebral small vessel disease

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17
Q

What is the characteristic of memory loss in cerebral small vessel disease?

A

Memory often relatively intact – problem with retrieval rather than encoding i.e recall improves with prompt

apathy often misinterpreted as depression

pseudobulbar affect - inappropriée invpluntary laughing and crying

often gait disorder

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18
Q

What is the role of anti-platelet therapy or statins in vascular cognitive impairment?

A

no evidence

some role of cholinesterase inhibitors in improvement

BP control however hypotension can accelerate cognitive decline in established small vessel disease

19
Q

What is a big risk with cerebral amyloid angiopathy?

A

antiplatelets and anticoagulation can increase bleeding risk

you can also get micro bleeds and cortical superficial siderosis

20
Q

What is the histology of cerebral amyloid angiopathy?

A

AB protein in cortical and leptomeningeal blood vessel walls

21
Q

What is CADASIL?

A

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy

22
Q

What are the MRI findings in CADASIL?

A

Lacunes, white matter changes (especially anterior temporal lobe), atrophy

23
Q

What are the pathological findings in CADASIL?

A

Granuloma osimophilic material in blood vessel walls, muscles and skin.

skin biopsy 100% specificity

24
Q

What is the genetic problem in CADASIL?

A

Frameshift mutation in NOTCH gene on chromosome 19 coding for transmembrane receptor

25
Q

What are Lewy bodies?

A

abnormal aggregation alpha- synuclein and eosinophilic inclusions found in
* basal ganglia in Parkinson’s disease
* cortex, brainstem and limbic system in Lewy Body dementia

26
Q

What are core clinical features of Lewy body dementia?

A
  • fluctuating cognitive impairment
  • Visual hallucinations
  • REM sleep behaviour disorder
    *Parkinsonism: at least 1 of rigidity, bradykinesia or tremor
27
Q

What are biomarkers in Lewy body dementia?

A
  • reduced dopamine transport uptake basal ganglia SPECT/PET
  • low uptake 1231-MIBG myocardial scintigraphy
    *Polysomnographic confirmation REM sleep without atonia
28
Q

What is the mean age of Frontotemporal dementia?

A

62 years

29
Q

What dementia if motor neuron disease associated with?

A

frontotemporal dementia

30
Q

What is the pathology of frontotemporal dementia?

A

Pick bodies- argyrophilic inclusions- 3 Tau repeat

31
Q

IS there a role for cholinesterase inhibitors in FTD?

A

nope, can worsen behaviour

32
Q

What is a physical manifestation of corticobasal degeneration?

A

alien limb- progressive asymetric rigidity and apraxia

33
Q

What is the most common cause of rapidly progressive dementia?

A

Creutzfeldt Jacob disease
- 14-3-3 CSF
- 2nd generation RT-QuLc
- Ribbon sign MRI

34
Q

What is the greatest factor in prevention of dementia?

A

hearing

35
Q

Describe some markers of delirium

A

Too much: glutamate, dopamine, noradrenaline

Too little: melatonin, Ash

Change: serotonin, histamine, GABA

36
Q

What is the major risk factor for injurious fall?

A

history of previous fall > fall associated with syncope > decreased executive functioning

37
Q

Medications associated with falls?

A

(1) antidepressants
(2) neuroleptics/antipsychotics
(3) benzodiazepines
(4) sedatives/hypnotics
(5) anti-hypertensives
(6) diuretics
(7) b-blockers

38
Q

What is the best Prevention for falls in the community?

A

certified exercise program

39
Q

Is there a role for multifactorial intervention in minimising falls risk?

A

no

40
Q

Is there a role for vitamin D in reducing falls?

A

no

41
Q

What does the SARC-F screen?

A

Strength
assistance in walking
Rise from a chair
Climb stairs
falls

Sarcopenia if score >4

42
Q

What are muscle change with ageing?

A

*Loss of fast twitch fibres and fast motor units (Type II fibres)
*loss of cross-sectional area muscles
*anabolic resistance
* increased adiposity
*Decrease in muscle quality (reduction in velocity shortening

43
Q
A

Aisha (33 decks)

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