Elderly Flashcards
Antipsychotics for behavioural disturbance in dementia associated with what?
Death
Sleep changes in the elderly
Decreased total sleep time
Increased sleep latency
Increased nocturnal wakenings
Decreased REM
Decreased amplitudes in the sleep-wake cycle
Decreased slow wave sleep
Best antipsychotic for delirium in elderly people when pharmacotherapy is indicated
Haloperidol has the best evidence
DSM-V criteria for frontotemporal dementia
A. Criteria for a NCD met
B. Insidious onset and gradual progression
C. 1 of the following
a. Behavioral Variant
i. Prominent decline in social cognition and/or executive abilities and 3+ of the following:
ii. Behavioral disinhibition
iii. Apathy or inertia
iv. Loss of sympathy or empathy
v. Perseverative, stereotyped, or compulsive/ritualistic behavior
vi. Hyperorality and dietary changes
b. Language variant
i. Prominent decline in language ability in form of speech production, word-finding, objectnaming, grammar, or word comprehension
ii. Relative sparing or learning, memory, and perceptual-motor function
D. Probable frontotemporal NCD if 1 of the following is present, otherwise it should be possible
a. Evidence of causative gene from family history or genetic testing
b. Evidence of disproportionate frontal/temporal involvement from neuroimaging
Old age insomnia - Sedative hypnotics in older adults?
Not first line, risk of accidents, hip fractures. CBT and brief behavioural interventions are first line
Genetic marker associated with late onset AD
APOE4
What happens to the seizure threshold with advancing age?
It gets higher
Investigation for an elderly person on high dose citalopram
ECG
What’s the cutoff on the GDRS?
6
Which is more sensitive, the MOCA or the MMSE?
MOCA
Best scale for depression in dementia
Cornell Scale for Depression in Dementia
Tool to assess pattern of agitation in dementia
Dementia observation scale DOS
Minor delay in word finding is normal with age T/F
T
Rate of conversion of mild NCD to major per year and rate of conversion to normal
5-10% to major 25-30% to normal
Rate of Alzheimer’s In population
5%
% of dementia that is vascular
15%
Depression and apathy are common in vascular dementia T/F
T
Family history is a RF for frontotemporal dementia T/F
T
Profound apathy- which dementia most likely?
FTD
Abnormal clock drawing shows exec dysfunction T/F
T
Late onset delusional disorder has a good prognosis T/F
F
Female sex has a better outcome in delusional disorder T/F
T
Elderly people have decreased adrenergic receptor sensitivity T/F
T
Late life depression more common in women T/F
T
Suicide rates in the elderly are nearly twice as high T/F
T
Why do elderly people get orthostatic hypotension?
Because of a decrease in adrenergic receptor sensitivity
What’s the most prevalent anxiety disorder in the elderly?
Specific phobia 3-5%
Features of melancholic depression
- Early morning wakening
- Morning mood worse
- Psychomotor retardation
- Morning awake
- Excessive guilt
- Loss of emotional reactivity
- Anorexia
- Anhedonia
Which is the condition most assiciated with psychotic symptoms in the elderly?
Dementia
Late onset depression is associated with higher rates of relapse T/F
T
EEG changes in delirium
Diffuse slowing. Generalised theta or delta slow wave activity, poor organisation of background rhythm, loss of reactivity to eye opening and closing
Indications for CT head in dementia
Indications for CT head in dementia
o Age <60y
o Rapid decline in cognition (ie over 1-2m)
o Duration of dementia <2y
o Recent significant head trauma
o Unexplained neurological symptoms
o History of cancer (especially locations that frequently metastasize to brain)
o Use of anticoagulants or bleeding disorder
o Symptoms of NPH
o New localizing neurologic symptom
o Unusual or atypical cognitive Sx (ie progressive aphasia)
o Gait disturbance
o If presence of undiagnosed CVD would change treatment
Genetic testing in dementia is recommended when in terms of age at onset?
<65y
Treatment of choice for behavioural sx of LBD
Rivastigmine
There is no increased rate of suicide in dementia T/F
T
Prevalence of MCI over 65
10-20%
Rate of conversion of MCI to dementia each year
10%
Percentage of MCI that do not develop dementia
25%
Cognitive impairment, fluctuations, frequent falls and visual hallucinations
LBD
The nost frequently used tests of executive function in aging
- Trail making test
- Verbal fluency test
- VFT animals category
- Clock drawing test
- Digits forward or backward subtest of WAIS
- Stroop test
- Wisconsin card sorting test
What is the strongest risk factor for Alzheimer’s dementia?
Age
Prevalence of AD at 90 years of age
21%
EEG pattern of periodic synchronous bi- or triphasic sharp wave complexes is highly suggestive of what?
CJD
The MMSE is good for what in dementia?
It has high sensitivity and specificity for separating moderate dementia from normal cognition
Which type of dementia does not respond to ACEi
FTD
Neurofibrillary tangles only occur in Alzheimer’s dementia T/F
F also in Down syndrome, dementia pugilistica (punch drunk syndrome). Not in vascular dementia though
The most characteristic focal finding on MRI in AD
Reduced hippocampal volume
What’s the one year mortality after an episode of delirium?
As high as 50% K&S
Anticholinergics can precipitate delirium T/F
T frequently
Subcortical NCDs
- Parkinsons disease dementia
- HIV dementia
- Vascular lesions which are subcortical
Delirium DSM V
DSM-5
A. Disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).
B. The disturbance develops over a short period of time (usually hours to a few days), represents an acute change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.
C. An additional disturbance in cognition (e.g.memory deficit, disorientation, language, visuospatial ability, or perception).
D. The disturbances in Criteria A and C are not better explained by a pre-existing, established or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal such as coma.
E. There is evidence from the history, physical examination or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e. due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies.
Risk factors for post op delirium
● pre-existing dementia (strongest)
● severe medical illness. (2nd strongest)
● Advanced age
● Little contact with family
● male sex
● depression
● alcohol abuse
● Electrolyte abnormalities
● Medication use
● hearing/visual impairment
● Limited pre-morbid activities
● pre-existing challenges with ADLs
● fracture on admission
● General anesthesia is NOT a RF for post-operative delirium
APOE4 increases risk of earky onset AD T/F
F, its late onset
LBD criteria DSM V
DSM-5 Diagnostic Criteria for Major or Mild Neurocognitive Disorder with Lewy Bodies
The criteria are met for major or mild neurocognitive disorder AND
The disorder has an insidious onset and gradual progression AND
The disorder meets a combination of core diagnostic features and suggestive diagnostic features for either probable or possible neurocognitive disorder with Lewy bodies.
For probable major or mild neurocognitive disorder with Lewy bodies, the individual has two core features or one suggestive feature with one or more core features.
For possible major or mild neurocognitive disorder with Lewy bodies, the individual has only one core feature or one or more suggestive features.
Core diagnostic features of neurocognitive disorder with Lewy bodies include the following:
fluctuating cognition with pronounced variations in attention and alertness
recurrent visual hallucinations that are well-formed and detailed
spontaneous features of parkinsonism, with onset subsequent to the development of cognitive decline
suggestive diagnostic features:
meets criteria for rapid eye movement sleep behavior disorder
severe neuroleptic sensitivity
disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder
AD has predominant PET changes in the temparo-parietal region T/F
T
General anaesthesia is a risk factor for post op delirium T/F
F
