Elderly

Question 1

Dementia blood screen

Answer 1

FBC
U+E's
LFTs
Calcium
Glucose
TFTs
Vit. B12
Folate

Question 2

Common causes of dementia

Answer 2

Alzheimer’s
Cerebrovascular disease
Lewy body dementia
Frontotemporal lobar degeneration

Question 3

Treatable/reversible causes of dementia

Answer 3

Hypothyroidism
Addison's
B12/Folate/Thiamine deficiency
Syphilis
Brain tumour
Depression
Subdural haematoma

Question 4

Lewy body dementia

Answer 4

Alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas

Question 5

Features of lewy body dementia

Answer 5

Progressive cognitive impairment (including attention and executive function, unlike alzheimer’s)
Cognition can be fluctuating
Parkinsonism
Visual hallucinations

Question 6

Management of lewy body dementia

Answer 6

Acetylcholinesterade inhibitors (donepezil, rivastigmine)
Memantine

Question 7

Alzheimer’s disease

Answer 7

Progressive degenerative disease
5% inherited
Down Syndrome is a huge risk factor

Question 8

Alzheimer’s disease pathology

Answer 8

Macroscopic:
Cerebral atrophy (particularly cortex + hippocampus)

Microscopic:
Cortical plaques due to amyloid proteins and neurofibrillary tangles (caused by aggregation of tau protein)

Question 9

Alzheimer’s disease clinical features

Answer 9

Primarily affects memory, less involvement of other symptoms

Question 10

Alzheimer’s management

Answer 10

Non-pharmacological:
Wellbeing activities
Group cognitive stimulation
Reminiscence therapy/cognitive rehabilitation

Pharmacological:
Acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine)
Memantine (NMDA receptor antagonist)

Question 11

When is donepezil contraindicated

Answer 11

Moderately contraindicated in patients with bradycardia

Question 12

Drugs to avoid in alzheimer’s

Answer 12

Antidepressants

Antipsychotics

Question 13

Frontotemporal lobar degeneration types

Answer 13

Frontotemporal dementia (Pick’s disease)
Progressive non-fluent aphasia (chronic progressive aphasia)
Semantic dementia

Question 14

Features of frontotemporal lobar dementias (FTLDs)

Answer 14

Onset before 65
Relatively presered memory and visuospatial skills
Personality change and social conduct problems

Question 15

Pick’s disease

Answer 15

Most common FTLD

Is characterised by personality change and impaired social conduct

Question 16

Pathology in Pick’s disease

Answer 16

Macroscopic:
Atrophy of the frontal and temporal lobes

Microscopicd:
Spherical aggregations of tau protein (silver-staining)
Gliosis
Neurofibrillary tangles
Senile plaques

Question 17

Treatment of frontotemporal dementia

Answer 17

Antidepressants (SSRIs) - can help with loss of inhibition
Antipsychotics - rarely used, but can be if SSRIs are ineffective

Conservative:
OT input
SALT
Physio
Memory cafes etc

Question 18

Symptoms of vascular dementia

Answer 18

Slowness of though
Difficulty with planning and understanding
Problems with concentration
Changes to your mood, personality or behaviour
Feeling disorientated and confused

Question 19

Treatment of vascular dementia

Answer 19

Typically a step-wise progression

Eating a healthy, balanced diet
Losing weight
Stopping smoking
Reducing alcohol
HTN meds, statins etc. to lower risk