Frailty_and_Dementia

Question 1

What factors have contributed to the changing age structure of the UK population?

Answer 1

Lower birth rates (higher cost of living), reduced child deaths, and longer life expectancy due to medical and public health advancements.

Question 2

How does the rising age of the population affect the prevalence of dementia?

Answer 2

Dementia prevalence increases because the risk doubles every five years over age 65, despite falling incidence.

Question 3

What are the two types of Lasting Power of Attorney (LPA)?

Answer 3

Health & Welfare LPA and Property & Financial Affairs LPA.

Question 4

Under what circumstances can an LPA’s powers be revoked?

Answer 4

An LPA’s powers can be revoked by a court if they are not acting in the patient’s best interests.

Question 5

What are the criteria for determining mental capacity under the Mental Capacity Act?

Answer 5

Understanding, retaining, using/weighing up information, and communicating the decision.

Question 6

How can mental capacity fluctuate in a person with dementia?

Answer 6

Mental capacity can fluctuate during delirium or when taking sedative medications, but it may return when these resolve.

Question 7

What are the five principles of the Mental Capacity Act?

Answer 7

Assume capacity unless proven otherwise. Provide reasonable support for decision-making. Respect unwise decisions. Decisions must be in the person’s best interests if capacity is lacking. Choose the least restrictive option.

Question 8

Under what conditions can confidentiality about a dementia diagnosis be broken?

Answer 8

Confidentiality can only be broken if it is clearly in the patient’s best interests.

Question 9

What societal attitudes can negatively impact the care and wellbeing of older people?

Answer 9

Patronizing attitudes, ignoring symptoms as inevitable, unnecessary polypharmacy, and lack of autonomy in decision-making.

Question 10

What strategies can healthcare providers use to improve communication with older people?

Answer 10

Active listening, avoiding jargon, using a clear adult tone, and recognizing the patient’s full life experience.

Question 11

What is the electronic frailty index (eFI), and what information does it use?

Answer 11

The eFI uses primary health record data, scoring disease states, symptoms, signs, disabilities, and social vulnerability.

Question 12

What is the Rockwood Frailty Score, and how is it used?

Answer 12

The Rockwood Score is a simple tool to assess frailty and guide clinical decisions.

Question 13

What factors are assessed when taking a history of falls from a frail patient?

Answer 13

Details of the fall (timing, location, preceding symptoms, what happened before/during/after), frequency, and triggers.

Question 14

What are the major system reviews to perform when assessing a frail patient with falls?

Answer 14

Cardiovascular (palpitations), neurological (dizziness, LOC), respiratory (SOB), gastrointestinal, and musculoskeletal systems.

Question 15

What medications can increase the risk of falls in frail individuals?

Answer 15

Beta blockers (bradycardia), antihypertensives (hypotension), benzodiazepines (sedation), and diabetic medications (hypoglycemia).

Question 16

What are the clinical features of Parkinson’s disease that impair mobility?

Answer 16

Tremor, cogwheel rigidity, bradykinesia (slow movement), postural instability, and freezing of gait.

Question 17

What are Parkinson’s-plus syndromes, and how do they differ from idiopathic Parkinson’s disease?

Answer 17

Parkinson’s-plus syndromes involve additional features like cranial nerve involvement, cognitive decline, and atypical progression.

Question 18

What are the major causes of dementia?

Answer 18

Alzheimer’s disease, vascular dementia, Lewy body dementia, and frontotemporal dementia.

Question 19

What are the macroscopic and microscopic pathological changes in Alzheimer’s disease?

Answer 19

Macroscopic: atrophy of frontal, temporal, and parietal lobes; microscopic: amyloid-beta plaques and neurofibrillary tau tangles.

Question 20

What are the clinical features and risk factors for vascular dementia?

Answer 20

Stepwise progression, patchy cognitive deficits, and risk factors like hypertension, stroke, diabetes, and smoking.

Question 21

What are Lewy bodies, and how do they contribute to dementia?

Answer 21

Lewy bodies are protein deposits (alpha-synuclein) that disrupt brain function, causing symptoms like hallucinations and Parkinsonism.

Question 22

What are the clinical features of frontotemporal dementia?

Answer 22

Early-onset dementia with behavioral changes (e.g., disinhibition), language difficulties, and compulsive behaviors.

Question 23

What commonly used tools assess cognitive function, and what are their limitations?

Answer 23

MMSE, MoCA, Mini-Cog, and 6-CIT; limitations include education bias, incomplete cognitive testing, and reduced sensitivity in early dementia.

Question 24

What are the differences between episodic memory, semantic memory, and procedural memory?

Answer 24

Episodic: memory of events; Semantic: knowledge of facts; Procedural: unconscious skills like riding a bike.

Question 25

How does amyloid-beta contribute to the pathophysiology of Alzheimer’s disease?

Answer 25

Amyloid-beta forms plaques that interfere with signaling, trigger inflammation, and damage neurons.

Question 26

What is the role of tau protein in Alzheimer’s disease?

Answer 26

Tau protein detaches from microtubules, aggregates into neurofibrillary tangles, and disrupts cellular transport.

Question 27

What is amyloid-beta immunotherapy, and how might it influence Alzheimer’s progression?

Answer 27

Immunotherapy uses antibodies to clear amyloid-beta plaques but does not stop tau spread. It may slow Alzheimer’s progression.

Question 28

How do acetylcholinesterase inhibitors work, and what are their effects on Alzheimer’s disease?

Answer 28

They inhibit acetylcholinesterase, increasing acetylcholine levels to improve cognition and delay symptoms by 6-12 months.

Question 29

What is memantine, and how does it act on the brain?

Answer 29

Memantine blocks NMDA receptors, preventing excitotoxicity and protecting neurons.

Question 30

What are the steps involved in raising and addressing safeguarding concerns in vulnerable adults?

Answer 30

Identify needs, respond to immediate risks, assess capacity, address harm with relevant services, and review actions.