General Flashcards
What is frailty?
State of increased vulnerability resulting from ageing associated decline such that the ability to cope with every day stressors is comprised.
What are the geriatric giants?
Falls Confusion Off legs -immbility Incontinence Chest pain, SOB polypharmacy fatigue depression Social admission
What is deconditioning?
Idea already worse state gets worse when ill
What is the endocrine physiology of ageing?
reduced testosterone, renin, angiotensin, growth hormone and IGF. Diurnal ADH lost –> nocturnal urine production
What is the renal physiology of ageing?
reduced renal blood flow, increased arteriole resistance, reduced in GFR
What is the CNS physiology of ageing?
beta amyloid plaques, small vessel ischaemic disease, reduced memory learning
What is the respiratory physiology of ageing?
reduced elastic recoil and chest wall compliance, reduced RV, VC and FEV1.
What is the MSK physiology of ageing?
reduced skeletal muscle, reduced bone density
What is the immunological physiology of ageing?
reduced specific AB, reduced T cell, blunted fever response
What is the gastrological physiology of ageing?
less saliva production, diverticulitis, malnutrition
What are the phenotype and cumulative deficit models of frailty?
phenotype models are unintentional weight loss, reduced muscle strength, reduced gait speed, low energy expenditure.
Cumulative Deficit model- add up co morbidities, correlate with outcome
What is a method of assessing frailty?
Bartell index
WHen should postural hypotension be diagnosed?
Orthostatic hypotension can be diagnosed when there is:
a. A drop in systolic BP of 20mmHg or more (with or without symptoms)
b. A drop to below 90mmHg on standing even if the drop is less than 20mmHg (with or without symptoms)
c. A drop in diastolic BP of 10mmHg with symptoms (although clinically much less significant than a drop in systolic BP).
mx for postural hypotension
Non-pharmacological treatments include increasing water and salt intake, or using compression garments or bandages and physical manoeuvres to counter the drop in blood pressure.
can take them off anti-htn meds
What is the mx of moderate alzheimers?
1st line: Acetylcholinesterase (AChE) inhibitors (donepezil, galantamine, and rivastigmine)
What is the mx of severe alzheimers?
Memantine -NMDA receptor antagonist
What are the 5 As of alzheimers?
aphasia (speech) agnosia (recognition) apraxia (motor pathways eg doing up button) amnesia apathy
How does FTD/ picks disease present?
<65.
insidious onset
changes in personality and behaviour.
One form in particular (primary progressive aphasia) can present with the inability to produce speech and loss of literacy skills.
Relatively preserved memory and visuospatial skills
How does vascular dementia present?
>65 progressive step wise may be pmhx vascular issues focal neuro nocturnal confusion
How does Huntingtons dementia present?
possible personality changes,
it typically presents differently with motor dysfunction and tends to be a strong inheritance pattern.
younger
A 72-year-old man presents with his daughter. She reports that he seems to have been struggling intermittently with his attention, and sometimes his speech is muddled. She says he has been very low in mood and does not seem to enjoy anything anymore, saying he doesn’t have any energy. He has also been experiencing visual hallucinations and at night he ‘acts out’ his dreams. His gait appears slow and shuffling. WHat is likely cause?
LBD - as fluctuates, hallucinates, speech and attention, mood effected, parkinsonisms, sleep disturbed
What med should be avoided in LBD?
Avoid neuroleptics (eg haloperidol) in Lewy body dementia- may cause irreversible parkinsonism
1st line mx of LBD?
Donepezil is a cholinesterase inhibitor which is the first-line treatment for cognitive impairment and behavioural symptoms in DLB.
other mx of LBD?
Carbidopa/Levodopa are dopaminergic agents used to treat motor symptoms which present in Lewy body dementia
Clonazepam is used to treat REM sleep behaviour disturbances and should be given in low doses 30 minutes before bedtime.
Sertraline is an SSRI which are the preferred drugs to treat depression with Lewy body dementia because they have limited side-effects and favourable pharmacokinetics
LBD vs parkinsons dementia?
Lewy body dementia is more likely if dementia starts before or within 1 year of the onset of the parkinsonian symptoms. Lewy body dementia also commonly causes visual hallucinations of people. The poor response to co-careldopa is also a clue, as the ‘Parkinson’s plus’ syndromes are often less responsive to classical antiparkinsonian drugs.
Outline meds on stop-start criteria for pt with dementia
anticholinergics
Antimuscarinics
antipsychotics
