Geri Flashcards
Features of geriatric depression (2 features)
- melancholic. 2. somatic complaints
What does the Wisconsin Card Sorting Test test?
executive funx
cut-off for MMSE
below 26 high specificity for dementia
Is the moca more sensitive than mmse?
yes
most common psych sx in Alz
apathy
most common hallucination in Alz
visual
Rivastigmine inhibits which two enzymes?
cholinesterase and butylcholinesterase
How does memantine work
NMDA inhibitor
Which memory med works only as cholinesterase inhibitor
- donepezil (it’s selective and reversible)
first choice treatment for LBD and PD dementia
rivastigmine
which two things does galantamine work on
- acetylcholinesterase 2. nicotine receptor
most common reason for psychosis in the elderly
dementia
What is Wernicke’s aphasia
Fluent speech, poor comprehension
Broca’s aphasia?
Cannot express, but can understand
Most common med responsible for delirium
anticholinergics
What factor in pharmacodynamics is not affected by aging?
absorption
Does late onset depression have more or less relapses
More
percentage depressed in community dwelling elderly
1%
percentage depressed of hospitalized elderly
10-15%
least and most anticholinergic TCA
least- desipramine and nortriptyline most- tertiary amines: amytriptyline, imipramine
What is the most common progression of episodes in bipolar as one ages
Increase in frequency and severity of both mania and depression.
what happens to REM in the elderly?
more episodes but less total REM
what happens to liver conjugation as we age
no change
what are the two types of FTD variants?
- behavioral 2. language
periodic sharp wave discharged are suggestive of which disease
prion/ creutzfeld-jacob
What is the main fnx of a cholinesterase inhibitor
slow cognitive decline (doesnt change function)
which neuroanatomy structures are primarily affected in Alz
parietotemporal (therefore frontal atrophy is often seen last)
percent of hospitalized patients that develop delirium
6-56%
most common type of hallucination in alz
VH
classic pathology found in Alz
amyloid plaques (white matter intensities) and tau tangles with gliosis and granulovaculoar degeneration
best AP to use in someone with PD or LBD and psychosis?
clozapine (least EPS risk)
what percent of individuals with a delirium will die within a year
40%
what is the primary pathology found in the brains of LBD and PD
alpha synuclein misfolding/aggregation
which dementia affects both cortical and subcortical?
vascular
subcortical dementias are associated with what disorder
movement d/o (Huntington, PD, LBD)
What does APO E4 increase the risk of
late onset Alz
Which three genes are associated with early onset Alz
- APP 2. presinilin 1 3. presinilin 2
what’s the risk of alz disease over age 65
5%, which doubles every 5 yrs
which vitamin is associated with treatment for Alz
Vit E (but also high doses is not recommended as tx..)
In which gender is Pick’s more common
M
Impairment to recall > recognition in which types of dementia
subcortical
retrograde amnesia and agnosia are common in which types of dementia
cortical
What part of the brain does Binswager’s affect
white matter arterioles (subcortical specific)
Where are argyrophilic intracellular inclusions found
Pick bodies
what is the most common anxiety disorder in the elderly
phobias
EEG characteristics of delirium
generalized increase in theta or delta activity
best med tx for TBI related aggression
BB (propranolol)
least likely anxiety disorder in elderly
panic disorder (1%)
two key features of PSP
- impaired walking/balance 2. slow/restricted eye mvt
does levodopa work in LBD
no- can worsen psych sx
only three recommendations for tx of dementia according to CMAJ article
- exercise. 2. tx HTN. 3. cholinesterase inh + memantine
late onset depression is more common in which gender
F
prevalence of MDD in community dwelling elderly
1-5%
what imbalance can PPIs cause
hyponatremia
qtc max for the elderly
M= 440 F= 460
First investigation for NPH
MRI head
mechanism of action of AD induced hyponatremia
SIADH
next intervention if patient does not respond to atypicals for BPSD
SSRI (citalopram)
Which type of dementia is HIV
subcortical
best tx for neurobehavioral sx of FTD (i.e. impulsivity)
- SSRI. 2. trazodone
imaging most consistent with LBD
medial temporal lobe sparing
imaging most consistent with Alz
cerebral atrophy especially hippocampal and medial temporal lobes
most common dementia
Alz (60-70%)
what does the hummingbird sign on MRI indicate
PSP
what’s the one similarity between mini-cog and mmse
delayed recall of three words
what is the relationship bw dementia and suicide
none
which dementia has apathy without depression
FTD
the first complaint of someone with MS
memory loss
what is the porphyria triad
- abdo pain 2. psychosis 3. neuropathy
