Geriatric Flashcards
investigations done when originally diagnosing dementia
primary care:
blood tests to look for reversible causes
FBC, U&Es, LFTs, TFTs, glucose, calcium, vitamin B12 and folate, ESR/CRP
secondary care: neuroimaging
e.g. subdural haematoma, normal pressure hydrocephalus
role of acetylcholine
has a role in parasympathetic innervation
- smooth muscle contraction
- blood vessel dilation
- slows heart rate
- releases secretions
management of Alzheimer’s disease
non-pharmacological:
- offer a range of activities to promote wellbeing based on preference
- group cognitive stimulation therapy for patients with mild and moderate dementia
- to consider include group reminiscence therapy and cognitive rehabilitation
pharmacological:
acetylcholinesterase inhibitors
e.g. donepezil, galantamine, rivastigmine
for mild to moderate dementia
memantine = NMDA receptor antagonist
monotherapy in severe Alzheimer’s
add on drug to acetylcholinesterase inhibitors for patient’s with moderate/severe Alzheimer’s
moderate alzheimer’s where intolerance/contraindication to acetylcholinesterase inhibitors
NOT to recommend antidepressants
anti-psychotics used for patients at risk of harming themselves or others, or when agitation, hallucinations, delusions causing them severe distress
contraindications for donepezil
bradycardia
adverse effects include insomnia
should be started with caution in patients with conduction abnormalities or those already taking negatively chronotropic medications such as beta blockers, rate-limiting calcium channel blockers or digoxin
first line neuroimaging for diagnosing dementia
MRI
what is a Q risk score
identifies the 10 year risk of heart disease and who should be started on statins
role of STOPP tool
identifies medications where the risk outweighs the therapeutic benefits in certain conditions
what is frontotemporal dementia
form of dementia more common in those < 65yrs
various forms, where individuals can experience changes in personality & behaviour
e.g. primary progressive aphasia = inability to produce speech and loss of literacy skills
common features of frontotemporal lobar dementias
onset before 65yrs
insidious onset
relatively preserved memory & visuospatial skills
personality change & social conduct problems
what are the 3 types of frontotemporal lobar dementia
frontotemporal dementia (Pick’s disease)
chronic progressive aphasia/ progressive non-fluent aphasia
semantic dementia
what is Pick’s disease & its presentation
most common type of fronto-temporal dementia
characterised by personality change & impaired social conduct
hyperorality
disinhibition
increased appetite
perseveration behaviours
macro/microscopic changes seen in Pick’s disease
Focal gyral atrophy with a knife-blade appearance = characteristic
macroscopic: atrophy of the frontal and temporal lobes
microscopic:
pick bodies (spherical aggregations of tau protein, silver-staning)
Neurofibrillary tangles
gliosis
senile plaques
management of Pick’s disease
NICE do not recommend acetylcholinesterase inhibitors or memantine
presentation of chronic progressive aphasia
chief factor is non-fluent speech
short utterances that are agrammatic
comprehension relatively preserved
presentation of semantic dementia
speech is fluent but empty and conveys little meaning
unlike in Alzheimer’s memory is better for recent than remote events
predisposing factors to delirium
age > 65 years
background of dementia
significant injury e.g. hip fracture
frailty/multimorbidity
polypharmacy
precipitating factors to delirium
infection: particularly UTIs
change of environment
constipation
severe pain
metabolic e.g. hypoglycaemia, dehydration, hypercalcemia
alcohol withdrawal
any significant condition