Geriatric

Question 1

MoCA Score

Answer 1

> 25 normal

Average score:
< 26 : MCI or AD
22.1 with mild cognitive impairment (MCI)
16.2 in people with Alzheimer’s disease.

Question 2

Delirium

Answer 2

Acute onset, fluctuating
Inattention
Disorganized thinking
Altered LOC

Question 3

Lewy Body Dementia

Clinical Features

Answer 3

Dementia
Parkinsonian symptoms
Visual hallucinations and paranoid episodes
Frequent falls
Autonomic dysfunction
Rapid eye movement sleep behavior disorder (RBD)

Question 4

Transient Causes of Incontinence

Answer 4

DIAPERS
Delirium
Infection
Atrophic urethritis/vaginitis
Pharmaceuticals
Excessive urine output
Restricted mobility
Stool impaction

Question 5

TUG test

Answer 5

Timed Up and Go test (TUG) used to assess a person’s mobility
- Time that a person takes to rise from a chair, walk three meters, turn around, walk back to the chair, and sit down

Question 6

Causes of delirium

Answer 6

Infections– UTI, pneumonia, encephalitis

Withdrawal - ethos, bento, sedative

Acute metabolic – electrolyte disturbance, dehydration, acidosis/alkalosis

Toxins, drugs – opiates, salicylates, indomethacin

CNS pathology- stroke, TIA, tumors, seizures

Hypoxia - anemia, hypotension

Deficiencies – thiamine, b12

Endocrine - thyroid, hypo/hyperglycemia, adrenal dysfunction

Acute Vascular- shock

Trauma- head injury

Heavy metals- lead, mercury

Question 7

Parkinson’s sx but also visual hallucinations and cognitive deficit?

Answer 7

It’s Lewy body dementia

Question 8

Lewy Body vs Parkinson’s

Answer 8

Lewy body will present with cognitive changes before motor sx, Parkinson’s is the opposite

Question 9

How long must you have Parkinson’s motor sx before being DX with Parkinson’s dementia

Answer 9

At least one year

Question 10

Motor sx of Parkinson’s

Answer 10

Bradykinesia, shuffling gait, masked facies

Question 11

Functions and locations of Broca and Wernicke’s areas

Answer 11

Broca - frontotemporal - expression of language (muscles of oration) - understand but can’t speak
Wernicke’s - temporal - comprehension of language - speaks well but can’t understand and speech is nonsensical

Question 12

Why Down’s develop Alzheimer’s

Answer 12

Over production of secretase (breaks down the neuron) by PSEN - associated with the 19th and 21st chromosome (also the cause of early onset Alzheimer’s)

Question 13

Other cause of neurocognitive disorders

Answer 13

Huntington’s, Parkinson’s, B12 deficiency, EtOH, hepatic encephalopathy, infections (HIV, syphilis), NPH

Question 14

Signs of B12 deficiency

Answer 14

Demyelination of spinothalamic tract - Ataxia, decreased sensation

Question 15

When should you do neuroimaging in the work up of dementia

Answer 15

When there are FND (seizures, paralysis, vision changes, ataxia) or under the age of 65

Question 16

Tx of dementia

Answer 16

There are 3 - just pick one and try it - donepezil, rivastigmine, galantamine - anticholinergics. Memantine- late stage dementia. These are for the neuropsychiatric effects.