Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RC Nuggets > Geriatric > Flashcards

Geriatric Flashcards

1
Q

Major NCD prevalence

A

1-2% in 65yo (2/10)
30% in 85yo (1/3)

F > M

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Global deterioration scale (1-7)

A 
Mild = 3
Major = 4
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mild NCD prevalence

A

10-20% in 65yo (1-2/10)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Mild NCD conversion rates

A

5-10% / year to AD
75-80% / 10 years

BUT
25-30% RETURN TO NORMAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Mild NCD treatment

A

ACEi not helpful

TREAT HYPERTENSION (target < 140mmHg systolic)
Healthy lifestyle

Treat depression: SSRI tx > 4 years can delay progression to AD by 3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Major NCD distribution

A 
AD 50-60%
Vascular 15-30%
Lewy body 10-25%
Mixed 10%
FTD 5%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Normal pressure hydrocephalus

A

WACKY, WOBBLY, WET

Cognitive decline, gait disturbance, urinary incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pseudodementia

A

Secondary DD, hospitalization, fecaloma, sensory deficit
NOT IMMOBILIZATION

Abrupt, symptoms progress rapidly
Distressed about symptoms
Worst in the morning
Improves with sleep deprivation
"I don't know" instead of confabulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Ribot’s Law

A

Gradient to retrograde amnesia

recent > remote memories

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Proteinopathies

A

AD = amyloid plaque, neurofibrillary tangles, TAU

Pugilistica (secondary TBI) = amyloid plaque, neurofibrillary tangles, TAU

LBD/PD = alpha synuclein

FTD (Pick) = TAU, TDP-34, ubiquitine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which dementia aetiologies don’t have neurofibrillary tangles?

A

Those secondary to repeated cerebral insult

  • vascular
  • due to substance
  • due to HIV
  • due to other medical diagnosis (infection)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cortical dementias

A

Alzheimer’s
FTD (Pick’s)
CJD

AMNESIA (recall + recog)
AGNOSIA
APRAXIA
APHASIA
SEIZURES
COUNTING (EARLY)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Subcortical dementias

A 
Parkinson's dementia
Huntington's dementia
Wilson's dementia
HIV dementia
NPH dementia
Depletion
Depression
Dysexecutive
Delay
Dysmnesia (recall only)
Dysarthria
Dystonia
Chorea
Slowing
Counting (LATE)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mixte dementias (cortical + subcortical)

A

Vascular dementia
LBD
Alcohol dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Indications for genetic testing

A

< 65 yo + family history

6-7% of cases
PSEN1 = ch 14 (30-70%)
PSEN2 = ch 1 (< 5%)
APP = ch 21 (10-15%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Mini cog

A

Repeat 3 words
Clock
Recall 3 words

0/3 = positive
1-2/3 = positive only if abnormal clock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

MMSE

A

Ceiling (not sensitive if high education) + floor (not specific if very low score) effect

Cutoff 24/30

Sensitivity 82%
Specificity 87%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MOCA

A

Extra point if schooling < 13 years

Cutoff 26/30

More SENSITIVE than MMSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does FMRI measure?

A

OXYGENATION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does PET measure?

A

Glucose metabolism

NO DECREASE IN THALAMIC TUMOR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is CT scan better for?

A

Acute bleed
Calcium
Bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Test for frontal function?

A

LURIA SERIE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Major NCD due to AD criteria?

A

At least 2 cognitive domains

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Mild NCD due to AD criteria?

A

At least 1 domain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Alzheimer’s dementia prevalence

A

10% in 70yo

20% in > 70yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Risk factors for AD

A 
Age
Women
Low education
Depression
Increased homocysteine
Increased estrogen
Trisomy 21
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Protective factors for AD

A

Education (> 15 years)
APO-E2
Blood pressure (< 140mmHg systolic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Genes involved in late AD

A

APO-E4 on CHROMOSOME 19
E4/E4 RR 8-11
E4/E3-2 RR 3

SORL1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Extracellular pathology in AD

A

AMYLOID PLAQUES (beta 42)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Intracellular pathology AD

A

NEUROFIBRILLARY TANGLES (tau)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Neurotransmitters in AD

A

LOW ACETYLCHOLINE (low AChE, high BuChe)
LOW NOREPINEPHRINE
LOW SOMATOSTATIN
LOW CORTICOTROPINE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Most common hallucination in AD?

A

Visual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Mechanisms of vascular dementia

A
  1. Multiple cortical strokes
  2. Strategic stroke (anterior cerebral artery, thalamus, parietal lobe, singular gyrus)
  3. Lacunar strokes (small vessel disease)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Vascular dementia

A

Decreased complex attention
Decreased executive functioning

STEPWISE DECLINE rather than insidious

Risk factors:
Cerebral amyloid antipathy
CADASIL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Binswanger

A 
Type of VASCULAR dementia
Slowly progressing
SUBCORTICAL vascular encephalopathy
Chronic hypertension
Pseudobulbar, parkinsonian, pyramidal sx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Lewy body dementia symptoms

A

CORE SX

  • fluctuating cognition
  • repeated visual hallucinations
  • spontaneous Parkinsonism (more often symmetrical)

SUGGESTIVE SX

  • REM sleep trouble
  • Severe hypersensitivity to antipsychotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Lewy body dementia criteria

A

Probable = 2 core OR 1 core + 1 suggestive

Possible = 1 core OR many suggestive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Other diagnostic elements of Lewy body dementia

A

Fall/syncope
Autonomic dysfunction
Delusions
Depression

Decreased dopamine in the basal ganglia

OCCIPITAL HYPOMETABOLISM ON PET

Fully formed “little” people or animals (lilliputian)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Parkinson Plus syndromes

A
  1. Corticobasal degenerescence
  2. Supranuclear progressive paralysis
  3. Multi-system atrophy
  4. Lewy body dementia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Corticobasal degenerescence

A

Strange limb
Fronto-parietal symptoms
Resistant to L-dopa
Asymmetrical rigidity

41
Q

Supranuclear progressive paralysis

A 
Symmetric Parkinson
Supranuclear paralysis (can't look up)
Postural problems
Moderate response to L-dopa
TAU disease

HUMMINGBIRD SIGN on imaging

42
Q

Multi-system atrophy

A 
Autonomic dysfunction
Urinary incontinence
Orthostatic hypotension
Cerebella syndrome
Decreased sensitivity to L-dopa
43
Q

Frontotemporal dementia

A

Suspect if young (average age 56 yo)
Life expectancy 3-14 years after diagnosis

POST-SYNAPTIC SEROTONIN DEFICIT

Genes = TAU/TDP34
Chromosomes 9 & 17

Early personality & language changes
Preserved memory and visuospatial function

44
Q

Frontotemporal dementia genes?

A

10-15% autosomal DOMINANT

MAPT
Granulin
C9orf72

45
Q

Frontotemporal dementia types?

A

Behavioural variant (50%)

Language variant aka primary progressive aphasia (50%)

a) semantic
b) agrammatical/non-fluent
c) logopenic

46
Q

FTD behavioral variant

A

M&raquo_space;

BILATERAL ORBITOFRONTAL

At least 3 criteria

  • disinhibition
  • apathy
  • lack of empathy
  • stereotyped movements
  • hyperorality

Pick’s disease - 40% familial

47
Q

FTD language variant

A

a) Semantic
- M&raquo_space;
- LEFT TEMPORAL LOBE atrophy
- trouble with naming + understanding

b) Agrammatical/non-fluent
- F >
- LEFT POSTERIOR FRONTOTEMPORAL
- trouble with naming + understanding
- lacks spontaneity in speech

c) Logopenic
- associated with Alzheimer’s

48
Q

NCD secondary TBI treatment

A

Apathy: modafinil, psychostimulants, ADs that increase NE

Aggressivity: propranolol, pindolol, epival, tegretol
NOT ENOUGH EVIDENCE FOR NEUROLEPTICS

49
Q

Risk factors for psych issues following TBI

A

Long period unconscious
Long period amnesia
Older age

50
Q

CJD

A

CORTICAL
Prion disease

Classical pathology triad

  1. Spongiform vacuolisation
  2. Neuronal loss
  3. Astrocyte proliferation

Predominant cerebellar and motor symptoms

  • myoclonus
  • choreoathetoid movements
  • ataxia
  • ballistic movements

Anomaly in FLAIR/DWI MRI = multifocal hyper intensities of cortical grey matter (“cortical ribbon” sign)

Protein TAU or 14-3-3 in CSF

EEG = diffuse slowing, typical periodic sharp wave complexes (triphasic waves)

51
Q

Huntington Chorea

A

Mutation on CHROMOSOME 4
Gene = IT15

Trinucleotide repetition CAG (cytosine-adenosine-guanine) > 36-40

of repeats correlates with cognitive symptoms but NOT WITH PSYCHIATRIC SYMPTOMS

Triad = MOTOR, PSYCHIATRIC, COGNITIVE

Atrophy of CAUDATE & lenticular nuclei (especially putamen then globus pallidus

52
Q

NNT for ACEi?

A

4-13

53
Q

2 types of cholinesterase?

A

Acetylcholinesterase (in synaptic cleft)

Butyrylcholinesterase

54
Q

ACEi not indicated for?

A

Mild NCD
FTD

Being in a CHSLD is NOT a reason to stop treatment

55
Q

RAMQ coverage for ACEi?

A

For MMSE 10-26

Stops if decrease of > 3 points in 6 months of tx

56
Q

Contra-indications for ACEi?

A

Bundle branch block
Fascicular block
Interaction with OXYBUTYRIN (decreased efficacy)

DO ECG BEFORE STARTING

57
Q

ACEi side effects?

A 
GI (increased ulcer risk)
Insomnia
NIGHTMARES (especially Donepezil)
Bradycardia (via VAGAL nerve stimulation)
Syncope
Urinary incontinence
Neuromuscular
58
Q

Aricept (Donepezil)

A

Selective inh. acetylcholinesterase

LIVER (2D6/3A4)
Half life = 70 hours

10mg DIE

59
Q

Galantamine (Reminyl)

A

Inh. acetylcholinesterase + STIMULATES NICOTINIC

Liver + kidney
Half-life = 7-8 hours

16-24mg (DIE or BID dosing)

60
Q

Rivastigmine (Exelon)

A

Inh. BOTH acetylcholinesterase + butyrylcholinesterase

Oral or transdermal
3-6mg BID
5-10mg patch
TAKE WITH FOOD

KIDNEYS

First choice for Lewy body dementia

61
Q

Memantine (Ebixa)

A

ANTAGONIST NMDA RECEPTORS
(glutamate in excess in Alzheimer’s)

10mg BID

Side effects
Dizziness, headache, constipation

Contraindicated in RENAL FAILURE

RAMQ covers if MMSE 2-14 and NOT in CHSLD
RAMQ does NOT cover combination with ACEi

62
Q

FTD treatment

A

NOT ACEi

Trazodone (irritability)
Paxil

63
Q

Lewy body dementia treatment

A

RIVASTIGMINE which can decrease hallucinations

Avoid APs but if need SEROQUEL or CLOZAPINE

64
Q

Parkinson’d dementia treatment

A

CLOZAPINE

65
Q

Vascular dementia treatment

A

Not enough evidence for ACEi but if yes then Donepezil or Galantamine

66
Q

BPSD

A

in > 90% patient with dementia

Only APs approved to treat are:
Risperdal
Abilify
Zyprexa

PRNs:
Trazodone
Ativan

Symptoms that don’t respond well to Rx:

  • apathy (anterior cingulate)
  • disinhibition
  • wandering (“errance”)
  • verbal

Try to decrease or stop Rx every 3-6 months

67
Q

What is the #1 cause of psychotic symptoms in elderly?

A

DEMENTIA

68
Q

What medication is NOT RECOMMENDED in BPSD

A

EPIVAL

69
Q

Black box warning in elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs

A

NNH = 100 (1 extra death per 100 patients)

RR death 1.6-1.7 (1% higher than placebo over 10 weeks)
RR stroke 10 (@ 1 week)
RR fall 1.7
RR pneumonia 4.5

70
Q

DICE approach to non-pharmacological interventions

A

Describe
Investigate
Create a plan
Evaluate if working

71
Q

Delirium criteria

A 
ATTENTION
AWARENESS
\+ 
1 OTHER COGNITIVE DOMAIN
\+
Direct physiological consequence of illness/substance
72
Q

Delirium types

A

Hyperactive 30%
Hypoactive 24%
Mixed 46%

73
Q

What medication to give ventilated patients to prevent delirium?

A

PRECEDEX

dexmedetomidine

74
Q

Risk factors for delirium?

A 
>65yo
Male
Cognitive deficit
Delirium hx 
Sensory deficit
Immobilization
Malnutrition
Medical co-morbidity
75
Q

Delirium prevalence?

A

1-2% in general population

10-30% in hospitalized population

76
Q

Most implicated neurotransmitter in delirium?

A

ACETYLCHOLINE (decreased)

77
Q

Most implicated brain region in delirium?

A

RETICULAR FORMATION (regulates attention and arousal)

Main pathway = dorsal tegmental (reticular formation and thalamus)

78
Q

EEG in delirium

A

Generalized slowing (theta & delta)

79
Q

Increased mortality in the year following delirium dx by how much?

A

40-50%

80
Q

Pharmacokinetic changes in elderly

A

NO CHANGE IN ABSORPTION
Decreased gastric motility
Increased gastric pH

Increased fat stores (less liposoluble Rx)
Increased volume of distribution (increased 1/2 life)

Decreased CYP metabolism by 2-3x (linear with age, down first pass)

GLYCUROCONJUGAISON SAME (2nd pass)

Decreased albumin so increased free Rx

Decreased body water volume (more hypo soluble Rx)

81
Q

Neurobiology changes in elderly

A

Decreased processing speed & motor speed
Decreased norepinephrine in CNS
Increased serotonin & MAO in brain

82
Q

Suicide in the elderly

A

High res despite low rates of depression, due to solitude

DEMENTIA IS NOT A RISK FACTOR

Less explicit signs
Higher lethality (less history of past attempts)
Less contact with services

83
Q

Emotions in the elderly

A

MORE POSITIVE EMOTIONS

Less negative emotions

84
Q

Geriatric depression scale

A

30 Y or N questions about how they feel THAT DAY/OVER THE LAST WEEK

Target: healthy, medically ill, mild to moderate cognitive impairment

92% sensitivity
89% specificity

Cutoff is 10/30
(20 = severe)

85
Q

Anticholinergic toxicity

A 
Flushing, dry skin
Mydriasis
Loss of accommodation
Tachycardia
Hypertension
Fever
Urinary retention
Functional ileus
Tremor
Myoclonic jerking
Altered mental status
86
Q

Rx causing delirium

A 
Psychoactive medications
Anticholinergic medications (MOST COMMON as per K&S)
Sedative/hypnotics
Meperidine (opioids)
Corticosteroids
87
Q

Which opioid is worst for delirium?

A

MEPERIDINE (demerol)

88
Q

Delirium treatment

A

PHARMACOTHERAPY IS OFF-LABEL

Haldol (least anti-cholinergic)
Second-generation antipsychotic

89
Q

Which genetic syndrome common in FTD?

A

KLUVER-BUCY

no hypersomnia unlike Kleine-Levin…think they have inappropriate sexual behaviour so they are UP ALL NIGHT

90
Q

Which BPSD symptom responds best to antipsychotics?

A

AGGRESSION/agitation

91
Q

Most common BPSD?

A

APATHY (72%)

92
Q

Which dementia has NO TANGLES?

A

VASCULAR dementia

93
Q

What percentage of dementias are reversible?

A

15%!

Hypothyroid, tumor, NPH, B12

94
Q

Memory centres in brain?

A

Medial temporal lobe:

  • hippocampus
  • amygdala
95
Q

Most commonly reported elder abuse in Canada

A

FINANCIAL (according to K&S)

96
Q

Late-onset schizophrenia

A

Good response to antipsychotics, use lower doses
Generally negative symptoms are rarer in late-onset
Paranoid most common

97
Q

Schizophrenia in >65yo

A

20% have no active symptoms by 65

98
Q

Pharmacokinetics in elderly

A 
Absorption largely unchanged
No change in LFTs (reflect damage, not liver function)
Unchanged conjugation (phase 2)
Decreased phase 1 (oxidation, reduction, hydrolysis)

RC Nuggets (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions