Geriatric medicine Flashcards
MGT in Alzheimer’s disease
Non-Pharmacological
- cognitive simulation therapy in mild-moderate dementia
- other include group reminiscence therapy and cognitive rehabilitation
Pharmacological
- three acetylcholinesterase inhibitors (Donepezil, Galantamine, and Rivastigmine)
- memantine (an NMDA receptor antagonist) - second line
Who should memantine be used for?
moderate Alzheimer’s who are intolerant of, or have a contraindication to, acetylcholinesterase inhibitors
as an add-on drug to acetylcholinesterase inhibitors for patients with moderate or severe Alzheimer’s
monotherapy in severe Alzheimer’s
Contraindications for Donepezil?
is relatively contraindicated in patients with bradycardia
adverse effects include insomnia
What is sick sinus syndrome?
AKA sinus node dysfunction, is a disorder of the SA node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. These include atrial bradyarrhythmias, atrial tachyarrhythmias and, sometimes, bradycardia alternating with tachycardia often referred to as tachy-brady syndrome.
abbreviated mental test (AMT) 10
what is included
AMT-10 Score
0-3
Severe cognitive impairment
4-6
Moderate cognitive impairment
> 6
No delirium
Ask the patient:
Age
Time (To the nearest hour)
Give the patient the following address for recall at end of test: “42 West Street” (have patient repeat to ensure it has been heard correctly)
Current year
Patient’s home address
What jobs do these people do?
Show the patient two pictures: a postman and a cook
Date of birth
Year World War I started
Current president
Use setting-specific equivalent, e.g. “monarch” in the UK
Count backwards from 20 to 1
Ask to recall address given earlier
i.e., 42 West Street
Korsakoff syndrome?
It is an amnestic disorder caused by thiamine deficiency associated with prolonged ingestion of alcohol. The main symptoms are amnesia, confabulation, minimal content in conversation, lack of insight and apathy.
It is usually the result of untreated Wernicke’s encephalopathy.
In Wernicke’s encephalopathy the patient may be confused and have an altered conscious level. They also may be ataxic and have ophthalmoplegia (the ‘triad’), Rx is thiamine
Sedative use in delirium?
1st line -haloperidol or olanzapine
in pt with Parkinson’s
–>
careful reduction of the Parkinson medication may be helpful
if symptoms require urgent treatment then the atypical antipsychotics quetiapine and clozapine are preferred
Sedative use in delirium?
1st line -haloperidol or olanzapine
in pt with Parkinson’s
–>
careful reduction of the Parkinson medication may be helpful
if symptoms require urgent treatment then the atypical antipsychotics quetiapine and clozapine are preferred
Addenbrooke’s Cognitive Exam-3 (ACE-3) exam ?
