Geriatric Medicine Flashcards
The precipitating events of Acute confusional stateare often multifactorial
infection: particularly urinary tract infections
metabolic: e.g. hypercalcaemia, hypoglycaemia, hyperglycaemia, dehydration
change of environment
any significant cardiovascular, respiratory, neurological or endocrine condition
severe pain
alcohol withdrawal
constipation
management of delirium in older people:
- treatment of the underlying cause
- modification of the environment
If not working then
3. recommended haloperidol 0.5 mg as the first-line sedative
factors predispose to the development of pressure ulcers:
malnourishment
incontinence: urinary andfaecal
lack of mobility
pain (leads to a reduction in mobility)
Management of Pressure ulcers
surgical debridement may be beneficial for selected wounds
moist wound environment encourages ulcer healing.
Hydrocolloid dressings and hydrogels may help facilitate this.
The use of soap should be discouraged to avoid drying the wound
mini-mental state examination (MMSE)suggests dementia if the score….
Score < 24 of 30
Risk factors of Alzheimer’s disease
- increasing age
- family history of Alzheimer’s disease
- Down’s syndrome
- Caucasian ethnicity
- apoprotein E allele E4- encodes a cholesterol transport protein
- of cases are inherited as an autosomal dominant trait
mutations in the amyloid precursor protein (chromosome 21), presenilin 1 (chromosome 14) and presenilin 2 (chromosome 1) genes are thought to cause theinheritedform
biochemical pathological changes of Alzheimer’s disease
there is a deficit of acetylcholine from damage to an ascending forebrain projection
microscopic pathological changes of Alzheimer’s disease
cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein
hyperphosphorylation of the tau protein has been linked to AD
macroscopic pathological changes of Alzheimer’s disease
widespread cerebral atrophy, particularly involving the cortex and hippocampus
Management of Alzheimer’s disease
- acetylcholinesterase inhibitors(donepezil,galantamine and rivastigmine) as options for managing mild to moderate Alzheimer’s disease
- memantine(an NMDA receptor antagonist) is in simple terms the ‘second-line’ treatment.
Indications for memantine in Alzheimer’s disease
- 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 disease
In Alzheimer’s, antipsychotics should only be used for patients at risk of
- harming themselves or others.
- when the agitation, hallucinations, or delusions are causing them severe distress.
Donepezil is relatively contraindicated in patients with
bradycardia
Donepezil adverse effects include
insomnia
Bradycardia
Focal gyral atrophy with a knife-blade appearance is characteristic of….
Frontotemporal dementia (Pick’s disease)
Microscopic changes seen in Pick’s disease
Pick bodies - spherical aggregations of tau protein (silver-staining)
Gliosis
Neurofibrillary tangles
Senile plaques
Macroscopic changes seen in Pick’s disease
Atrophy of the frontal and temporal lobes
Management of Frontotemporal dementia (Pick’s disease)
not recommend that AChE inhibitors or memantine are used in people with frontotemporal dementia
Onset before 65
Insidious onset
Relatively preserved memory and visuospatial skills
Personality change and social conduct problems
Features of
frontotemporal lobar dementias
Features of Lewy body dementia
- parkinsonism
- visual hallucinations
- progressive cognitive impairment
Diagnosis of lewy body dementia
usually clinical
single-photon emission computed tomography (SPECT)
Management of Lewy body dementia
both acetylcholinesterase inhibitors(e.g. donepezil, rivastigmine) and memantine can be used as they are in Alzheimer’s
- neuroleptics should be avoidedin Lewy body dementia as patients are extremely sensitive and may develop irreversible parkinsonism.
The main subtypes of Vascular dementia:
Stroke-related VD - multi-infarct or single-infarct dementia
Subcortical VD - caused by small vessel disease
Mixed dementia - the presence of both VD and Alzheimer’s disease
Risk factors of Vascular dementia
History of stroke or transient ischaemic attack (TIA)
Atrial fibrillation
Hypertension
Diabetes mellitus
Hyperlipidaemia
Smoking
Obesity
Coronary heart disease
A family history of stroke or cardiovascular
VD can be inherited as in the case of ….
CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.
Stepwise deterioration in cognitive function? - think ….
vascular dementia
Only consider AChE inhibitors or memantine for people with vascular dementia if they have suspected ….
comorbid Alzheimer’s disease, Parkinson’s disease dementia or dementia with Lewy bodies.
Haloperidol is contraindicated in patients with
Parkinson’s disease
Symptoms worsen with neuroleptics in ….
Lewy body dementia
Antipsychotics are associated with a significant increase in mortality in
dementia patients
Typical antipsychotics should be avoided in delirious patients with a background of…….
Parkinson’s disease
Mini mental test score
Mild dementia :
Moderate dementia :
Severe dementia:
Mild dementia : > 20
Moderate dementia : 10 - 20
Severe dementia: < 10
What is The effect of cholinesterase inhibitors ?
Improvement in activities of daily living
