Geriatrics Flashcards
Investigation for all forms of dementia?
Adenbrooks investigation, GPCOG, 6 item CIT
Tau tangles and amyloid plaques are classic of what form of dementia?
Alzheimers
Risk factors for alzheimers?
Downs syndrome, age, 1st degree relative, amyloid precursor protein gene mutation
Symptoms of alzheimers
STML - progressive and persistent
Global cog impairment
Irritable, mood swings
Treatment of alzheimer’s
Ach-esterase inhibitor
NMDA receptor antagonist
Symptoms of lewy body dementia?
EPSE
Visual hallucinations
REM sleep disturbance
Fluctuates but overall worse over time
Investigations for lewy body dementia?
SPECT shows reduced metabolism and reduced occipital perfusion
Treatment of lewy body dementia?
Levodopa, dopamine agonists, (Antipsychotics contraindicated)
Symptoms frontotemporal dementia?
< 65 yo onset, impulsive, irritable, crying, overweight (appetite increase, portly man/ woman)
Later on halluc and parkinsonism
Treatment of FT dementia?
SSRI for depression, olanzapine for agitation and hallucx, Alzheimers drugs are contraindicated
Causes of delirium?
HE IS NOT MAAD
Hypoxia
Endocrine - cushings, thyroid, glucose
Infection - UTI/ pneumonia
Stroke - raised ICP, head trauma
Nutrition - thiamine/B12 deficiency
Others - pain, lack of sleep
Theatre - anaesthetics
Metabolic - electrolytes
Abdominal - urine retention
Alcohol - intox + withdrawal
Drugs - BZD, opioids
What causes vascular dementia?
Many strokes/TIA
Signs and symptoms of vascular dementia?
Sudden onset
Stepwise deterioration
Motor disorders
Behavioural changes
Cognitive impairment
How is delirium managed?
Treat underlying cause
Calm environment
IM Haloperidol ( or Lorazepam in Parkinson’s)
Main cause of injury/disability/death in elderly?
Falls
Causes of falls?
I HATE FALLING
Inflammation (joints)
Hypotension
Arrhythmia
Tremor
Equilibrium
Foot pain
Leg length discrepancy
Lack of conditioning
Illness
Nutrition poor
Gait issues
T-score interpretations?
> -1 = normal
-1 - -2.5 = osteopenia
< -2.5 = osteoporosis, with fracture = severe
Management of osteoporosis?
Calcichew and Bisphosphonates e.g. alendronic acid are first-line
Alternatives : HRT, denosumab, strontium
Risk factors for osteoporosis?
Female
Increasing age
Long term corticosteroid use
RA
Low BMI
Low mobility
Ix for osteoporosis
FRAX score - shows risk of # in next 10 years
Hip DEXA scan performed if Frax is > 65 in females and > 75 in males.
What is a z-score?
BMD corrected to patient age and gender
Criteria for a total anterior circulation stroke (TACS)?
- Unilateral weakness and/or sensory deficit of face, arm, leg
- Homonymous hemianopia
- Higher cerebral dysfunction e.g. dysphasia, visuospatial disorder
ALL 3 MUST BE PRESENT
Criteria for partial anterior circulation stroke (PACS)?
Need 2 of the 3 TACS criteria, or just higher cerebral dysfunction
Criteria for posterior circulation syndrome (POCS)?
One of the following must be present…
- Cranial nerve palsy and contralateral motor/sensory deficit
- Bilateral motor/sensory deficit
- Conjugate eye movement disorder e.g. horizontal gaze palsy
- Cerebellar dysfunction (vertigo, nystagmus, ataxia)
- Isolated homonymous hemianopia
Criteria for lacunar stroke (LACS)?
One of the following…
- Pure sensory stroke
- Pure motor stroke
- Sensori-motor stroke
- Ataxic hemiparesis
What is donezepil used for and how does it work?
Alzheimer’s - cholinesterase inhibitor - improves mental function
