Geriatrics Flashcards
Medications to use in PD for delusions/hallucination
- ## clozapine, quetiapine, pimavanserinAVOID:
- haloperidol
- risperidone, olanzepine
Medications to use in PD for delusions/hallucination
- ## clozapine, quetiapine, pimavanserinAVOID:
- haloperidol
- risperidone, olanzepine
The simplified Fried criteria are:
decreased grip strength;
unintentional weight loss (>5% over 3 months, or 10% over 6 months);
low energy;
low physical activity
slow walking speed (<0.8m/s).
corticobasal syndrome
progressive asymmetric movement disorder with symptoms initially affecting one limb, including various combinations of akinesia and extreme rigidity, dystonia, focal myoclonus, ideomotor apraxia, and **alien limb phenomenon. **
hyperreflexic with axial rigidity
Cognitive impairment is a common manifestation of CBD and may be a presenting feature, while the parkinsonian motor features may emerge later as the disease progresses.
MSA
MSA commonly presents with parkinsonism, but patients also have varying degrees of dysautonomia, cerebellar involvement, and pyramidal signs. The prominence of these manifestations along with **symmetry of onset **and poor response to levodopa suggests this diagnosis rather than PD. Subtypes include: MSA with predominant parkinsonism (MSA-P) subtype. MSA with predominant cerebellar ataxia (MSA-C) subtype. Brain magnetic resonance imaging (MRI) in patients with MSA-P and MSA-C may reveal atrophy of the putamen, pons, and middle cerebellar peduncles.
Olfactory loss or cardiac sympathetic denervation on MIBG, iobenguane I-123 scintigraphy.
associated with PD
Corticobasal degeneration
Corticobasal degeneration is a rare form of atypical parkinsonism. The classic description of CBD is that of a progressive asymmetric movement disorder with symptoms initially affecting one limb, including various combinations of akinesia and extreme rigidity, dystonia, focal myoclonus, ideomotor apraxia, and alien limb phenomenon. Cognitive impairment is a common manifestation of CBD and may be a presenting feature, while the parkinsonian motor features may emerge later as the disease progresses. Important cognitive features of CBD include executive dysfunction, aphasia, apraxia, behavioural change, and visuospatial dysfunction, with relatively preserved episodic memory. The distinctive clinical phenotype and the lack of clear response to an adequate trial of levodopa are typical for CBD and help to distinguish it from PD.
Genes associated with FTD
C90RF72
Microtubule associated protein tau (MAPT)
Progranulin (GRN)
Tau-opathies
PSP
CBD
Chronic traumatic encephalopathy
Pick’s disease (FTD)
Comprehensive geriatric assessment
- more likely to be living at home and are less likely to be admitted to a nursing home at** up to a year** after hospital admission
- It found **no evidence **that CGA reduces risk of death during follow‐up at up to a year after admission, and there was too much variation in cognitive function and length of hospital stay to draw a conclusion. Uncertainty regarding the cost‐effectiveness analysis suggests that further research is needed.
Falls in elderly
Most falls occur during the day, at home. Women are more likely to fall but men are more likely to have mortality from falls.
Risk factors for Delirium:
The CAM tool is both sensitive (94-100%) and specific (90-95%) for diagnosing delirium
- Depression has an odds ratio of 1.9 of increasing risk for delirium, particularly in the post operative patient
Bladder physiology/innervation
Bladder filling is mediated by sympathetic innervation via the hypogastric nerve via beta 3 receptors. Bladder emptying is mediated by S2-S4 parasympathetic nerves via M2 and M3 receptors. Urethral closure at the bladder neck is mediated by alpha 1 receptors (especially in males)
MRI findings:
PSP: humming bird sign - mid brain atrophy
MSA: hot cross bun, pons atrophy
Dementia with LB: diffuse atrophy with relative perseverance of the medial temporal lobes (in contrast to Alzheimer’s dementia)
NOK#
surgical repair within 24 hours is associated with reduced pain and decreased length of stay compared with delayed surgery, in addition to reducing several other complications such as pneumonia and venous thromboembolism. Tramadol should be avoided in the elderly population due to higher risk of adverse events such as delirium.
