Geriatrics

Question 1

Give the irreversible causes of Dementia (Neuro, Infection, Toxins, Vascular, Trauma)

Answer 1

Neuro - Alzheimer’s (most common cause of dementia), Lewy-Body, Frontotemporal
Infection - HIV, Syphilis
Toxins - Alcohol, Benzos
Vascular - Vascular dementia, cvd
Head trauma

Question 2

Give some 3 reversible neuro causes of dementia

Answer 2

Hydrocephalus
Tumours
SDH

Question 3

What vitamin deficiency’s can cause dementia ? Is this reversible?

Answer 3

B12
Folic acid
Thiamine
Yes this is reversible

Question 4

What endocrine disorders can cause dementia like symptoms?

Answer 4

Cushing’s
Hypothyroidism

Question 5

Give the aetiology of Alzheimer’s

Answer 5

Degeneration of the cerebral cortex with cortical atrophy
Beta amyloid protein accumulation (amyloid precursor protein) -> progressive neuronal damage, neurofibrillary tangles, amyloid plaques and loss of ACh

Question 6

What are the symptoms of Alzheimer’s disease?

Answer 6

Short term memory loss (progressive and persistent)
Global cognitive impairment
Mood/personality changes - Irritability, mood swings and apathy

Question 7

What investigations are used to diagnose Alzheimer’s?

Answer 7

CT
MMSE

Question 8

What is dementia?

Answer 8

A syndrome caused by a number of brain disorders
Symptoms include:
Memory loss, difficulties thinking, problem-solving or language
Difficulties with activities of daily living

Question 9

Describe the epidemiology of dementia

Answer 9

AD is more common in females
Prevalence rises with age
Vascular and mixed dementia are more common in men

Question 10

What is the aetiology of Vascular Dementia?

Answer 10

Brain damage due to cvd - major stroke, multi-infarct, or chronic changes in smaller vessels
Presents with signs of vascular pathology - raised BP, past strokes and focal CNS signs
Progresses in a stepwise fashion

Question 11

What is Lewy-body dementia?

Answer 11

3rd most common cause of dementia
Deposition of abnormal protein (alpha-synyclein) within neurons in brain stem and neocortex

Question 12

How does Lewy-body Dementia typically present?

Answer 12

Fluctuating cognitive impairment
Detailed visual hallucinations
Associated with Parkinson’s

Question 13

What are the key features of Fronto-temporal dementia?

Answer 13

Specific atrophy of the frontal and temporal lobes
Behavioural and personality changes
Early preservation of episodic memory and spatial orientation
Apathy and lowered inhibitions
Mixed dementia and Parkinson’s dementia

Question 14

What are the risk factors for vascular dementia?

Answer 14

Hypertension
Other general vascular risk factors - smoking, dm, hyperlipidaemia, obesity and hypercholesterolaemia

Question 15

What are the clinical features of vascular dementia?

Answer 15

Mood disturbances and disorders are common, including - psychosis, delusions, hallucinations and paranoia
Pts should be screened for depression and psychomotor retardation

Question 16

What are the different presentations of FTD

Answer 16

Non-fluent - progressive breakdown in output of language, speech takes effort, speech apraxia, impaired comprehension and impact on literary skills
Semantic - progressive decline in understanding the meanings of words, speech make be fluent but difficult in name-retrieval and use of less precise terms, tends to develop into inability to recognise objects or familiar faces
Behavioural - Altered emotional responsiveness, apathy, dis-inhibitions, impulsivity, changes in food preference, obsessions and rituals

Question 17

Give some differential diagnoses for dementia-like symptoms

Answer 17

Prion protein disease - CJD
HIV-related cognitive impairment - almost half of all people with HIV experience cognitive symptoms, even with the use of antiretrovirals around 2% will develop dementia
Normal pressure hydrocephalus - abnormal build-up of csf in ventricles (more likely in elderly) - rf inclue head trauma, infection, inflammation, tumour and sah
Severe depression
Mild Cognitive impairment