Geriatrics Flashcards
Irreversible causes of dementia
Neuro: AD, LBD, FTD
Infection: HIV, syphilis
Toxins: alcohol, BZD
Vascular: VD, CVD
Trauma: head trauma
Reversible causes of dementia
Neuro: hydrocephalus, tumours, SDH
Vitamin: B12, folic, thiamine deficiencies
Endocrine: Cushing’s, hypothyroidism
Dementia investigations
Adenbrook’s Ix
GPCOG
6 item CIT
Alzheimer’s pathology (2)
Beta amyloid plaques
Neurofibrillary tangles
Alzheimer’s risk factors (4)
Down’s
Amyloid precursor protein gene mutation
Age
1st degree relative
Clinical picture Alzheimer’s
Short term memory loss (progressive and persistent)
Global cognitive impairment
Irritable, mood swings, apathy
Alzheimer’s Ix
CT
MMSE
2 pharmacological treatments for AD
ACh-esterase inhibitor
NMDA receptor antagonist
Lewy body dementia pathology
Cerebral atrophy + Lewy bodies = alpha synuclein +ve cytoplasmic inclusions in neurones
Risk factors Lewy body dementia (4)
> 60 y/o
Male
FHx
Parkinson’s/LBD
Clinical picture Lewy body dementia
EPSE
Visual hallucinations
Falls
REM sleep disturbance
Fluctuates but overall worse with time
Lewy body dementia Ix
SPECT - shows reduced metabolism and reduced occipital perfusion
Lewy body dementia Tx
Levodopa
DA agonists
Frontotemporal dementia causes
Alcohol
Trauma
Genetics
Frontotemporal pathology
FT atrophy
Pick bodies (tau proteins)
Pick’s disease
Frontotemporal clinical picture
<65 year old onset
Impulsive
Irritable
Crying
Overweight (pick’s increases appetite)
Akinesia
Hallucinations
Parkinsonism later
Frontotemporal treatment
SSRI for depression
Olanzapine for agitation/hallucinations
NB: drugs used for AD make FTD Sx worse
Vascular dementia risk factors
HTN
DM
Age
Hyperlipidaemia
Vascular dementia clinical picture
Sudden onset, stepwise deterioration, motor disorders, behavioural changes, cognitive impairment
Vascular dementia Ix
MMSE, carotid USS, CT/MRI head
Vascular dementia treatments
Treat RFs
Antiplatelets
Aspirin (secondary prevention)
Cholinesterase inhibitors if AD comorbidity
Delirium causes
(HE IS NOT MAAD)
Hypoxia - resp failure, MI, PE
Endocrine - Cushing’s, thyroid, glucose
Infection - pneumonia, UTI
Stroke - ^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
Clinical picture delirium
Disordered thinking
Fear
Euphoria
Language impairment
Inattention
Delusions
Delirium Ix
Brief MSE
Confusion assessment method (CAM)
ABC
GCS
Vitals
Bloods
Urinalysis
Blood culture
CXR
ABG
CT head
EEG if epileptic
Delirium Rx
Underlying cause
Calm environment
IM haloperidol (Larazopam if PD)
4 differences between delirium and dementia
Onset: delirium is abrupt/dementia is insidious
Duration: delirium days to weeks/dementia permanent
Speech: delirium incoherent/dementia word-finding difficulty
Thought: delirium disorganised/dementia impoverished
Investigations after a fall
Bloods (FBC, UE, LFT, TFT, vitamins)
If head injury: CT head
ECG
PRISMA-7 to assess frailty
Postural hypotension medication
Fludrocortisone
Causes of falling in elderly
(I HATE FALLING)
Inflammation (joints)
Hypotension
Arrhythmia
Tremor
Equilibrium (balance issues, drug induced or other causes)
Foot pain
Auditory/visual impairment
Leg length discrepancy
Lack of conditioning
Illness
Nutrition
Gait problems
osteoporosis risk factors
Ix osteoporosis
FRAX: risk of fracture in 10 years (for females >65, males >75)
DEXA scan (done at the hip)
T-SCORE: BMD of healthy young person
Z-SCORE: corrected to patient age
T score indications
>
- 1 = normal
- 1 to - 2.5 = osteopenia
< - 2.5 = osteoporosis
< - 2.5 + fracture = severe osteoporosis
1st line management osteoporosis
Calcichew + bisphosphonates
Ischaemic stroke treatment <4.5 hours after onset
Thrombolysis w/ alteplase
Ischaemic stroke treatment >4.5 - 6 hours after onset
Thrombectomy (stent/aspirate) if proximal LV occlusion
If thrombectomy is contraindicated give aspirin
Endarterectomy for carotid stenosis
Secondary prevention of ischaemic stroke
Clopidogrel, atorvastatin, treat modifiable RFs
Causes of urinary incontinence
Overactive bladder
Dementia
Stress incontinence
BPH
Hypotonic bladder
Nocturia
management for different causes of urinary incontinence (6)
Overactive bladder: antimuscarinics + bladder retraining
Dementia: regular toileting
Stress incontinence: pelvic floor exercise
BPH: antiandrogens, surgery
Hypotonic bladder: intermittent catheter
Nocturia: desmopressin (not for >65 due to hyponatraemia), drainage sheath
Faecal incontinence
Parkinson’s disease clinical picture
Resting tremor
Bradykinesia
Shuffling gait
Flexor rigidity resisting passive extension
Anosmia
REM sleep disturbance
PD management
Levodopa + COMTi (Sx relief)
DA agonists
MAO-Bi
PT, OT, SALT, deep brain stimulation, Co morbid tx
Huntingtons disease inheritance
Autosomal dominant
Huntington’s onset
30 to 50 yrs
Anticipation (each generation has more CAG repeats = earlier onset)
Huntington’s genetic mutation
Trinucleotide CAG repeat HTT gene chromosome 4
Huntington’s pathology
Degeneration of cholinergic + GABAergic neurones
Huntington’s signs and symptoms
Huntington’s pharm treatment
Olanzapine for psych Sx
SSRI for depression
Diazepam
Tetrabenazine (DA-depleting agent)
