Geriatrics Flashcards
What is dementia ?
disorders characterised by loss of memory + other cognitive abilities affecting IADLs + ADLs
- group of disease (like cancer)
what acronym can be sued for overall presentation of dementias ?
DIRE
- Decline in cognition (language, attention)
- Impairment (not keeping up with IADL + ADLs)
- Rule out delirium (acute state of confusion)
- Exclude mental disorders (depression, schizophrenia)
what are IADLS ? acronym
SHAFT
- Shopping
- Houskeeping
- Accounting
- Food prep
- Transportation
what are ADLs ? acronym >
DEATH
- Dressing
- Eating
- AMbulating
- Toilet
- Hygiene
what are the different types of dementia ? (5) most common ?
- Alzheimers disease (most common)
- Vascular
- Lewy body
- Frontotemporal
- Mixed (multiple types)
Describe the presenfiaotn of Alzheimers disease ? onset ? symptoms ?
gradual onset
- amnesia + neurocognitive deficits (amnesia, aphasia, apraxia, agnosia)
- Psychiatric symptoms: mood changes (depressed, anxious, irritability), psychotic symptoms (delusional misidentification
- activity; sundown activity
- lack of insight (don’t usually have knowledge of illness)
Alzheimers disease pathophysiology ?
caused by plaques made of beta amyloids
- tends to misgold => becomes sticky => clumping => large insoluble fibril s=> plaques => weaken communication + plasticity at synapses => neurodegeneration + neural death
How Is Alzheimers investigation ? diagnosed ?
- diagnosis made clinically
- bedside cognitive test
- FBC (rule out delirium)
- CSF testing (amyloid + tau biomarkers)
- Structural MRI (atrophy => shrinkage)
what found in css in alzeihmers disease ?
amyloid plaques + neurofibirially tau tangles
alzheimers epi ?
less than 1%
(20% >80, 50% >90)
F>M
Alzheimers disease management ?
can’t halt or reverse progression (so symptom reduction and slow progression)
- cholinesterase inhibitors (=> increase Ach in brain)
- Antidepressants and antipsychotics
What is vascular dementia ? pathophys
infarction, haemorrhage + small vessel changes cause damage to white + grey matter (loss of brain parenchyma)
- multiple infarcts exhaust the brains compensatory mechanisms
vascular dementia présentation ?
due to the vascular pathology, doesn’t present with specific sign or symptoms but series of stepwise decreases in cognition
what will be seen on imaging in vascular dementia ?
imagine of brain will show multiple areas of ischaemic damage to varying ages
vascular dementia mangment ? (2)
- Cholinesterase inhibitors
- Reduce stroke RF: atiplatelt therapy, BP control, statins, control DM
what causes dementia with leeway bodies ?
accumulation of leeway bodies in CNS: protein alpha-synuclein accumulations that affects synaptic communication + plasciticy
dementia will Lewy bodies presentation ? age of onset ?
earlier onset (staring around 50) + worse decline than Alzheimers
- visual hallucinations (distinctive features - visual Hal-lewy-cinations, often have insight that not real)
- cognitive defects (memory not affected as much, more attention + concentration)
- neuroleptic sensitivity
- sleep
- Parkinsonism
describe how sleep is affected in dementia with Lewy bodies ?
REM sleep behaviour disorder => thrashing + flailing while asleep
(often one of the first signs)
why should you be careful prescribing antipsychotics to a px with Lewy body dementia ?
greater risk of neuroleptic malignant syndrome
- don’t give em (easily mistaken with psychosis)
- AP => extrapyramidal SE, confusion, catatonia, neuroleptic malignant syndrome)
Lewy body dementia epi ?prognosis ?
M=F
4 yrs life expectancy form diagnosis (alzheiemrs is 5-10)
Lewy body dementia management ? avoid what ?
- cholonetsrase inhibitors
- antiparkinsonsims (levodopa)
- Avoid AP
what is frontotemporal dementia ? (2)
degeneration of the frontal + temporal lobes of brain => decline in cognition + inappropriate/impulseive behaviour
fronttemporal dementia pathophysiology ?
caused by focal neurodegeneration of the frontal or temporal lobes of the brain
- neuronal loss, gloss, microvascular changes
frontotemporal dementia presentation ?
- obliviousness (saying hurtful things, not respecting pals personal space)
- hyperorality (even inedible objects)
- disinihibition (hypersexual)
- apathy (indifference to self care)