Geriatrics Flashcards
Give 4 common features of frontotemporal dementia
- Onset before 65
- Insidious onset
- Personality change and social conduct problems
- Preserved memory and visuospatial skills
Score used to assess the risk of pts developing a pressure sore
Waterlow score
4 RF for pressure ulcers
Malnourishment
Incontinence
Lack of mobility
Pain
Management of mild alzheimer’s
Donepezil
Mechanism of action of donepazil
acetylcholinesterase inhibitor
Management of moderate - severe alzheimers
Donepazil + memantine
Mechanism of action of memantine
NMDA receptor antagonist
Give 3 features of leqy body dementia
- Progressive congitive impairment
- Parkinsonism
- Visual hallucinations
Explain the presentation of the cognitive impairment seen in lewy body dementia
- Occurs BEFORE the parkinsonism
- Can fluctuate
what should be avoided in lewy body dementia due tothe risk of causing irreversible parkinsonism ?
Neuroleptics (e.g. haloperidol)
give 5 predisposing factors to delirium
- > 65
- Background of dementia
- Sig onjury (e.g. hip fracture)
- Frailty or multiborbidity
- Polypharmacy
Give 7 precipitating events for delirium
- Infection
- Constipation
- Change in environment
- Metabolic
- Sig CV, resp, neuro or endo condition
- Severe pain
- Alcohol withdrawal
2 medications used for management of delirium
- Haloperidol (IM lorazepam if parkinsons)
- Olanzapine
what tool is used to identify medications where risk outweighs therapeutic benefits in certain conditions
STOPP tool
when is haloperidol used for management of delirium ?
If treating underlying cause and environmental modification has not helped (verbal and non verbal de-escalation techniques)
4 RF for alzheimer’s disease
- FHx
- Increasing age
- Down’s syndrome
- Caucasian ethnicty
Macroscopic changes seen in the brain in alzheimer’s
Widespread cerebral atrophy involving the cortex and hippocampus particularly
what is required in secondary care for a diagnosis of dementia
MRI brain
Explain the grading of pressure ulcers
- Non blanchable in tact skin
- Partial thickness skin loss involving epidermis, dermis or both
- Fukl thickness skin loss involving damage to or necrosis of subcut tissue
- Extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures.
example of a medicaiton that should be stopped following diagnosis of alzheimers
amitriptyline
what tool is used in ots with multiple morbidities to dertermine whether the introduction of a new medication will be beneficial
START
Give 7 RF for vascular dementia
- History of stroke or transient ischaemic attack (TIA)
- Atrial fibrillation
- Hypertension
- Diabetes mellitus
- Hyperlipidaemia
- Smoking
- Obesity
Explain the presentation of congitive dysfunction seen in vascular dementia
Several months or several years of a history of a sudden or stepwise deterioration of cognitive function.
what medications are associated with an increased risk of mortality in dementia pts
Antipsycholtics such as olanzapine
If a pt is on digoxin, what can trigger digoxin toxicity
- Renal failure
- Hypokalaemia (viral gastroenteritis)
Symtoms of digoxin toxicity
N&V
Abdo pain
Dizziness
Confusion
Blurry / yellow vision
Arrhythmias
Medications that can precipitate gout
Thiazide diuretics (e.g. gout)
Explain how parkinsons and lewy body dementia can be distinguished
- Parkinsons : parkinsons symptoms BEFORE congnitive decline
- Lewy body dementia : cognitive decline BEFORE parkinsonism
