Geriatrics

Question 1

What are the types of dementia?

Answer 1

1. Alzeimer’s
2. Vascular
3. Lewy Body
4. Parkinson’s
5. Frontotemporal
6. Creutzfeldt-Jakob disease (CJD)/ prion disease
7. Alcohol related

Question 2

What are the symptoms of Alzheimer’s?

Answer 2

• Short term memory loss
• Dysphasia - speaking problems
• Dyspraxia - movement problems
• Behavioural changes, eg wandering
• Psychotic symptoms
• Apathy

Question 3

What are the investigations for dementia generally?

Answer 3

• History/ exam
• Cognitive testing - Mini- ACE/ ACE in Dementia. For delirium 4AT, AT 10
• Bloods → norm + B12/ folate, ESR, antinuclear antibody (ANA), syphilis, and HIV.
• Brain imaging → CT/ MRI

Question 4

What is the management for Alzheimer’s?

Answer 4

• cholinesterase inhibitors, eg donepezil, rivastigmine, and galantamine
  ◦ mild to moderate disease
  ◦ improve cognitive and behavioural symptoms
  ◦ increase acetylcholine availability.
• memantine:
  ◦ moderate to severe disease
  ◦ N-methyl-d-aspartate (NMDA) glutamate receptor antagonist

Question 5

What are the symptoms of vascular dementia?

Answer 5

• Gait disturbance
• Personality change
• Labile mood
• Urinary symptoms
• Insight preserved

Question 6

What are the management of vascular dementia?

Answer 6

modify cerebral risk factors (eg smoking)

Question 7

What are the symptoms of Lewy body?

Answer 7

• Sleep disorders
• Delirium + memory problems
• Visual (people + animals) + auditory hallucinations
• Parkinsonism
• Fluctuating dementia (periods of dementia then delirium)
• Autonomic instability

Question 8

What is the management of Lewy body?

Answer 8

• cholinesterase inhibitors
• avoid anti-psychotics as can precipitate parkinsonian symptoms

Question 9

What are the symptoms of Parkinson’s?

Answer 9

• Classical triad of features: bradykinesia, tremor and cogwheel
• Motor symptoms
• Parkinson’s dementia (after having Parkinson’s for a couple of years)

Question 10

What are the clinical features of Parkinson’s?

Answer 10

• bradykinesia → slow hand movements + shuffling gait
• cogwheel → Stiff joints with a tremor
• Resting tremor → ‘pill-rolling’, i.e. in the thumb and index finger. Improves with voluntary movements

Question 11

What is the management of Parkison’s?

Answer 11

• Levodopa (for motor symptoms)
• Dopamine agonists e.g. bromocriptine (given if motor symptoms don;t effect QoL)
• MAO-B inhibitors e.g. selegiline (given if motor symptoms don;t effect QoL)

Question 12

What are the symptoms of Frontotemporal dementia?

Answer 12

• Stereotyped behaviours
• Personality change
• Loss of insight
• Expressive dysphasia
• Preserved memory
• Primitive reflexes

Question 13

What is the management of Frontotemporal dementia?

Answer 13

• no specific treatment
• psychotropic drugs used with caution for depression and psychotic symptoms

Question 14

What are the symptoms of Creutzfeldt-Jakob disease (CJD)?

Answer 14

• dementia (rapid onset)
• myoclonus

Question 15

What are the symptoms of Normal pressure hydrocephalus?

Answer 15

• Apathy
• Inattention
• Urinary incontinence
• Gait apraxia
  This suddenly happens

Question 16

What is the management of Normal pressure hydrocephalus?

Answer 16

shunting

Question 17

Which type (s) of dementias progress in a slow decline over time?

Answer 17

• Alzheimer’s
• Frontotemporal
• Parkinson’s

Question 18

Which type (s) of dementias progress in a rapid decline over time?

Answer 18

• Lewy Body
• Creutzfeldt-Jakob disease (CJD)

Question 19

Which type (s) of dementias progress in a stepwise decline over time?

Answer 19

Vascular