Geriatrics

Question 1

Acute confusional state: if treating the underlying cause and environmental modification not working then

Answer 1

haloperidol sometimes used

Question 2

dementia pugilistica

Answer 2

, also known as chronic traumatic encephalopathy (CTE), results from repeated head injuries often seen in professional boxers. It presents with behavioural changes, memory loss followed by parkinsonism but the history usually provides clues towards the diagnosis and it does not show marked sensitivity to neuroleptics like haloperidol.

Question 3

**** presents with autonomic failure (including urinary incontinence), poorly levodopa-responsive parkinsonism and cerebellar ataxia.

Answer 3

Multiple system atrophy

Question 4

is characterised by early onset of postural instability leading to falls, vertical supranuclear gaze palsy and cognitive dysfunction.

Answer 4

Progressive supranuclear palsy

Question 5

**** is a long latent-latency infection caused by a prion. It is associated with rapid cognitive decline, which is absent in this case. The stereotypical EEG in established disease demonstrates disease-typical periodic sharp wave complexes.

Answer 5

CJD

Creutzfeldt-Jakob disease

typically additional symptoms such as abnormal jerking movements, loss of coordination, mobility, vision and slurred speech are also present.

Question 7

***** is the only dementia subtype where MRI is superior to CT, as cortical and subcortical ischaemic lesions are better demonstrated, and some vascular pathologies such as micro-bleeds may be otherwise missed.

Answer 7

Vascular dementia

Question 8

The STOPP-START Criteria (Gallagher et al., 2008) outlines medications that we should consider withdrawing in the elderly.

Answer 8

One example of this is the use of tricyclic antidepressants in patients with dementia, due to the risk of worsening cognitive impairment.

Donepezil can cause cardiac conduction issues, hallucination, dizziness.
Amitrip can cause cardiac conduction issues (long QT), dizziness, sedation.
Therefore the combination of the two is a recipe for disaster.
Thats why of all of the medications, amitrip needs to be stopped ahead of the others.

Question 9

Lewy body dementia (LBD) is characterised by fluctuating cognitive impairment, visual hallucinations, parkinsonism and a pronounced sensitivity to neuroleptics.

Answer 9

This sensitivity can manifest as a severe worsening of motor symptoms or the development of Neuroleptic Malignant Syndrome (NMS), a potentially fatal condition characterised by hyperthermia, altered mental state, autonomic dysregulation and generalised muscle rigidity

Question 10

defined as rapid, often exaggerated changes in mood, where strong emotions or feelings (uncontrollable laughing or crying) occur. commonly associated with pseudobulbar affect that may be seen in conditions like amyotrophic lateral sclerosis or multiple sclerosis.

Answer 10

Emotional lability,

Question 11

Faecal incontinence is a risk factor for pressure ulcers

Question 12

APOE polymorphic alleles are the main genetic determinants of sporadic Alzheimer disease risk.

Answer 12

Individuals carrying the γ4 allele have the highest risk

Question 13

Tight control of vascular risk factors, rather than antidementia medication, is recommended by NICE in vascular dementia

Question 14

Typical antipsychotics should be avoided in delirious patients with a background of Parkinson’s disease

Answer 14

Abrupt discontinuation of carbidopa-levodopa has been reported to cause parkinsonism-hyperpyrexia syndrome, which is similar to the neuroleptic malignant syndrome and therefore should be avoided.