Geriatrics

Question 1

Drugs causing delirium

Answer 1

• Anticholinergics
• Benzo’s
• Opioids

Question 2

Best scan for Lewy body dementia

Answer 2

FDG PET

Question 3

Insulin resistance is a RF for which types of dementia

Answer 3

Alzheimer’s

Vascular

Question 4

Neurotransmitter changes in delirium

Answer 4

• decreased acetylcholine

- increased dopamine

Question 5

Biggest risk factor for Alzheimer’s

Answer 5

Advancing age.

F>M

Question 6

Gene for Alzheimer’s dementia - Early and Late onset

Answer 6

Early onset

• presenelin genes - PSEN1 and PSEN2
• APP gene
• Amyloid beta 42

Late onset
- Homozygous for APOE E4

Question 7

Beta amyloid levels and Tau levels in CSF in Alzheimer’s

Answer 7

• Beta amyloid - low (earliest sign of Alzheimer’s)

- Tau - high

Question 8

Best imaging for assessing amyloid plaques

Answer 8

PiB scan - Pittsburg compound B

Question 9

Alzheimers drugs

Answer 9

• Donepezil
• Rivastigmine
• Memantine - NMDA receptor

Question 10

Symptoms of frontotemporal demential

Answer 10

• behavioural changes
• progressive dysphasia
• specific food cravings
• decline in hygiene and grooming

Question 11

First cognitive deficit in Lewy body dementia

Answer 11

Visio-spatial skills

Question 12

Area of brain affected in Alzheimer’s

Answer 12

Hippocampus

Question 13

Fat changes in normal aging

Answer 13

• reduced subcut fat and reduced appendicular.

- increased visceral and axial fat.

Question 14

Who assesses for capacity?

Answer 14

Clinician/ Doctor - NOT neuropsych

Question 15

Best management of frailty

Answer 15

Group resistance exercise

Question 16

Neurotransmitter involved in delirium

Answer 16

Acetylcholine.

Question 17

Delirium physiology

Answer 17

Inattention - due to ascending reticular activating system (ARAS)
Cortical + subcortical dysfunction

Question 18

Delirium EEG

Answer 18

slow wave activity

Question 19

4 core features of Lewy body dementia

Answer 19

• Fluctuating cognition and lack of attention
• Hallucinations
• REM sleep behaviour disorder
• Parkinson’s features

Question 20

Treatment of Lewy Body dementia

Answer 20

• Cholinesterase inhibitors work very well - BETTER than in Alzheimer’s.
• Antipsychotics DO NOT work.

Question 21

Fried frailty criteria

Answer 21

1. decreased grip strength
2. unintentional weight loss
3. low energy
4. low physical activity and slow walking
   speed (<0.8m/s).

Question 22

Highest population risk factor for Alzheimer’s

Answer 22

low education

Question 23

Diabetic drug which is neuroprotective for Parkinsons

Answer 23

Exenatide/ GLP1 agonists

Question 24

Comparison of MOCA and MMSE for MCI

Answer 24

MOCA - more sensitive

MMSE - poor sensitivity, more specific.

Question 25

SE Donepezil

Answer 25

- GI side effects - insomnia - heart block/ QT

Question 26

Role of MRI/CT in MCI

Answer 26

Has a role in assessing focal patterns of atrophy, such as temporal lobe volume loss; which may indicate high risk of converting from MCI to dementia.

Question 27

Can MCI revert/improve?

Answer 27

Yes. Improvements seen in 15-50%

Question 28

Risk of dementia for those with MCI vs no-MCI

Answer 28

three times the risk of developing dementia.

Question 29

Blood pressure aim in elderly patients who are ambulant

Answer 29

SBP <120 - reduced cardiovascular and all cause mortality compared to target of <140

Question 30

Effect of Vit D supplements on falls risk

Answer 30

reduces risk ONLY if Vit D levels were deficient

Question 31

Intervention with biggest improvement in outcomes for dementia

Answer 31

Carer skill training

Question 32

Relevance of TDP43 (TAR DNA binding protein 43)

Answer 32

- a mutated form causes frontotemporal dementia - ubiquitin positive but tau and alpha synuclein negative. - a mutated form is found in ALS - normally is protective against HIV as it suppresses transcription.

Question 33

Components of CAM score

Answer 33

``` Needs BOTH of: 1. Acute and fluctuating 2. Inattention And ONE of 3. Disorganised thinking 4. Altered conscious state ```

Question 34

Components of 4AT score

Answer 34

Alertness Attention Acuity AMT4 - orientation to TPP