Geriatrics Flashcards
Most common subtype of dementia
Alzhiemers disease
Frailty (not complete)
> 3 or = to
-
MMSE cut off for possible dementia
MMSE
Hallmark feature of AD
Rapid forgetting + one other cortical manifestation
- no physical signs
- speech
- executive
- visuospatial
Which molecule is responsible for 7% of dementia
APOE4
Mechanism underpinning early onset of AD in Down syndrome patients
Extra copy of amyloid precursor gene on chromosome 21
Probable benefit in preventing AD
1) Physical acigtivty
2) Cognitive stimulation
3) Social interaction
Pathophysiology of AD
Accumulation of amyloid plaque + tau
PET: Increased deposition of amyloid
Where does AD commence
Atrophy of medial temporal lobe/hippocompus
Cortical atrophy
Findings on post mortem in AD (not complete)
1) Neurofibirrilary tangles -
2)
Early onset autosomal dominant AD associated mutations
- Amyloid precursor protein (APP)
- Presenilin 1 Chromosome 14
- Presenilin 2 Chromosome 1
Collectively <1% of all adults alzheimers
Genetic screening if there appears to be a pedigree
Late onset AD genetics
Apolipoprotein E on chromosome 19
- E4 allele strongest risk factor for AD
Nb: no preventive measures specific to APOE therefore no genetic screening in late onset
A/E for anti-cholinesterase inibitors
1) Nausea/vomitting/diarhoea
2) Bradycardia –> cannot give to anyone with long PR/conduction deficits
3) Nightmares
C/I in asthma/gastric ulcer disease
A/E of Memantine
Seizures
MOA of memantine
Neuroprotective NMDA antagonist as it blocks glutamate induced excitotoxicity
Mortality risk of operatively managed hip fracture
- 15-30% mortality (some study say 15-20%)
- doubled if >2 days delayed
Treatment for urge incontinence (not complete)
Oxybutinin - Anti-muscarinic (cannot use in acute angle closure glaucoma)
Mirabegron - B3 adrenergic receptor agonist
Treatment for stress incontinence (not complete)
First line: Physical therapy
Second line: Topical oestrogens
Mirabegron mechanism of action and adverse effects
MOA: B3 agonist –> sympathetically medicated relaxation of the detrusor muscle
Adverse Effects: Hypertension, urinary tract infections and headaches
Oxybutinin mechanism of action and adverse effects
MOA: Antagonist of the muscarinic receptor on the bladder –> reduction in contraction
Advers Effects: Can precipitate acute angle closure glaucoma.
Genes associated with early onset AD
Amyloid Precursor Gene (Chromosome 21) Preselin 1 (Chromosone 14q) Preselin 2 (Chromosone 1q)
Gene associated with late onset AD
Apolipoprotein E (Chromosome 19) APOE4 = Greatest risk of developing AD
Memantine Mechanism of Action
MOA: NMDA receptor antagonist. Blocks glutamate induced excitotxicity.
PBS for MMSE 10-14
Adverse effects: Seizures
Mechanism of Action of Rosozoumab
MOA: Inhibits sclerostin. Binds sclerostin, a regulatory factor in bone metabolism. Sclerostin inhibition increases bone formation and, to a lesser extent, decreases bone resorption
MRI findings in Dementia with Lewy Bodies
typical MRI findings is that of diffuse atrophy with relative preservation of the medial temporal lobes
Cardinal features of Dementia with Lewy Bodies
1) visual hallucinations
2) motor parkinsonism
3) REM sleep disorder
4) fluctuating cognition
Differentiating features of MSA and PD
1) Autonomic instability
2) Early falls
3) Lack of response to LD
