Geriatrics

Question 1

What are the 3 syndromes of neurocognitive disorder

Answer 1

Delirium, mild neurocognitive (mild cognitive impairment), major neurocognitive (dementia)

It is KEY to ask about FUNCTION, dementia - loss of IADLs, treat depression

Question 2

Disorientated?

Answer 2

Advocate for a bed by the window, gently reorientate them to the date using board, cognitive delirium, mobilize with OT/PT, try and make sure they can sleep, have aids in place.

Question 3

Medications that increase decline in people cognitively

Answer 3

Many but specifically long term benzodiazepines and anti-cholinergics

Question 4

Types of dementia

Answer 4

Alzheimer’s - slow decline
Vascular - step-wise decline
Lewy body - hallucinations, with decline
Frontotemporal - really uninhibited, younger
Parkinson’s dementia

Question 5

Should you screen for cognitive decline?

Answer 5

No.

Can just open the door - how is your memory? Can you tell me about the big items in the news? Who pays bills? Driving? Can use spouse/ informant/ can talk to privately - get agreement. Do you make your own meals? What did you have yesterday?

Question 6

Do you need a CT to diagnose Alzheimer’s?

Answer 6

No. Can be done clinically. Can do a head CT if sudden precipitous decline, or unusual presentation

If referral to seniors mental health - CBC, extended lytes, A1C, TSH, Liver, BUN/Cr, Lipids, Vit B12 (300 or more)

Question 7

Sun downing?

Answer 7

Try to prevent - make sure they have glasses, dentures, hearing aids, lights on and try to have family around

• can give a tiny dose of benzos