Geriatrics - Confusion

Question 1

what are the 6 neurocognitive domains in DSM5?

Answer 1

motor, language and executive function, complex attention, learning and memory, social cognition

Question 2

why is important to assess cognition?

Answer 2

associated with risk of death, capactiy, may alter appropriateness of tests.

Question 3

What should you ask in the hx to diagnose cognitive impairment?

Answer 3

onset- when and how rapid? Course- fluctuating or progressive decline, associated features- other illness or functional loss?

Question 4

what is delerium?

Answer 4

disturbed conciousness, change in cognition, acute onset and fluctuating, sleep disturbance, emotional disturbance

Question 5

what precipitates delirium

Answer 5

most common complicaiton of hospitalisation, infection, dehydration, pain, drugs, hypoxia, urinary retention, sleep disturbance, brain injury. Effects 20-30% of patients

Question 6

what are the types of distured conciousness?

Answer 6

hypoactive, hyperactive, mixed

Question 7

What is 4AT?

Answer 7

delerium assessment tool for 65 and over, alertness, amt4, attention, acute change or fluctuating course?

Question 8

What is AMT4?

Answer 8

Abbreviated mental test, 4 questions asked quickly (age, dob, place of birth, current year)

Question 9

what do you do when you find delerium?

Answer 9

treat the cause (full history and exam), explain the diagnosis, pharmacological / non-pharma measures

Question 10

Name the non-pharmacological tx of delerium

Answer 10

use families and carers to reorientate and reassure patients, encourage mobility and self-care, correct sensory impairment, normalise sleep-wake cycle, ensure continuity of care, avoid urinary caths and venflons.

Question 11

Name the pharmacological tx of delerium

Answer 11

stop anitcholinergics and sedatives. Drug tx usually not nessesary. Only if in danger to themselves or others use quetapine orally.

Question 12

quick definition of dementia…

Answer 12

Acquired decline in memory and other cognitive functions in an alert person sufficiently severe to cause functional impairment and present for more than 6 months

Question 13

types of dementia…

Answer 13

alzheimers, vascular, mixed, lewy body, fronto-temporal

Question 14

alzheimers definition and rf’s

Answer 14

slow incidious onset, loss of recent memory, progressive funcitonal decline. Rf’s: age, vascularm genetics

Question 15

vascular dementia and rf’s

Answer 15

step-wise deterioration, executive dysfunction, gait problems. Rf’s: t2dm, af, ihd, pvd.

Question 16

lewy body dementia definition

Answer 16

fluctuant, hallucinations, associated with parkinsonism, falls common.

Question 17

fronto temporal dementia definition

Answer 17

earlier age onset, behavioural change, language difficulties, lack of insight into diffiuculties.

Question 18

how is dementia diagnosed and what are the problems with the tests.

Answer 18

MMS exam or Montreal cognitive assessment. Can be culturally/generation ally specific, falsely resassuring, remember to use in parallel with the Hx.

Question 19

pharmacological mx of dementia?

Answer 19

cholinesterase inhibitors (Galantamine, Rivastigmine (used more in lewy body)), anti-psychotics (increases risk of cvs death, also start low and go slow)

Question 20

nonpharmacological mx of dementia?

Answer 20

support, cognitive stimulation, exercise, environmental design, avoid changes in environment, care planning.

Question 21

what are the reversible causes of dementia?

Answer 21

hypothyroidism, intracerebral bleeds/tumours, b12 deficiency, hypercalcaemia, normal pressure hydrocephalus (wet wobbly wacky), depression.

Question 22

what to think about when considering capacity to consent to tx…

Answer 22

capacity decision specific, do they hhave a legally appointed proxy (welfare POA or guardian)

Question 23

name the members of the MDT in caring for dementia…

Answer 23

physios, nurses, pharmacists geriatricians, psychiatrists, social workers, OT’s.

Question 24

case 1 …

Answer 24

82m, aande, walking with trouser down on the street. Hx fro family- increasing forgetful over past year, gradual decline over past 2 years.

Question 25

case 2 …

Answer 25

no memory problems, falls with subsequent sore knees recently (gp started a new tablet), bloods - crp15, wcc8, urea12, creat65

Question 26

case 3 …

Answer 26

92w, pmh - diverticular disease, admitted with vomoiting and abdo pain, diagnosed with diverticulitis (tx - iv fluids, abx), aggitated and aggressive overnight and very unsteady on her feel, consistently wanting to go to the toilet. (NPH)

Question 27

case 4 …

Answer 27

old man, lives alone, phm - bph, hypertension, af. Dhx - codydramol, thyroxine, tamsulosin, ompeprazol. Metoclopramide, Ramipril, amlodipine. He has been shoiuting at people who arent there, lots of falls, slowed down over the past few months (dementia with lewy bodies)

Question 28

what drugs exacerbate case 4’s condition?

Answer 28

avoidmedicationswith anticholinergic properties, which canworsencognition, or dopamine agonists, which can cause hallucinations. First-generation antipsychoticmedications, such as haloperidol (Haldol), should not be used to treatLewy body dementia