Geriatrics for study group

Question 1

What is the most likely risk factor for late onset dementia for a patient above 75?

Answer 1

Advancing age

Question 2

What is the relationship with age and dementia

Answer 2

Doubling of risk every 5 years after 65

Question 3

what genes are associated with early onset Alzheimer’s dementia (3 genes)

Answer 3

amyloid precursor, presenilin 1 gene,
presenilin 2 gene all of which alter the production, aggregation or
clearance of amyloid-beta protein

Question 4

What gene is associated with late onset ADementia and what is the risk

Answer 4

ApoE
2 alleles - 8-12 fold increase in risk
1 allele - 2-3 fold in risk

Question 5

An 82-year-old female complains of a decline in short term memory, specifically
difficulty remembering some names and telephone numbers. She lives alone in her
own home and has been independent in all activities of daily living and instrumental
activities of daily living, since the death of her husband one year previously. Her mini-
mental state examination (MMSE) score is 27 out of 30, with short-term recall of only
one out of three items.
The most likely diagnosis is:
A. Early vascular dementia
B. Early Alzheimer’s dementia
C. Mild cognitive impairment
D. Grief reaction
E. Normal ageing

Answer 5

Mild cognitive impairment

Objective evidence of impairment without functional impairment

Question 6

What parts of cognition are affected by normal ageing?

Answer 6

Episodic and working memory domains of cognition that are most
affected by ‘normal’ ageing, which begin in the sixth decade:
- Occasional forgetfulness for details
- Interruptions retrieving names/numbers previously memorised

Question 7

What parts of cognition are normally preserved in normal ageing?

Answer 7

Procedural, primary, semantic memory

Question 8

Mild cognitive impairment

Answer 8

Mild cognitive impairment describes a loss that exceeds expected age-related
memory loss but does not interfere significantly with daily activities

Question 9

What are amnestic and non amnestic MCI and what are they precursors for?

Answer 9

Amnestic MCI is a memory defect where non-Amnestic impairs a non-memory domain (e.g. executive functioning, language, visual spatial skills)

Amnestic MCI is thought to be a precursor for AD where as non-amnestic MCI is thought to progress onto other syndromes e.g. FTD, LBD, PSP

Question 10

What is the rate of progression from MCI to Alzheimer’s dementia?

Answer 10

5-15%

Question 11

Management of MCI

Answer 11

Exercise and social engagement most important

Note that cholinesterase inhibitors and memantine inhibitors have not been shown to prevent progression of MCI to dementia

Question 12

What type of dementia is MMSE best for?

Answer 12

Alzheimer’s dementia

Question 13

What type of dementia is MoCA best for

Answer 13

Parkinson’s Disease, vascular dementia

Question 14

What neurological disorder is frontotemporal dementia associated with

Answer 14

MND

Question 15

Cause and features of stress incontinence

Answer 15

Weakness in urinary sphincter or pelvic floor muscles

Triggered by actions that increase intra-abdo pressure

Question 16

Cause and features of urge incontinence

Answer 16

Detrusor overactivity; bladder muscle contractions that are out-of-sync

Loss of urine preceded by the urge to pass urine with loss of urine occuring on the way to the toilet

Question 17

Cause and features of overflow incontinence

Answer 17

Occurs when person is in chronic urinary retention where the bladder does not empty fully and leakage is due to over distended bladder

Associated with reduced sensation of bladder fullness and incomplete emptying

Question 18

Causes and features of functional incontinence

Answer 18

Involuntary loss of urine caused by physical or psychological limitations to going toiletting normally

Cause by impaired mobility/cognition

Question 19

What kind of incontinence is anti cholinergic/anti-muscarinic good at treating

Answer 19

urge incontinence (detrusor overactivity)