Geriatrics - Psychogeriatric

Question 1

Dementia

Spectrum of dementia

Answer 1

Dementia: syndrome that may be caused by a number of different brain disorders involving mental decline severe enough to disrupt daily life that affects more than one core brain functions: Recent memory, Language, Visuospatial function, Executive function.

Major Neurocognitive Disorder: Significant cognitive decline + interfere with B-ADL and I-ADL

Mild Neurocognitive Disorder: Modest cognitive decline + does not interfere B-ADL nor I-ADL. 10-15% of Mild NCD progress into Major NCD every year

Mild Cognitive Impairment: minor problems with cognition, NOT severe enough to interfere significantly with daily life (B-ADL, I-ADL), and so are not defined as dementia. 6-25% Annual rate of progression to Dementia (compared to normal individual 1-2%)

Question 2

Dementia

Prevalence with age
Distribution of most common causes

Answer 2

Question 3

Mnemonic for dementia

Answer 3

Question 4

Primary neurological diseases/ dementia syndromes

Answer 4

Question 5

Secondary causes of dementia

Answer 5

Question 6

Congenital causes of dementia

Answer 6

Question 7

Risk factors of dementia
Protective factors against dementia

Answer 7

Question 8

*

Domains of cognitive impairment

Answer 8

PCELLS

Perceptual motor
Cognition
Executive function
Language
Learning and memory
Social cognition

Question 9

Complex attention

Signs of impairment

Answer 9

Question 10

Executive ability

Signs of impairment

Answer 10

Question 11

Learning and memory

Signs of impairment

Answer 11

Question 12

Language

Signs of impairment

Answer 12

Question 13

Perceptual motor

Signs of impairment

Answer 13

Question 14

Social cognition

Signs of impairment

Answer 14

Question 15

Behavioural psychological symptoms of Dementia

Answer 15

Question 16

Diagnostic criteria of dementia

Answer 16

+ Caregiver stress, Institutionalisation

Question 17

Clinical assessment of dementia

Answer 17

ADL: B-ADL and I-ADL

Behavioural psychological symptoms of Dementia
- Anxiety, Apathy, Aggression, Agitation, Irritability, Verbal outbursts
- Delusion, Hallucination
- Motor behavior abnormality, night time behavioural disturbance

Cognition: 6 domains
- AMT, MMSE, MoCA, Clock drawing test

Question 18

Dementia

Ix

Answer 18

Question 19

Alzheimer’s disease

Brain region affected

Answer 19

Question 20

Frontotemporal dementia

Brain region affected

Answer 20

Question 21

Primary Progressive Aphasia

Brain region affected

Answer 21

Pericentral sulcus

Question 22

Corticobasal degeneration

Brain region affected

Answer 22

Corpus Callosum, Perisylvian fissure

Question 23

Progressive Supranuclear Palsy

Brain region affected

Answer 23

Question 24

Multisystem atrophy

Brain regions affected

Answer 24

Question 25

Lewy body dementia Brain regions affected

Answer 25

Question 26

Vascular dementia Brain regions affected

Answer 26

Question 27

Normal pressure hydrocephalus Brain region affected

Answer 27

Question 28

Advanced neuroimaging techniques for dementia

Answer 28

Question 29

Dementia management

Answer 29

Heart block, Asthma, Acute angle closure glaucoma C/I vs AchEi S/E: Rhabdomyoltsis, NMS, Bradycardia, Anorexia, GI S/E

Question 30

Prevention of dementia

Answer 30

Question 31

Alzheimer's disease Prevalence Prognosis

Answer 31

Question 32

Alzheimer's disease Risk factors

Answer 32

Question 33

Alzheimer's disease Pathogenesis

Answer 33

Clinical manifestation- Atrophy in AD usu. starts from Temporal lobe, then to Hippocampus → Memory deficit- **Cholinergic deficit ** * Loss of cholinergic biosynthetic machinery * Loss of basal forebrain cholinergic neurons (that projects to Hippocampus) * Cholinergic deficit also contributes to memory and attention impairment

Question 34

Clinical course of Alzheimer's disease

Answer 34

Early Alzheimer signs: Amnesia, Spatial disorientation, Circumlocution Advanced Alzheimer: Sloppily dressed, Slow, Apathetic, Confused, Disoriented, Stooped posture Terminal Alzheimer: Bedridden, Stiff, Unresponsive, Nearly mute, Incontinence

Question 35

Neuropsychiatric features of Alzheimer's disease

Answer 35

Question 36

Alzheimer's disease Diagnostic criteria

Answer 36

Question 37

Alzheimer's disease Investigations

Answer 37

Question 38

Alzheimer's disease Management plan

Answer 38

Question 39

Alzheimer's disease AChEI and NMDA-R MoA, ADR

Answer 39

Question 40

Vascular dementia Spectrum

Answer 40

Question 41

Vascular dementia Causes

Answer 41

Question 42

Vascular dementia Risk factors

Answer 42

Question 43

Vascular dementia Clinical presentation

Answer 43

Stepwise deterioration of cognitive ability - Lose executive function first - Sparing episodic memory, recall, verbal learning - Cortical signs + narrow based gait BPSD of VD: - Apathy, pseudo-bulbar effect, depression

Question 44

Vascular dementia Diagnostic criteria

Answer 44

Question 45

Vascular dementia Management

Answer 45

Question 46

Lwey body dementia Disease spectrum

Answer 46

Question 47

DLB Clinical features

Answer 47

Core: Visual hallucination Cognitive fluctuations: Staring, disorganized speech, drowsiness Parkinsonism REM sleep behaviour disorder: Dream enactment BPSD of LBD: Apathy, Anxiety, Depression

Question 48

DLB Diagnosis

Answer 48

Question 49

DLB Management

Answer 49

Question 50

Types of Parkinsonian syndromes with dementia

Answer 50

Question 51

Normal pressure hydrocephalus Risk factors

Answer 51

Question 52

NPH Clinical presentation

Answer 52

Question 53

NPH Diagnosis

Answer 53

Question 54

NPH Management

Answer 54