GERIS Flashcards
meds to manage acute delerium
olanzapine/haloperidol
inheritance pattern of alzheimers
5% of cases are inherited as an autosomal dominant trait
macroscopic alzheimers changes
macroscopic:
widespread cerebral atrophy, particularly involving the cortex and hippocampus
microscopic alzheimers changes
microscopic:
cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein
medications to manage MILD-MOD Alzheimer’s disease
donepezil, galantamine and rivastigmine
MOA donepezil, galantamine and rivastigmine
acetylcholinesterase inhibitors
memantine when is it used
-moderate Alzheimer’s who are intolerant of, or have a contraindication to, acetylcholinesterase inhibitors
-dd-on drug to acetylcholinesterase inhibitors for patients with moderate or severe Alzheimer’s
-monotherapy for severe alzheimers
which alzheimers med is contraindicated in bradycardia
donepezil
which alzheimers med causes insomnia
donepezil
Delirium vs. dementia
Factors favouring delirium over dementia
impairment of consciousness
fluctuation of symptoms: worse at night, periods of normality
abnormal perception (e.g. illusions and hallucinations)
agitation, fear
delusions
types of dementia
- Alzheimers
- Vascular
- Lewy body
- fronto temporal
A MMSE score of ??? suggests dementia
24 or less out of 30 suggests dementia
Common features of frontotemporal lobar dementias
-Onset before 65
-Insidious onset
-Relatively preserved memory and visuospatial skills
-Personality change and social conduct problems
what type of dementia causes personlaity change
fronto temporal
pathological feature lewy body dementia
alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas.
what type of dementia causes visual hallucinations
lewy body
diagnosis imaging for lewy body dementia
SPECT) scan
neuroleptics/antipsychotics should be avoided in which type of dementia- and why
lewy body
may develop irreversible parkinsonism
Questions may give a history of a patient who has deteriorated following the introduction of an antipsychotic agent
Management lewy body dementia
both acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and memantine can be used
which type of scoring used for pressure sores
waterlow score
The main subtypes of VD:
Stroke-related VD – multi-infarct or single-infarct dementia
Subcortical VD – caused by small vessel disease
Mixed dementia – the presence of both VD and Alzheimer’s disease
rate of deterioration in vascular dementia
step wise
several years of a history of a sudden or stepwise deterioration of cognitive function.
management vascular dementia
conservative - no pharmacological tx for just VD.
can give ACHEi’s etc if sus mixed dementia w alzheimers
why only haloperidol given as sedation in the elderly
to reduce risk of CV event (associated with olanzapine, risperidone)
