Medicine For Elderly + Dementia Flashcards by Sam Donnelly

7 things needed to verify death

No response to voice
No response to painful stimuli
Absence of carotid pulse (1 min)
Absence of heart sounds (2mins)
Absence of breath sounds (2 mins)
Fixed and dilated pupils
Check for pacemaker

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corzyal symptoms
fever
muscle aches
fatigue

Influenza

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Investigations for flu

PCR Nasal/throat swab

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Management for flu

Vaccine prophylaxis (Autumn)
Oseltamivir
Zanamivir

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Falls in >65s

1/3rd each year

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Falls in >80s

1/2 each year

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Causes of falling in elderly

Hypoglycaemia
Delirium
Syncope
Postural hypotension
Vertigo
Muscle weakness
Anaemia
Peripheral neuropathy

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Drowsy
Disorganised thinking
Decreased attention

Delirium

Elderly have low threshold for developing delirium

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Management for delirium

Acute:

haloperidol
benzodiazepines

Treat underlying cause (infection/ constipation)

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Drugs that cause constipation

Opiates
Antipsychotics
Tricyclic antidepressants
Anti-muscarinics

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Management for constipation

Laxatives

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Types of laxatives

Bulk forming
Stimulant
Osmotic
Stool Softeners

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2 examples of stimulant laxatives

Senna
Bisocodyl

Can cause urgency
Take at night

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2 examples of osmotic laxatives

Lactulose
- takes 48 hours to work
Laxido

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Example of stool softener laxatives

Sodium docusate

- absorbs water and lubricates stool

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4 types of dementia

most common > less common

Alzheimer’s Disease
Vascular dementia (15%)
Lewy body dementia (15%)
Frontotemporal dementia

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Genetics for Alzheimer’s

Autosomal dominant (5%)
Chromosomes 21 (amyloid precursor protein), 14 (presenilin 2), and 1 (presenilin 1) involved
Associated with downs syndrome

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Macroscopic pathophysiology of alzheimer’s

widespread cerebral atrophy, particularly involving the cortex and hippocampus

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Microscopic pathophysiology of alzheimer’s

cortical plaques (deposition of type A-Beta-amyloid protein)
intraneuronal neurofibrillary tangles (abnormal aggregation of the tau protein)

Biochemical pathophysiology of alzheimer’s

there is a deficit of acetylcholine from damage to an ascending forebrain projection

Function of tau protein

interacts with tubulin to stabilize microtubules and promote tubulin assembly into microtubules
in AD are tau proteins are excessively phosphorylated, impairing the function

Reversible causes of dementia

hypothyroidism
Addison’s
B12/folate/thiamine deficiency
syphilis
brain tumour
normal pressure hydrocephalus
subdural haematoma
depression
chronic drug use e.g. Alcohol, barbiturates

Management of alzheimer’s

Acetylcholinesterase inhibitors
- Donepezil
- Galantamine
- Rivastigmine
NMDA receptor antagonist
- Memantine

Give an example of 3 acetylcholinesterase inhibitors

Donepezil
Galantamine
Rivastigmine

Give an example of an NMDA receptor antagonist

Memantine

Side effects of Donepezil

- insomnia | - contraindicated in bradycardia

Risk factors for Vascular Dementia

- TIA - AF - HTN - diabetes - Hyperlipidaemia - Smoking - Obesity - CHD - FHx CVD

- Months/years of sudden/stepwise deterioration of cognitive function - Marche a petits pas (short, stepping, rapid gait)

Vascular dementia

MRI evidence in vascular dementia

infarcts and extensive white matter changes

Management for Vascular dementia

- Reduce CVD risk factors | - If mixed with alzheimer's then treat as such

3 main sub-types of vascular dementia

- Stroke-related VD (multi-infarct/ single-infarct dementia) - Subcortical VD (caused by small vessel disease) - Mixed dementia (VD and Alzheimer’s)

- progressive cognitive impairment (attention, executive function and memory) - fluctuating cognition - parkinsonism visual hallucinations - apathetic mood (lack of feelings)

Lewy body dementia

Lewy bodies are found in X% of patients with alzheimer's

40%

Pathophysiology of lewy body dementia

alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas.

Investigation of lewy body dementia

DaTscan/ SPECT (Single-photon ei scion computed tomography) using dopaminergic iodine - 100% specific - 90% sensitive

Management of Lewy body dementia

- Acetylcholinesterase inhibitors | - NMDA receptor antagonists

What drug is contraindicated in lewy body dementia

Haloperidol (neuroleptics) - can lead to irreversible parkinsonism - use Lorazepam instead

3 types of frontotemporal lobar degeneration

- Frontotemporal dementia (Pick's disease) - (chronic) progressive non fluent aphasia (CPA) - Semantic dementia

- onset < 65 years - insidious onset - preserved memory and visuospatial skills - personality change and social conduct problems - emotional lability

Frontotemporal lobar degeneration

Macroscopic pathophysiology of Pick's disease

focal gyral atrophy of frontal and temporal lobes | - knife blade appearance

Microscopic pathophysiology of Pick's disease

- Pick bodies: spherical aggregations of tau protein (silver-staining) - Gliosis - Neurofibrillary tangles - Senile plaques

Main feature of (chronic) progressive non fluent aphasia (CPA)

Non-fluent speech (short utterances that are agrammatic) with preserved comprehension

Main feature of Semantic dementia

Fluent speech but empty meaning

Main feature of Pick's disease

Personality change

Agnosia (inability to perceive and utilise information correctly) - can't recognise people/things

Alzheimer's