Neurology Flashcards
how is the risk of falls determined?
The Timed Up and Go test, also known as the TUG test, is a simple evaluative test used to measure your functional mobility. The TUG test measures how long it takes to stand up, walk a distance of 10 feet, turn, walk back, and sit down again.
donepezil
acetylcholinesterase inhibitor used in the management of the dementia of Alzheimer’s Disease
ropinerole
used in parkinson’s
Ropinirole is a non ergoline D2/D3 dopamine agonist which stimulates striatal dopamine receptors.
what is the triad of parkinson’s used in diagnosis?
pill rolling/intention tremor
shuffling gait/parkinsonian
bradykinesia
what is another fx of parkinsons to examine?
stops in doorway…takes longer to walk and turn around
what is LPOP?
liason psychiatry older people
what is the anticholinergic burden?
The ACB effects are proportionate to the dose and duration of exposure. ACB score of 3 or more may increase the risks of cognitive impairment, functional impairment, falls and mortality in older adults (> 50 – 65 years). Increased doses and long duration of use are associated with increased risk of dementia. Long term effects of anticholinergics on cognition is unknown
define delirium tremens
alcohol dependence withdrawal delirium
lewy body dementia v parkinsons dementia
Lewy body dementia is more likely if dementia starts before or within 1 year of the onset of the parkinsonian symptoms. Lewy body dementia also commonly causes visual hallucinations of people. The poor response to co-careldopa is also a clue, as the ‘Parkinson’s plus’ syndromes are often less responsive to classical antiparkinsonian drugs.
alzheimer’s affects which part of the brain
cortex and hippocampus - atrophy
what drug should you consider stopping in dementia?
The STOPP-START Criteria (Gallagher et al., 2008) outlines medications that we should consider withdrawing in the elderly. One example of this is the use of tricyclic antidepressants in patients with dementia, due to the risk of worsening cognitive impairment
how is frailty assessed?
Frailty should be specifically assessed through the evaluation of gait speed, self-reported health status, or the PRISMA-7 questionnaire
what drug should be avoided in lewy body dementia?
haloperidol - D2 receptor antagonist
can result in parkinsonian features
how can delirium be acutely managed?
IM haloperidol
medical management of alzheimers
Acetylcholinesterase (AChE) inhibitors (donepezil, galantamine, and rivastigmine) [NICE, 2006; NICE, 2011]:
These drugs can be used for mild to moderate Alzheimer’s disease but must only be prescribed by healthcare professionals with expertise in this area …
Memantine is an option for managing Alzheimer’s disease for people with:
Moderate Alzheimer’s disease who are intolerant of, or have a contraindication to, AChE inhibitors or
Severe Alzheimer’s disease.
what score is used to assess a patient’s risk of bed sore?
Waterlow score - used to identify patients at risk of pressure sores
what medications increase the risk of falls in the elderly?
Medications that cause postural hypotension Medications associated with falls due to other mechanisms
Nitrates Benzodiazepines
Diuretics Antipsychotics
Anticholinergic medications Opiates
Antidepressants Anticonvulsants
Beta-blockers Codeine
L-Dopa Digoxin
Angiotensin-converting enzyme inhibitors - (ACE) inhibitors Other sedative agents
delirium v dementia
Delirium involves an impairment of conscious level and often involves psychotic symptoms
pick’s disease
Middle aged adult with insidious onset dementia and personality changes = Pick’s disease
which investigations are required for dementia?
A blood screen including FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate levels should be done in patients with suspected dementia to check for reversible causes
what is normal pressure hydrocephalus?
Condition in which there is excess cerebrospinal fluid in the ventricles, and with normal or slightly elevated cerebrospinal fluid pressure
how many ventricles are there in the brain?
2 x lateral
third
and fourth ventricle
