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CASC > Old Age > Flashcards

Old Age Flashcards

1
Q

How many patients with Parkinsons develop depression

A

66%

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2
Q

How many patients with Parkinsons develop dementia

A

40%

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3
Q

How many patients develop delirium one week after a stroke

A

30-40%

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4
Q

How many people with chronic physical illness develop depression

A

20%

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5
Q

How much more common is depression in patients with chronic physical health problems?

A

2-3 times more common than gen pop

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6
Q

Which memory is often affected in alcohol related dementia

A

Autographical

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7
Q

Triad of normal pressure hydrocephalus

A

Gait ataxia
Dementia
Urinary incontinence

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8
Q

Prevalence of normal pressure hydrocephalus in the elderly

A

0.4%

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9
Q

What is the first sx in normal pressure hydrocephalus?

A

Gait disturbance

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10
Q

Investigation of NPH

A

CSF tap test - 40-50mp withdrawn by LP with assessment of gait and cognition before and afterwards

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11
Q

Risk factors for subdural haematoma

A 
Post trauma
Elderly after fall
HI
Cerebral atrophy
Alcoholism
Epilepsy
Clotting disorders
Anticoagulants
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12
Q

When and how does Huntingtons usually present?

A

40s - frontal dementia and movement disorder

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13
Q

Risk of alzheimers in first degree relatives with the disease

A

3-4 times compared to controls

15-19% compared with % in controls

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14
Q

Risk of dementia with age

A

1% aged 60
5% aged 65
40% aged 85
Doubles every 5 years

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15
Q

Risk factors for Alzheimers

A 
Age
Downs
APO4 allele
Female
HI
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16
Q

Which memory tends to be affected in Alzheimers

A

Initially short term followed by long term

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17
Q

Common sx of Alzheimers

A

Short-term memory followed by long term memory impairment
Expressive and receptive dysphasia
Lexical anomia - word-finding difficulty
Apraxia

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18
Q

Psychiatric symptoms in Alzheimers

A

Delusions - 15%
Hallucinations - 10-15%
Depression - 20%

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19
Q

Symptoms in BPSD

A 
Apathy - 59.6%
Depression - 58.5%
Irritability - 44.6%
Anxiety - 44%
Agitation - 41.5%
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20
Q

Average survival expectation for Akzhaimers

A

8 years

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21
Q

Limitations of MMSE

A

Subject to variation with age, socio-economic status and educational achievement
Weighted towards verbal performance

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22
Q

Cut off for MMSE

A

24/30

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23
Q

Medications for mild to moderate cognitive impairment in Alzheimers

A

Donepezil
Rivastigme
Galantamine
(Cholinesterase inhibitors)

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24
Q

SEs of Donepezil

A

Nausea, vomiting, diarrhoea, anorexia

Headaches, dizziness

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25
Q

Benefits of Rivastigmine

A

Can be given as patch

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26
Q

What is Memantine described as

A

Drug modifying drug as NMDA antagonist and can be neuroprotective, protections neurons from excessive amounts of glutamate

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27
Q

SEs of Memantine

A 
Dizziness
Headache
Diarrhoea
Fatigue
Gastric pain
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28
Q

Medication for severe Alzheimers

A

Memantine

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29
Q

When are cholinesterase inhibitors contraindicated

A

Severe asthma

Severe conduction defects

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30
Q

Prevalence of psychosis in Alzheimers

A

30-50%

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31
Q

How many cases of dementia are due to Vascular

A

20%

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32
Q

What type of stroke is linked with cognitive impairment

A

Midbrain and thalamic strokes

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33
Q

What is Binswangers disease?

A

Progressive small vessel disease

Subcortical dementia with slow intellectual decline and generalised slowing.

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34
Q

Common sx in Binswangers

A

Short term memory difficulties
Disorientation
Gait disturbance and dysarthria
Depression

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35
Q

Risk factors for vascular dementia

A 
Old age
Hypertension
IHD
Smoking
Alcohol
Hyperlipidaemia
AF
FHx
Valvular disease
Coronary artery disease
Coagulopathies
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36
Q

Characteristics of vascular dementia different to Alzheimers

A

Vascular more common in males, Alzheimers in female
Stepwise in Vascular compared to gradual progressive course in alzheimers
Focal neurological signs present
Insight retained in vascular, often lost in alzheimers
Mood symptoms uncommon compared to flattened or euphoric mood in alzheimers
Somatic complaints like headache and dizziness common in vascular, uncommon in alzheimers

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37
Q

How many cases of dementia are LBD?

A

15-20%

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38
Q

Core symptoms of LBD

A

Progressive cognitive decline to interfere with functioning (central)
Two of the following for probable diagnosis: fluctuating cognition with profound variations in attention and alertness, recurrent visual hallucinations which are detailed, spontaneous motor features of parkinsonism (70% of cases)

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39
Q

Supported features suggestive of LBD

A 
Repeated falls due to autonomic dysfunction
Syncope
Transient disturbances of consciousness
Neuroleptic sensitivity
Systematized delusions
Hallucinations in other modalities
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40
Q

Prevalence of paranoid delusions in LBD

A

65%

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41
Q

Prevalence of auditory hallucinations in LBD

A

20%

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42
Q

Prevalence of visual hallucinations in LBD

A

60-80%

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43
Q

Impact of antipsychotics on LBD

A

Worsen parkinonism sx

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44
Q

How many patients with LBD may experience life threatening adverse effects to antipsychotics

A

50%

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45
Q

Decline rate per year of parkinsonism sx in LBD

A

10% per year

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46
Q

Which memory is spared in LBD

A

Short term

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47
Q

Medications in LBD

A

Cholinesterase inhibitors can improve cognition, delusion and hallucinations but not licensed in UK

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48
Q

What causes dementia in parkinsons

A

Degeneration of subcortical structures - substantia nigra, caudate, putamen and globus pallidus

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49
Q

Symptoms of Parkinsons Dementia

A

Executive dysfunction - planning, reasoning
Apraxia
Dysphasia

50
Q

SEs of Levodopa

A 
Visual hallucinations (most common) with preserved insight
Psychosis
Anxiety
Euphoria
Mania
Impulsive behaviour
Delirium
51
Q

Best antipsychotic in Parkinsons

A

Clozapine

Quetiapine

52
Q

Risk factors for psychosis in Parkinsons

A 
Older age
Longer duration of illness
Dementia
Severity of illness
Insomnia
Use of dopamine agonists
Polypharmacy
53
Q

Difference between diagnosis in LBD and Parkinsons

A

o Lewy body dementia: If both motor symptoms and cognitive symptoms develop within 12
months, then it is conventional to give a diagnosis of Lewy body dementia.
o Parkinson’s disease dementia: If the parkinsonian symptoms have existed for more than 12
months before dementia develops then a diagnosis of Parkinson’s disease dementia is given

54
Q

What scan can differentiate between Parkinsons and LDB

A

SPECT: greater caudate involvement in LBD

55
Q

What can DAT help to differentiate?

A

LBD from Alzheimers - shows dopamine deficiency

56
Q

What medication is licensed for treatment of parkinsons disease dementia?

A

Rivastigmine

57
Q

Types of FTD

A

Picks
Primary progressive aphasia
Semantic dementia
Corticobasal degeneration

58
Q

Age of onset of FTD

A

40-75

59
Q

How many presenile cases of dementia are due to FTD

A

20%

60
Q

Early clinical features of FTD

A

Personality change - disinhibited, social misconduct, lack of insight
Behaviour change - apathy, mutism, repetitive behaviour

61
Q

Late features of FTD

A 
Behavioural rigidity
Impulsivity
Emotional lability
Fatuosness
Executive dysfunction
Hyperorality
62
Q

Memory impairment in FTD

A

Affected later and not as seriously

Spatial orientation preserved

63
Q

Symptoms in Picks

A 
Emotional blunting
Coarsening of social behaviour
Disinhibition
Apathy or restlessness
Aphasia
64
Q

Symptoms in primary progressive aphasia

A

Progressive decline in language with sparing of other cognitive deficits
Speech is non-fluent, mute in later stages

65
Q

Symptoms in semantic dementia

A

Fluent speech but difficulties in word naming and meaning

Other cognitive domains preserved

66
Q

How many patients with Picks have a positive FHx?

A

50%

67
Q

Most common dementia in early onset (<65)?

A

Alzheimers

68
Q

What sx are common in early onset Alzheimers?

A

Language and visuospatial

69
Q

Sx in PSP

A 
Balance difficulties
Abrupt falls
Slurred speech
Dysphagia
Agitated at times
70
Q

Characteristic syndrome of PSP

A

ophthalmoplegia, pseudobulbar palsy, and axial dystonia

vertical gaze palsy

71
Q

What is Bells phenomenon?

A

Reflexive upturning of eyes on forced closure of the eyelids

72
Q

Eye signs in PSP

A

ophthalmoplegia
Loss of convergence and Bells phenomenon
Retraction of upper eyelids resulting in wide-eyed, unblinking stare

73
Q

Sx of delirium

A

Rapid fluctuations over minutes and hours
Clouding of consciousness
Reduced attention and distracted
Global impairment in cognition with disorientation
Impairment of recent memory
Disturbance in sleep/wake cycle with nocturnal worsening of sx
Emotional lability
Visual hallucinations
Incoherent speech
Paranoid delusions

74
Q

Prevalence of delirium in elderly on hospital

A

10-40%

75
Q

Prevalence of delirium in gen pop

A

0.4%

76
Q

Duration of delirium

A

Usually <1 week

77
Q

Environmental and supportive measures for delirium

A

Education
Reorientation
Reassurance
Adequate lighting
Reduce unnecessary noise, Consistent staffing
Correct sensory impairment
Optimise patients condition with attention to hydration, nutrition, elimination and pain
Safe environment - remove objects which patient could harm self or others

78
Q

NICE guidelines for medication in delirium

A

<1 week on Haloperidol or olanzapine

79
Q

Benzo use in delirium

A

Can increase agitation and increase risk of falls and disinhibition
Helpful if delirium caused by withdrawal of alcohol or sedatives

80
Q

Prevalence of depression in >65

A

10-15%

81
Q

Prevalence of depression in residential and nursing homes

A

15-30%

82
Q

Which physical health conditions are high risk of depression?

A

Cardiovascular disease
Cancer
CNS disorders - stroke, dementia

83
Q

Risk of depression in dementia

A

25%

84
Q

More common sx of depression in the elderly

A 
Hypochondiacal and delusional
Somatic concerns
Poor subjective memory
Apathy
Poor motivation
Anxiety/OCD-like
Psychomotor sx
85
Q

Risk factors for late life depression

A

Female
Poor health
Disability
Poor perceived social support

86
Q

Trial period of antidepressant in elderly should last how long

A

2-3 months

87
Q

Maintenance period of antidepressants in the elderly

A

2 years

88
Q

How many elderly do not respond to antidepressants

A

30%

89
Q

Recovery rate of elderly depression with ECT

A

80%

90
Q

Which SEs more common in elderly with ECT

A

Confusion

Cognitive impairment

91
Q

Prognosis of elderly depression

A

At 2 years 33% are we,, 33% remain depressed

92
Q

Good prognostic factors for elderly depression

A 
Onset less than 70 years old
Short duration of illness
Absent physical illness
Good previous adjustment
Good previous recovery
93
Q

Poor prognostic factors for elderly depression

A

Severe life events during follow up period
Poor medication adherence
Severity of initial illness
Co-morbid physical illness
Presence of psychotic symptoms
Duration of illness for more than 2 years
3 or more previous episodes
Previous history of Dysthymia
Cerebrovascular disease (including vascular depression)

94
Q

How many elderly patients with pseudodementia during depressive episodes go on to develop dementia

A

40% within 3 years

95
Q

Mania accounts for how much of mood disorders in the elderly?

A

5-10%

96
Q

One year prevalence of Bipolar in >65?

A

0.4% compared with 1.4% in younger adults

97
Q

Average age of onset of elderly bipolar

A

55

98
Q

M:F ratio of elderly bipolar

A

1:2

99
Q

First line prophylaxis for elderly bipolar

A

Lithium

100
Q

Prevalence of late onset psychosis in elderly in community

A

0.1-4%

101
Q

Which gender more affected by late onset psychosis?

A

Remales

102
Q

Clinical features of late onset psychosis

A

Paranoid delusions - 90% of patients
Auditory hallucinations - 70%
Visual hallucinations - 60%

103
Q

Characteristics of late onset psychosis

A

o Fewer negative symptoms
o Better response to antipsychotics
o Better neuropsychological performance
o Greater likelihood of visual hallucinations
o A lesser likelihood of formal thought disorder
o A lesser likelihood of affective blunting
o A greater risk of developing Tardive dyskinesia (The risk of developing Tardive dyskinesia
with older antipsychotics is increased in older people by 5-6 times)

104
Q

Risk factors for late onset psychosis

A 
Sensory deprivation
Social isolation
Cognitive decline
Polypharmacy
Paranoid and schizoid personality
Life events
Female
FHx - but weaker than early onset SCZ
105
Q

Most common psychiatric disorder excluding dementia in elderly

A

Anxiety

106
Q

Most prevalent anxiety disorder in elderly

A

Phobia

107
Q

Common anxiety sx in elderly

A

Hypochondriacal
Depressive sx
Abuse of sedative drugs and alcohol

108
Q

Most common cause of agoraphobia in the elderly

A

Physical illness

109
Q

CI of Disulfiram

A

HTN
Cardiac failure
CVE
IHD

110
Q

Risk factors for self-harm in the elderly

A

o Physical illness
o Widowhood and divorce or separation from a co-habitee
o Social isolation and loneliness
o Simply living alone
o Unresolved grief usually after death of a spouse is a commonly found risk factor for DSH.

111
Q

Social RFs of suicide in the elderly

A

social isolation, lack of someone to confide in,
concerns over dependents or a move from home to residential care.
Prolonged grief reaction

112
Q

Prevalence of PD in the elderly

A

5-10%

113
Q

Which personality traits may intensify with age?

A

Depressive illness

Paranoid traits

114
Q

Prevalence of inappropriate sexual behaviour in dementia

A

7%

18% in care homes

115
Q

Interventions for sexually inappropriate behaviour in dementia

A

ABC system

116
Q

When should treatment be initiated in bereavement?

A

Suicidal ideation
Severe functional impairment
Signs of severe depression

117
Q

How many of the elderly develop depression needing treatment one year after bereavement of spouse?

A

10-20%

118
Q

Phases of normal grief reaction

A

Phase 1 - Shock and protest – includes numbness, disbelief and acute
dysphoria
Phase 2 Preoccupation – includes yearning searching and anger
Phase 3 – disorganization – includes despair and acceptance of loss
Phase 4 – resolution

119
Q

Duration of normal grief reaction

A

In normal grief reactions substantial improvement is expected within 2 months
to 6 months, and those who continue to meet criteria for major depression after
this time period should receive antidepressant or psychotherapy

120
Q

What are the three types of abnormal grief?

A

Inhibited grief – absence of expected grief symptoms at any stage
Delayed grief – avoidance of painful symptoms within 2 weeks of loss
Chronic grief – continued significant grief related symptoms 6 months after
loss

CASC (16 decks)

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