Old age

Question 1

6 things that are examined in a cognitive exam?

Answer 1

Attention
Orientation
Memory
Language
Visuospatial 
Executive functioning

Question 2

2 types of episodic memory?

Answer 2

Anterograde and retrograde

Question 3

What is semantic memory and how do you test for it?

Answer 3

General knowledge and vocabulary

Test with category fluency and famous people

Question 4

How do you test for working memory?

Answer 4

3 item recall

Question 5

How do you examine orientation, attention and langugae?

Answer 5

Orientation = time, place, person
Attention = months of the year backwards
Language = point and name objects, repeat 'no ifs and no buts', tell them to pick up piece of paper and fold it then put it on the ground, read a sentence, write a sentence

Question 6

How long does dementia need to be present in order to be diagnosed?

Answer 6

6 months

Question 7

2 most common types of dementias?

Answer 7

Alzheimers 50%

Vascular 20%

Question 8

3 early onset genes relating to Alzheimers?

Answer 8

Presenilin 1 gene, chromosome 14
Presenilin 2 gene, chromosome 1
Amyloid precursor protein, chromosome 21 (down syndrome predisposed)

Question 9

1 late onset gene relating to Alzheimers?

Answer 9

Apolipoprotein e4, chromosome 19

Question 10

2 main pathologies occuring in Alzheimers disease?

Answer 10

Amyloid plaques form due to abnormal cleaving by beta secretase, clumping together to form oligomers and extracellular amyloid plaques (toxic)
Tau proteins made into neurofibrillary tangles - killing neurones

Question 11

How does the brain substance change in Alzheimers?

Answer 11

Reduced cortex and subcortical white matter
Enlarged lateral ventricles
Hippocampus and temporoparietal areas effected first

Question 12

What reductions in neurochemistry does the brain see in Alzheimers?

Answer 12

Decreased choline acetyltransferase (chAT)
Decreased GABA
Loss of serotonin receptors
Reduced noradrenaline
Decreased somatostatin

Question 13

Symptoms seen in the late stages of Alzheimers?

Answer 13

Immobile, 
incoherent
Incontinent
Increased muscle tone
Weight loss

Question 14

What is performed in a dementia screen?

Answer 14

FBC, CRP, LFT, U&E, Glucose, Calcium, Folate, B12, TFT, VDRL/TPHA
CT/MRI/PET
ECG

Question 15

Acetylcholinesterase inhibitor used to treat Alzheimers? Contraindications? SE?

Answer 15

Donepezil
Cardiac conduction defects, peptic ulcer, severe COPD
SE - GI disturb, dizzy, cardiac conduction defects

Question 16

What drug is used in moderate to severe alzheimers? Mode of action?

Answer 16

Memantine

non-competitive NMDA receptor antagonist

Question 17

What causes vascular dementia?

Answer 17

Multiple small infarcts or one large one

Question 18

What will CT scan show in vascular dementia?

Answer 18

Areas of infarction

Question 19

What medication will work for Alzheimers but not vascular dementia?

Answer 19

Acetylcholinesterase inhibitors like Donepezil

Question 20

How does Lewy body present in symptoms and signs?

Answer 20

Fluctuating cognition and mental state with visual hallucinations, recurrent falls and LOC, prominent memory impairment as it progresses

Question 21

Where are Lewy bodies found?

Answer 21

Substantia nigra and cortex

Question 22

Specific scan can be done for Lewy body dementia?

Answer 22

DaT scan

Question 23

What medication should be avoided in Lewy body dementia and what should be given?

Answer 23

Avoid antipsychotics

Give acetylcholinesterase inhibitors

Question 24

How does frontotemporal dementia present?

Answer 24

Asymmetrical atrophy of frontal and temporal lobes
Changes to character and behaviour
Memory deteriorates

Question 25

What disease can be seen as bodies inclusions in the frontal and temporal lobes?

Answer 25

Pick’s disease with picks bodies

Question 26

Can acetylcholinesterase inhibitors be used in fronto-temporal dementia?

Answer 26

Limited benefit

Question 27

What is pseudodementia and how do you distinguish it from normal dementia?

Answer 27

Depression in elderly presenting with cognitive impair
Still able to learn new information
Aware of their cognitive impair
More acute onset compared to progressive decline in alzheimers

Question 28

What is the sleeping pattern in delirium compared with dementia?

Answer 28

Delirium = no sleeping pattern
Dementia = inverted sleeping pattern

Question 29

Symptoms that elderly people can suffer from who take SSRIs?

Answer 29

Agitation
Confusion
Insomnia
Sedation
Serotonin syndrome
GI disturb
Hyponatraemia
Hypo/hypertension
Bleeding risk

Question 30

If an elderly person presents with late onset shizophrenis what needs to be ruled out?

Answer 30

Brain disease, history of schizophrenia, sensory deficits, exclude physical disease

Question 31

What medication can be considered for late onset schizophrenia in the non compliant?

Answer 31

Depot injections

Question 32

Elements of a MMSE?

Answer 32

Orientation - where are you, who are you, who am i, year is it, who is the president
Registration - apple, button, table and repeat
Attention/calculation - count back from 100 in 7s
Recall - those 3 words from registration
Langauge -
naming watch and pen as you point
repetition “no ifs and no buts”
comprehension “pick up paper, fold and put on floor”
read and perform this command
Close your eyes and write a sentence
Copy the diagram