Old age Flashcards
6 things that are examined in a cognitive exam?
Attention Orientation Memory Language Visuospatial Executive functioning
2 types of episodic memory?
Anterograde and retrograde
What is semantic memory and how do you test for it?
General knowledge and vocabulary
Test with category fluency and famous people
How do you test for working memory?
3 item recall
How do you examine orientation, attention and langugae?
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
How long does dementia need to be present in order to be diagnosed?
6 months
2 most common types of dementias?
Alzheimers 50%
Vascular 20%
3 early onset genes relating to Alzheimers?
Presenilin 1 gene, chromosome 14
Presenilin 2 gene, chromosome 1
Amyloid precursor protein, chromosome 21 (down syndrome predisposed)
1 late onset gene relating to Alzheimers?
Apolipoprotein e4, chromosome 19
2 main pathologies occuring in Alzheimers disease?
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
How does the brain substance change in Alzheimers?
Reduced cortex and subcortical white matter
Enlarged lateral ventricles
Hippocampus and temporoparietal areas effected first
What reductions in neurochemistry does the brain see in Alzheimers?
Decreased choline acetyltransferase (chAT) Decreased GABA Loss of serotonin receptors Reduced noradrenaline Decreased somatostatin
Symptoms seen in the late stages of Alzheimers?
Immobile, incoherent Incontinent Increased muscle tone Weight loss
What is performed in a dementia screen?
FBC, CRP, LFT, U&E, Glucose, Calcium, Folate, B12, TFT, VDRL/TPHA
CT/MRI/PET
ECG
Acetylcholinesterase inhibitor used to treat Alzheimers? Contraindications? SE?
Donepezil
Cardiac conduction defects, peptic ulcer, severe COPD
SE - GI disturb, dizzy, cardiac conduction defects
What drug is used in moderate to severe alzheimers? Mode of action?
Memantine
non-competitive NMDA receptor antagonist
What causes vascular dementia?
Multiple small infarcts or one large one
What will CT scan show in vascular dementia?
Areas of infarction
What medication will work for Alzheimers but not vascular dementia?
Acetylcholinesterase inhibitors like Donepezil
How does Lewy body present in symptoms and signs?
Fluctuating cognition and mental state with visual hallucinations, recurrent falls and LOC, prominent memory impairment as it progresses
Where are Lewy bodies found?
Substantia nigra and cortex
Specific scan can be done for Lewy body dementia?
DaT scan
What medication should be avoided in Lewy body dementia and what should be given?
Avoid antipsychotics
Give acetylcholinesterase inhibitors
How does frontotemporal dementia present?
Asymmetrical atrophy of frontal and temporal lobes
Changes to character and behaviour
Memory deteriorates
What disease can be seen as bodies inclusions in the frontal and temporal lobes?
Pick’s disease with picks bodies
Can acetylcholinesterase inhibitors be used in fronto-temporal dementia?
Limited benefit
What is pseudodementia and how do you distinguish it from normal dementia?
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
What is the sleeping pattern in delirium compared with dementia?
Delirium = no sleeping pattern Dementia = inverted sleeping pattern
Symptoms that elderly people can suffer from who take SSRIs?
Agitation Confusion Insomnia Sedation Serotonin syndrome GI disturb Hyponatraemia Hypo/hypertension Bleeding risk
If an elderly person presents with late onset shizophrenis what needs to be ruled out?
Brain disease, history of schizophrenia, sensory deficits, exclude physical disease
What medication can be considered for late onset schizophrenia in the non compliant?
Depot injections
Elements of a MMSE?
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
