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SBM psychiatry > older adults, dementia, delirium > Flashcards

older adults, dementia, delirium Flashcards

1
Q

3 aspects of successful aging

A
  • absence of disease
  • engagement with life
  • preserved cognitive and physical function
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2
Q

genetics accounts for how much of physical and mental aging?

A

30% of physical and 50% of mental

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3
Q

what is the largest factor affecting premature death? what is the second?

A

1) behavior

2) genetics

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4
Q

what are the three psychological processes of successful aging?

A

selection - fewer life domains
optimization - augmentation of reserves, maximize functioning
compensation - use psychological and technological aids

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5
Q

dementia is now called……under DSM-V

A

major neurocognitive disorder

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6
Q

diagnosis of major neurocognitive disorder

A
  • 1 or more significant cognitive impairments
  • interfering with daily function
  • NOT IN CONTEXT OF DELIRIUM
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7
Q

diagnosis of minor neurocognitive disorder

A
  • 1 or more modest cognitive impairments
  • does not interfere with daily function
  • NOT IN CONTEXT OF DELIRIUM
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8
Q

5 types of major neurocognitive disorder

A

1) alzheimers
2) vascular disease
3) frontotemporal lobar degeneration
4) lewy body disease
5) parkinsons

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9
Q

what are the 6 cognitive domains?

A
  • memory
  • language
  • social cognition
  • attention
  • executive function
  • perceptual motor ability
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10
Q

progression of alzheimers

A
  • short term memory loss
  • progresses to brain functions involving self care
  • depression, anxiety, and psychosis are common comorbidities
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11
Q

alheimers risk factors

A
  • age
  • head trauma
  • low education
  • female gender
  • cardiovascular risks, including obesity
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12
Q

genetics affecting early onset alzheimers

A

Presenelin-1 on chromosome 14

Presenelin-2 on chromosome 1

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13
Q

genetics affecting late onset alzheimers

A

APOE genotyping E4 on chromosome 19

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14
Q

amyloid precursor protein found where?

A

chromosome 21

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15
Q

accumulation of ……. is important in development of alzheimers

A

amyloid beta protein

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16
Q

explain role of presenelin in formation of

A
  • presenelin is a subcomponent of gamma secretase

- gamma secretes along with beta secretase cleaves amyloid precursor protein to amyloid beta protein

17
Q

contrast vascular disease with alzheimers in terms of deficit

A
  • executive and attention affected earlier

- less memory loss

18
Q

unique symptoms/deficits in frontotemporal lobar NCD

A

behavior/personality

  • hyperorality
  • disinhibition
  • socially inappropriate

speech/language
executive function

19
Q

lewy body disease symptoms

A

COGNITIVE IMPAIRMENT +
fluctuation in alertness
hallucinations
parkinsonism

20
Q

alzheimers meds

A 
MEMORY MEDICATIONS - only slow down the disease
choline esterase inhibitors
- donepezil
- rivastigmine
- galantamine
NMDA receptor antagonist
- memantine
21
Q

delirium is a disturbance in ……

A

attention and awareness
or an additional disturbance in cognition
acute change in baseline
usually direct physiological consequence of another disease process or toxicity

22
Q

cardinal symptom of delirium is ……..

A

new onset of fluctuation in mental status

23
Q

does a negative medical workup rule out delirium?

A

no

24
Q

neurotransmitters thought to be involved in delirium

A

DA up and ACh down

25
Q

what does EEG show in delirium?

A

diffuse slowing

26
Q

what is I WATCH DEATH?

A 
causes of delirium
Infections
Withdrawal
Acute metabolic
Trauma
CNS
Hypoxia
Deficiencies
Endocrinopathies
Acute vascular
Toxins
Heavy metals
27
Q

four drug categories commonly associated with delirium

A

opiates
anticholinergics
corticosteroids
benzodiazepines

28
Q

differential diagnosis for delirium

A

mania
schizophrenia
depression
dementia

29
Q

what is the best screening method for delirium?

A

confusion assessment method (CAM)

30
Q

what is the confusion assessment method?

A

algorithm

1) acute onset and fluctuating course
2) inattention
3) disorganized thinking
4) altered consciousness (sensorium)

diagnosis requires 1 and 2 plus 3 or 4

31
Q

treatment of delirium

A

typical antipsychotics - haloperidol

atypical antipsychotics - olanzapine, risperidone, quetiapine, ziprasidone

non-benzo anxiolytics - trazadone, gabapentin

SBM psychiatry (20 decks)

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