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Year 3 Medicine > Older Persons Medicine > Flashcards

Older Persons Medicine Flashcards

1
Q

What is Dementia?

A

An umbrella term for syndromes with cognitive and behavioural symptoms with an insidious onset

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2
Q

What does dementia lead to?

A

Impairment of Memory
Disorientation
Learning Capacity and Judgement affected

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3
Q

What are some broad non-cognitive symptoms dementia can present with?

A

Behavioural
Psychotic
Sleep
Depression + Anxiety

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4
Q

What are some behavioural symptoms dementia can present with?

A

Agitation
Aggression
Wandering
Sexual Inhibition

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5
Q

What are some psychotic symptoms dementia can present with?

A

Visual/Auditory hallucinations

Persecutory dellusions

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6
Q

What are some sleep symptoms dementia can present with?

A

Insomnia

Daytime drowsiness

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7
Q

What other conditions can lead to dementia-like symptoms?

A

Hypothyroidism
Hypercalcaemia
Vitamin B12 Deficiency
Normal Pressure Hydrocephalus

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8
Q

What symptoms are common with normal pressure hydrocephalus?

A

Abnormal gait
Incontinence
Reduced cognition

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9
Q

How does the brain change in Alzheimers?

A

Global Atrophy
Sulcal widening
Enlargement of 3rd and 4th ventricles

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10
Q

What happens pathologically in Alzheimers?

A

Formation of senile plaque and neurofibrillary tangles leads to neuronal death, giving reduced ACh, noradrenaline, serotonin and somatostatin

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11
Q

What is vascular dementia?

A

Cognitive impairment caused by ischaemia/haemorrhage secondary to CV disease

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12
Q

How does vascular dementia present?

A

Stepped decline

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13
Q

What happens pathologically in dementia with Lewy bodies?

A

Spherical Lewy Bodies are depositied in the Substantia Nigra, Temporal and Frontal lobes, and Cingulate gyrus

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14
Q

How does dementia with Lewy Bodies present?

A

Fluctuating cognition and alertness
Vivid visual hallucinations
Spontaneous Parkinsonism
Repeated falls

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15
Q

What are the generalised management options for dementia?

A

Acetylcholinesterase inhibitors

NDMA Antagonists

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16
Q

What occurs in Frontotemporal Dementia?

A

Atrophy of the Frontal and Temporal lobes

17
Q

What are some common symptoms of Frontotemporal dementia?

A 
Loss of inhibition
Inappropriate sexual behaviour
Loss of motivation
Repetitive behaviours
Non-fluent aphasia
18
Q

What are some common clinical features of dementia?

A 
Incontinence
Cognitive impairment
Psychomotor retardation
Tremor 
Ataxia
Dysarthria
19
Q

What is Delirium?

A

A clinical syndrome characterised by disturbed consciousness, cognitive function or perception which has an acute onset and a fluctuating course

20
Q

How long does it take for Delirium to develop?

A

1-2 days

21
Q

How can patients that are delirious present?

A

Hypoactive
Hyperactive
A mixed picure of both

22
Q

How may a patient with delirium present if hypoactive?

A

Withdrawn
Quiet
Sleepy

23
Q

How may a patient with delirium present if hyperactive?

A

Heightened arousal
Restless
Agitated
Aggressive

24
Q

What are some risk factors for delirium?

A

Age >65
Prev Cognitive Impairment +/- Dementia
Current Hip fracture
Severe illness

25
Q

What is the best indicator of delirium?

A

Reports of confusion from relatives/carers

26
Q

What behavioural changes can be present in delirium?

A

Cognitive function - Confusion
Perception - Hallucinations
Physical function - Reduced mobility, restlessness
Social - Behavioural withdrawal

27
Q

Which tool can be used to screen for delirium?

A

Short Confusion Assessment Method (CAM) score

28
Q

How can delirium be treated?

A

Through identification and managent of the cause

29
Q

How can falls be classified?

A

Syncopal

Non-Syncopal

30
Q

What does Syncope mean?

A

Loss of consciousness

31
Q

What are some risk factors for falls?

A 
Age >65
Lower limb weakness
Hx of falls
Gait/Balance problems
Visual impairment
Lower limb arthritis
Postural hypotension
Polypharmacy
Cognitive impairment
32
Q

What are some causes of postural hypotension?

A 
Drugs
Dehydration
Anaemia
Sepsis
Alcohol
Prolonged bed rest
Carotid sinus disease
Autonomic failure
Adrenal insufficiency
33
Q

Which drugs can cause postural hypotension?

A 
Nitrates
ACEi
Diuretics
Anticholinergics
L-DOPA
Antiplatelets
SSRIs
34
Q

What are some key questions to ask in a falls hisory?

A 
What were they doing, and how did they fall?
Any dizziness/vertigo?
Did they lose consciousness?
PMHx
Drug Hx - ?Polypharmacy
35
Q

Which examinations are appropriate for a patient presenting with falls?

A

Functional assessment of mobility and gait
CV Exam - ECG, Lying and Standing BP
Full neuro exam
MSK Exam - ?Arthritis

36
Q

If a patient is identified as being at high risk of falls, what should also be assessed?

A

Osteoporosis risk

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