Older Persons Medicine

Question 1

What is Dementia?

Answer 1

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

Question 2

What does dementia lead to?

Answer 2

Impairment of Memory
Disorientation
Learning Capacity and Judgement affected

Question 3

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

Answer 3

Behavioural
Psychotic
Sleep
Depression + Anxiety

Question 4

What are some behavioural symptoms dementia can present with?

Answer 4

Agitation
Aggression
Wandering
Sexual Inhibition

Question 5

What are some psychotic symptoms dementia can present with?

Answer 5

Visual/Auditory hallucinations

Persecutory dellusions

Question 6

What are some sleep symptoms dementia can present with?

Answer 6

Insomnia

Daytime drowsiness

Question 7

What other conditions can lead to dementia-like symptoms?

Answer 7

Hypothyroidism
Hypercalcaemia
Vitamin B12 Deficiency
Normal Pressure Hydrocephalus

Question 8

What symptoms are common with normal pressure hydrocephalus?

Answer 8

Abnormal gait
Incontinence
Reduced cognition

Question 9

How does the brain change in Alzheimers?

Answer 9

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

Question 10

What happens pathologically in Alzheimers?

Answer 10

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

Question 11

What is vascular dementia?

Answer 11

Cognitive impairment caused by ischaemia/haemorrhage secondary to CV disease

Question 12

How does vascular dementia present?

Answer 12

Stepped decline

Question 13

What happens pathologically in dementia with Lewy bodies?

Answer 13

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

Question 14

How does dementia with Lewy Bodies present?

Answer 14

Fluctuating cognition and alertness
Vivid visual hallucinations
Spontaneous Parkinsonism
Repeated falls

Question 15

What are the generalised management options for dementia?

Answer 15

Acetylcholinesterase inhibitors

NDMA Antagonists

Question 16

What occurs in Frontotemporal Dementia?

Answer 16

Atrophy of the Frontal and Temporal lobes

Question 17

What are some common symptoms of Frontotemporal dementia?

Answer 17

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

Question 18

What are some common clinical features of dementia?

Answer 18

Incontinence
Cognitive impairment
Psychomotor retardation
Tremor 
Ataxia
Dysarthria

Question 19

What is Delirium?

Answer 19

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

Question 20

How long does it take for Delirium to develop?

Answer 20

1-2 days

Question 21

How can patients that are delirious present?

Answer 21

Hypoactive
Hyperactive
A mixed picure of both

Question 22

How may a patient with delirium present if hypoactive?

Answer 22

Withdrawn
Quiet
Sleepy

Question 23

How may a patient with delirium present if hyperactive?

Answer 23

Heightened arousal
Restless
Agitated
Aggressive

Question 24

What are some risk factors for delirium?

Answer 24

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

Question 25

What is the best indicator of delirium?

Answer 25

Reports of confusion from relatives/carers

Question 26

What behavioural changes can be present in delirium?

Answer 26

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

Question 27

Which tool can be used to screen for delirium?

Answer 27

Short Confusion Assessment Method (CAM) score

Question 28

How can delirium be treated?

Answer 28

Through identification and managent of the cause

Question 29

How can falls be classified?

Answer 29

Syncopal | Non-Syncopal

Question 30

What does Syncope mean?

Answer 30

Loss of consciousness

Question 31

What are some risk factors for falls?

Answer 31

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

Question 32

What are some causes of postural hypotension?

Answer 32

``` Drugs Dehydration Anaemia Sepsis Alcohol Prolonged bed rest Carotid sinus disease Autonomic failure Adrenal insufficiency ```

Question 33

Which drugs can cause postural hypotension?

Answer 33

``` Nitrates ACEi Diuretics Anticholinergics L-DOPA Antiplatelets SSRIs ```

Question 34

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

Answer 34

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

Question 35

Which examinations are appropriate for a patient presenting with falls?

Answer 35

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

Question 36

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

Answer 36

Osteoporosis risk