OPH Flashcards
Early onset alzheimer’s disease - 5% of all AD, genes
Amyloid precursor protein, presenilin 1&2
Autosomal dominant with almost complete penetrance
Frontotemporal dementia genes
Autosomal dominant variable pentrance
40% affected 1st degree relative
Late onset alzheimers genetics
Apo E contributes vascular
Dementia lifetime risk
20% women
10% men
Clinical diagnosis of dementia
Mostly history from patient and relatives
FHx, PMH, Drug history
HPc
How did it start?
* When did it start?
* How has it progressed?
* What can they NOT do now that they could do before?
* What do they DO now that you wish they didn’t do?
* What are they still doing that you think they shouldn’t
be doing?
* Visual hallucination ,delusions, failure to recognise
family members
Dementia investigations
tests for remediable causes - FBC, Us&Es, B12, Folate, TSH, CXR
Imaging - CT, MRi - early in course of dementia often completely normal, check for alt diagnosis
Dementia risk factors
Age, FHx, HTN, Cholesterol, DM, Smoking, mid-life obesity, alcohol, head injury
Lewy body dementia characteristics
Prominent visual hallucinations, visuospatial problems, fluctuating course, 70% neuroleptic sensitivity
Frontotemporal dementia characteristics
Personality & behaviour change, language problems, younger age groups
Alzheimer’s meds
Cholinesterase inhibitors - donepezil or rivastigmine may help some people with symptoms
Dementia management
Social support, driving, EPOA
Frontotemporal dementia cell changes
Pick Bodies
Alzheimers cell changes
Tau tangle and amyloid plaques in hippocampus
Lewy body dementia
Lewy bodies in substancia nigra (basal ganglia)
Cortex, brainstem, limbic system
Parkinson’s associated
Delirium if a patient is on a benzo it is better to keep it going than to stop it
True
Delirium worse in
Evening, overnight
Common causes of delirium
Medical illnesses, drugs & their withdrawal esp benzos and alcohol, environmental changes, emotional stress, post-op
Delirium management
Prevention / treat underlying cause, patient watch, may need sedation, haloperidol
Parkinson’s disease dementia develops in
at least 30%
depression in 50%
Urinary frequency, urgency, incontinence, constipation, more delirium, swallowing issues, mobility, sleep
SMART goals in rehab
Specific
Measurable
Achievable
Relevant
Time-bound
NASC supports offered
Home help, personal care assistance, nutritional supports, care support/respite care, residential care placements
Home help eligibility
If have community service card
No if
- no community service card
- live with able bodied person
Home help includes
Vacuuming, cleaning bathroom, meal preparation
Not washing dishes, spring cleaning, dusting
Fluid cognition
Innate ability to learn new information and problem solve - reduces from 3rd decade
MCI reversible
Sometimes - if depression, meds etc
How many alzheimer’s
1/9
Don’t give donepezil or rivastimine in
Bradycardia, long QT
Vascular dementia
Post-stroke
Lewy body if need antipsychotic
Only quetiapine - try to avoid antipsychotics
Cholinesterase inhibitor, L-dopa may help
Rapid progressive dementia
Creutzfeldt jacon
4AT
Alertness. AMT4, attention (months backward), altered behaviour/cognition
Sarcopenia
Idenitfied by no.1, confirmed by no. 2, all 3 met then severe
1) low muscle strength
2) low muscle quality or quantitity
3) low physical performance
Cachexia
Metabolic syndrome secondary to underlying illness - loss of muscle +/- fat, catabolic>anabolic
Malnutrition criteria
At least 2 of
Weight loss, muscle loss, SC fat loss, insufficient energy intake, muscle strength loss, fluid acumulation
Frailty criterie (fried)
3/5
Low grip strength, unintentional weight loss, low physical activity, slow walking speed
