OPH

Question 1

Early onset alzheimer’s disease - 5% of all AD, genes

Answer 1

Amyloid precursor protein, presenilin 1&2

Autosomal dominant with almost complete penetrance

Question 2

Frontotemporal dementia genes

Answer 2

Autosomal dominant variable pentrance
40% affected 1st degree relative

Question 3

Late onset alzheimers genetics

Answer 3

Apo E contributes vascular

Question 4

Dementia lifetime risk

Answer 4

20% women
10% men

Question 5

Clinical diagnosis of dementia

Answer 5

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

Question 6

Dementia investigations

Answer 6

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

Question 7

Dementia risk factors

Answer 7

Age, FHx, HTN, Cholesterol, DM, Smoking, mid-life obesity, alcohol, head injury

Question 8

Lewy body dementia characteristics

Answer 8

Prominent visual hallucinations, visuospatial problems, fluctuating course, 70% neuroleptic sensitivity

Question 9

Frontotemporal dementia characteristics

Answer 9

Personality & behaviour change, language problems, younger age groups

Question 10

Alzheimer’s meds

Answer 10

Cholinesterase inhibitors - donepezil or rivastigmine may help some people with symptoms

Question 11

Dementia management

Answer 11

Social support, driving, EPOA

Question 12

Frontotemporal dementia cell changes

Answer 12

Pick Bodies

Question 13

Alzheimers cell changes

Answer 13

Tau tangle and amyloid plaques in hippocampus

Question 14

Lewy body dementia

Answer 14

Lewy bodies in substancia nigra (basal ganglia)

Cortex, brainstem, limbic system

Parkinson’s associated

Question 15

Delirium if a patient is on a benzo it is better to keep it going than to stop it

Answer 15

True

Question 16

Delirium worse in

Answer 16

Evening, overnight

Question 17

Common causes of delirium

Answer 17

Medical illnesses, drugs & their withdrawal esp benzos and alcohol, environmental changes, emotional stress, post-op

Question 18

Delirium management

Answer 18

Prevention / treat underlying cause, patient watch, may need sedation, haloperidol

Question 19

Parkinson’s disease dementia develops in

Answer 19

at least 30%

depression in 50%

Urinary frequency, urgency, incontinence, constipation, more delirium, swallowing issues, mobility, sleep

Question 20

SMART goals in rehab

Answer 20

Specific
Measurable
Achievable
Relevant
Time-bound

Question 21

NASC supports offered

Answer 21

Home help, personal care assistance, nutritional supports, care support/respite care, residential care placements

Question 22

Home help eligibility

Answer 22

If have community service card

No if
- no community service card
- live with able bodied person

Question 23

Home help includes

Answer 23

Vacuuming, cleaning bathroom, meal preparation

Not washing dishes, spring cleaning, dusting

Question 24

Fluid cognition

Answer 24

Innate ability to learn new information and problem solve - reduces from 3rd decade

Question 25

MCI reversible

Answer 25

Sometimes - if depression, meds etc

Question 26

How many alzheimer’s

Answer 26

1/9

Question 27

Don’t give donepezil or rivastimine in

Answer 27

Bradycardia, long QT

Question 28

Vascular dementia

Answer 28

Post-stroke

Question 29

Lewy body if need antipsychotic

Answer 29

Only quetiapine - try to avoid antipsychotics
Cholinesterase inhibitor, L-dopa may help

Question 30

Rapid progressive dementia

Answer 30

Creutzfeldt jacon

Question 31

4AT

Answer 31

Alertness. AMT4, attention (months backward), altered behaviour/cognition

Question 32

Sarcopenia

Answer 32

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

Question 33

Cachexia

Answer 33

Metabolic syndrome secondary to underlying illness - loss of muscle +/- fat, catabolic>anabolic

Question 34

Malnutrition criteria

Answer 34

At least 2 of
Weight loss, muscle loss, SC fat loss, insufficient energy intake, muscle strength loss, fluid acumulation

Question 35

Frailty criterie (fried)

Answer 35

3/5

Low grip strength, unintentional weight loss, low physical activity, slow walking speed