Week 1 - Geriatrics DDD

Question 1

T/F: a neurocognitive disorder is a general term that describes decreased mental function due to any medical condition including psychiatric illness

Answer 1

FALSE

Question 2

what is aphasia, apraxia, and agnosia

Answer 2

aphasia: language expression/comprehension

apraxia: coordinated movement

agnosia: ID familiar objects/people

Question 3

what is the most common type of dementia

Answer 3

Alzheimer’s disease

Question 4

what are the 3 stages of Alzheimers disease?

Answer 4

preclinical/pre-symptomatic

mild cognitive impairment (MCI)

dementia

Question 5

what are the 4 stages of dementia

Answer 5

mild - BADL intact, minor impairment to IADL

moderate - impaired BADL requiring prompting

severe - BADLs cannot be performed even with prompting

terminal - total care, nonverbal

Question 6

what distinguishes dementia from MCI?

Answer 6

MCI does NOT interfere with everyday activities - dementia affects memory + one other cognitive ability that interferes with everyday functioning

Question 7

what are some causes of reversible cognitive impairment

Answer 7

1. anemia
2. B12 deficiency
3. hypothyroidism
4. anticholinergic use
5. acute delirium
6. cerebral hypoperfusion

Question 8

what is the cutoff for MOCA to diagnose dementia

Answer 8

18

Question 9

in AD, what is the most common first clinical presentation?

Answer 9

selective memory impairment of RECENT events –> progresses over time to more distant events

Question 10

T/F: AD has a gradual onset

Answer 10

True

Question 11

what gene predisposes one to AD?

Answer 11

human apolipoprotein E (APOE) - allele e4

it increases risk by impairing amyloid beta clearance from cerebrum

Question 12

what are the 2 underlying mechanisms of AD

Answer 12

amyloid beta peptide (form plaques between neuron and disrupts cell function)

Tau protein aggregation that contribute to formation of neurofibrillary tangles in teh neuronal cytoplasm

Question 13

what causes & risk factors vascular dementia

Answer 13

cerebrovascular or CV illness - 10% of cases are linked to strokes or other issue with blood flow to the brain

risk factors include diabetes, hypertension, high cholesterol, metabolic syndrom, afib, obesity, tobacco smoking, >65yo

Question 14

what are symptoms of vascular dementia

Answer 14

varies depending on area of brain affected but can include:

deficits in attention
difficulty processing info
decline in executive functioning (flexible thinking, self-control, emotional control)

Question 15

what causes lewy body dementia?

Answer 15

deposits of alpha-synuclein (Lewy bodies) in the brain

Question 16

what is the unique characteristic of lewy body dementia

Answer 16

visual hallucinations

Question 17

LBD is an unbrella term inclusive of what two conditions?

Answer 17

Parkinson’s disease with dementia (PDD) & Dementia with Lewy Body (DLB)

PDD - parkinon’s disease established for at least one year prior to onset of symptoms

DLB - earlier cognitive impairment relative to parkinsonism

Question 18

What causes fronto-temporal dementia

Answer 18

damage to neurons in the frontal and temporal lobes of the brain

often abnormal amoutns of tau and TDP-43 proteins inside nerve cells

Question 19

what is common clinical presentation of fronto-temporal dementia

Answer 19

change in personality and behaviour - may embarrass themselves in public

Question 20

what are causes of delirium? (Iwatchdeath)

Answer 20

I - infection
W - withdrawal
A - acute metabolic disorder
T - trauma
C - cns pathology
H - hypoxia
D - deficiences in vitamins
E - endocinopathies
A - acute vascular insults
T - toxins
H - heavy metals

Question 21

what are the three types of delirium?

Answer 21

hyperactive, hypoactive, mixed

Question 22

what test is for delirium?

Answer 22

CAM

must have acute onset or fluctuation course

AND

inattention

AND

disorganised thinking or altered level of consciousness

Question 23

what are the two large classes of medications for treatment of dementia?

Answer 23

Cholinesterase inhibitors and NMDA Receptor Antagonists

Question 24

what indications are CIs NOT indicated for?

Answer 24

MCI and FTD

Question 25

what conditions CI Cholinesterase Inhibitors

Answer 25

ongoing unexpained dizziness, symptomatic bradycardia, prolonged QT (get baseline ECG), recent seizure, unstable COPD, active GI issues (IBS/IBD)

Question 26

what are the three main CIs?

Answer 26

Donepezil (for all severities)
Rivastigmine
Galantamine

Question 27

what medication is an NMDA receptor antagonist

Answer 27

Memantine

can be used in addition to CIs

for mod to severe stages of dementia

Question 28

what are treatment options for depression in the geriatric population (5 classes + examples)

Answer 28

SSRI (sertraline, citalopram, escitalopram)
SNRI (venlafaxine, duloxetine)
NDRIs (buproprion)
Alpha 2 antagonists (mirtazapine)
TCA (avoid if possible)

Question 29

what is pham treatment for delirium (2)

Answer 29

thiamine (vit B1)
haloperidol (avoid if possible)