Week 8- Ageing, Dementia and Sleep

Question 1

Score cut-offs for MMSE

Answer 1

Severe <10

Moderate 10-18

Mild 19-24

>27 normal

Question 2

For sleep apnea…what does snoring tell you?

Answer 2

That there is ventilatory effort happening

Question 3

Timing of withdrawal, seizures and delirium tremens in alcohol withdrawal

Answer 3

12-24h withdrawal symptoms, 24-48 hours for seizures, 72-96 hours for delirium tremens

DT: hyperactive, hand tremor, N/V, hallucinations, illusions, seizures

Question 4

What changes occur with sleep and ageing?

Answer 4

decreased number of eye movements in REM

Question 5

DDx for delirium

Answer 5

DIMS-R

Drugs (especially anticholinergics , NSAIDs, dimenhydrinate and dopamine agonist

Infection/Iatrogenic

Metabolic

Structual

Retention

Or STAT VITALS SIGNS

Stroke

Toxic/Metabolic Encephlaopathy

Autoimmune

Thyroid

Vitamin def

Infxn

Trauma

Alzheimers

Liver/Kidney/heart

Surgery

Iatrogenic

Geriatic risk factors

Neoplasia Seizures

Question 6

What disorders would you see decreased episodic memory? Non-declarative memory? Working memory?

Answer 6

Episodic: alzheimers

Procedural: Parkinson’s, Huntington’s, NOT alzheimers

Working: all of the above

Question 7

What are the two types of delirium?

Answer 7

Hyperactive (e.g. delirium tremens) and hypoactive

Question 8

How many hours does it take to diagnose delirium

Answer 8

24

Question 9

Parkinson’s patients more likely to get delirium when ill. They also have 33% chance of having REM sleep behaviour disorder

Hearing and vision are risk factors

Question 10

Screening tools for delirium?

Answer 10

CAM (confusion assessment method)

acute onset + fluctuation

+

inattention

+

disorganized thinking OR altered LOC

Question 11

What is a Lilliputian hallucination?

Answer 11

Seeing brightly colored little people

Question 12

What is the population risk and the recurrence risk familial of AD?

Answer 12

population: 6-8%

recurrence 15-30%

Question 13

What proportion of AD is sporadic and what proportion is familial?

Answer 13

75-85% is sporadic

5-25% is genetic

Question 14

What parts of the brain is involved in:

Attn

Memory

Executive function

Language

Visuospatial fxn

Social cognition

Answer 14

Attn: diffuse, involves cholinergic neurons

Memory: medial temporal lobes, hippocampus

Executive function: dorsolateral PFC, posterior parietal

Language: primary auditory cortex

Visuospatial fxn: parietal lobe (R>L)

Social cognition: orbitofrontal cotex (response inhibition), insular cortex (emotion, language), anterior cingulate (drive, motivated)

Question 15

Normal events of sleep

Answer 15

brief awakenings

5-14 hrs

Latency is <30

Absence of daytime sleepiness

Question 16

What are the stages of sleep?

Answer 16

I: light sleep

II: 52% of total sleep

III: deep and restorative (decreased by benzos, increased by Z drugs)

REM: atonic, eye movements

Question 17

What is the primary/secondary classification for sleep disorders?

Answer 17

Primary: due to an intrinsic abnormality in sleep/wake cycling

• dyssomnias (e.g insomnia, hypersomnia, narcolepsy, breathing related, circadian related)
• parasomnias (REM and Non-REM (e.g. sleep walking, night terrors)

Secondary:insomnia/hypersomnia/parasomnia due to something else (GMC/psych conditon/SUD)

Question 19

paired helical filaments are associated with what protein and what disease?

Answer 19

So many diseases….associated with hyperphosphorylated tau. Tau is also found in senile plaques

Question 20

early onset AD is associated with which genes?

Answer 20

APP and presenilin

Question 21

Would dementia be more likely to result from multiple small infarcts in the frontal lobe or throughout the brain?

Answer 21

throughout the brain

Question 22

normal pressure hydrocephalus features

Answer 22

triad of dementia, urinary incontinence, gait disturbance

pathologically enlarged ventricles….