Geri Flashcards
Which tasks/memory decline with age?
– Performance speed
– Short term memory (e.g. recalling a list)
– Episodic memory (e.g. details about a previous event)
– Divided attention/Task switching
– Abstract reasoning
– “Tip of the tongue” phenomenon
Which tasks/memory are preserved with age?
– Semantic memory (e.g. what is the capital of Turkey?)
– Cued recall
– Sustained attention
– Vocabulary, syntax, grammar
What does MMSE not test that MOCA does?
Executive functioning with clock draw, trails, abstraction, letter flucency
For what education level is MMSE superior to MOCA?
Limited education= MMSE
Highly educated-=MOCA
Non-Western upbringing= RUDAS
Define Vascular dementia. What are the 2 syndromes? How do they differ?
– Cognitive impairment (any domain, but often frontal) AND Imaging evidence of cerebrovascular disease
- Post-stroke vascular dementia – “step-wise decline”
- Subcortical ischemic syndrome – more common, insidious onset
• Imaging: periventricular white matter changes, lacunar infarcts
Diagnostic criteria for Lewy Body Dementia consists of: Dementia + 2 of the following:
- REM sleep disturbance
- Visual hallucinations
- Parkinsonism
- Fluctuating cognition
If dementia precedes or begins within 1 year of onset of parkinsonism, then DLB
Diagnostic criteria for Fronto-temporal dementia consists of: Dementia + 3 of the following:
– Dementia and 3 of • Disinhibition • Apathy • Loss of empathy • Perseveration • Hyperorality • Executive dysfunction
Benefits of exercise?
Improves:
- Muscle mass and strength
- Balance
- Functional ability
- Gait speed
- Falls
- Cognition in MCI NOT in dementia
Name 3 CHEi for tX for Alzheimers dementia and side effects.
ChEIs (Donepezil, Galantamine, Rivastigmine)
Side Effects: GI intolerance, urinary incontinence, wild or vivid dreams, bradycardia
Compare and contrast LBD and FTD treatments
LBD- CHEis
FTD- CHEis not effective!
Can use Androgen deprivation therapy for sexual side effects and cautious SSRI or Trazadone for other behaviours
What are the black box warning for Risperidone? If planning to Use, 3 conditions must be met. What are they?
Risperidone black box warnings = increased risk of death and stroke (1.6x, 2x)
Can only use if:
- Pure AD
- Not responding to non-pharm
- Harm to self/others
PHQ2 for depression asks which 2 questions:
Patient Health Questionnaire 2 (PHQ-2)
1. During the past two weeks, have you often been bothered by feeling down, depressed or hopeless?
- During the past two weeks, have you often been bothered by little interest or pleasure in doing things?
– Sensitivity 100%, specificity 77% in older adults!
What are some of the favourable side effects of SSRi to be capitalized on in the Geri population?
Avoid Paroxetine - ++ anticholinergic
mirtazapine (sleep, appetite)
duloxetine (pain)
bupropion (activating)
> 75yr population that you should consider treating aggressively for HTN with SBP target <120 (start treatment with SBP >130)
Consider SBP <120 in:
• Age ≥ 75y
• Clinical or subclinical cardiovascular disease
• CKD (GFR 20-59, protein <1g/d, non-diabetic nephropathy)
• 10 year global CV risk ≥ 15%
– Cautions: institutionalized, HFrEF or MI within 3mo, T2DM, previous stroke, GFR <20, indication for β-blocker but not taking
– CI: pt unwilling to adhere, standing SBP < 110 mmHg, inaccurate measurement, 2ndary cause of HTN
Hemoglobin A1c targets in the elderly
- 1-8.0%- Dependent older adult
7. 1-8.5%- Frail, dementia, limited life expectancy, history of recurrent severe hypoglycemia or hypoglycemia awareness.
