Care of the Elderly

Question 1

Define dementia

Answer 1

Progressive global cognitive impairment with normal consciousness

Question 2

Common types of dementia

Answer 2

Alzheimers
Lewy body 
Frontotemporal 
Vascular
Parkinsons
Normal pressure hydrocephalus
Depression
Korsakoffs

Question 3

Rare types of dementia

Answer 3

HIV
CJD
Syphilis
Space occupying lesions
Hypothyroid
B12 deficiency
Malnutrition

Question 4

What to ask about for dementia

Answer 4

Age
Onset 
Progression
Memory
Personality
Thinking
Planning
Judgement 
Language
Visuospatial skills
Concentration
Social behaviour
Confusion
Wandering
Falls
Head injury
Tremor
Mood
Sleep
Delusions
Hearing
Sight

Question 5

PMH for Dementia

Answer 5

Seizures

CVA/TIA

Question 6

DH for Dementia

Answer 6

Regular medications
Sleeping tablets
Anticholinergics

Question 7

FH for Dementia

Answer 7

Dementia

Neurological problems

Question 8

SH for Dementia

Answer 8

Effect on work, relationships and social activities
ADLs
Finances
Support at home

Question 9

What tests would you do for Dementia

Answer 9

MMSE, Abbreviated mental test score, full exam

Question 10

Investigations for Dementia

Answer 10

Full bloods
CXR, CT Brain
EEG, LP, ECG

Question 11

Initial management for Dementia

Answer 11

Refer to neuro, rule out reversible/treatable causes, ensure MDT to support patient’s needs

Question 12

Describe Alzheimers Dementia

Answer 12

Slowly progressive loss of memory, with later loss of language, executive or visuospatial functions

Question 13

Which drug may benefit moderate AD

Answer 13

Anticholinesterase inhibitors (Donepezil)

Question 14

Describe Vascular Dementia

Answer 14

Impairment of memory and at least one other cognitive domain. IN THE PRESENCE OF VASCULAR RISK FACTRS/ ISCHAEMIA ON IMAGING

Question 15

Describe Lewy Body Dementia

Answer 15

Early loss of executive function with HALLUCINATIONS and fluctuating levels of consciousness. Memory loss is a later feature.

Question 16

Describe Frontotemporal dementia

Answer 16

Prominent and early LANGUAGE LOSS and also loss of social functioning/disinhibition. May be a younger age group

Question 17

Name three reversible causes of dementia

Answer 17

Sub dural haematoma
Normal pressure hydrocephalus
Korsakoff syndrom

Question 18

What are the categories of the Mini Mental State Exam

Answer 18

Orientation
Registration
Attention and arithmetic
Recall
Language
Executive function

Question 19

Describe subdural haematoma dementia

Answer 19

Dementia and focal neurology. Elderly, atrophic brains. Trauma in history. Ix CT. Tx Evacuate

Question 20

Describe normal pressure hydrocephalus dementia

Answer 20

Dementia, gait disturbance and urinary incontinence with hydrocephalus on CT and normal CSF opening pressure

Question 21

Causes of normal pressure hydrocephalus

Answer 21

Idiopathic (50%)
Meningitis
Trauma
Subarachnoid haemorrhage

Question 22

Normal pressure hydrocephalus treatment

Answer 22

ventriculo peritoneal shunt

Question 23

Describe Korsakoffs syndrome dementia

Answer 23

Amnesia and confabulation seen in thiamine deficiency (eg alcoholism). Treatment thiamine (B1) replacement

Question 24

Define delerium

Answer 24

Acute onset of disordered cognition with attentional deficits typically involvalves changes in arousal and may be associated with hallucinations

Question 25

Clinical features of delerium

Answer 25

Globally impaired cognition, perception and consciousness Marked memory Disordered/ disorientated thinking Sleep/wake cycle reversal

Question 26

Describe hyperactive delerium

Answer 26

Restlessness Mood lability Agitation Aggression

Question 27

Describe hypoactive delerium

Answer 27

Patient becomes slow and withdrawn

Question 28

What is the third type of delerium

Answer 28

Mixed

Question 29

Risk factors for delerium

Answer 29

>65yo, dementia, hip fracture, acute illness, psychological agitation eg pain

Question 30

Causes of delerium

Answer 30

``` Sugery Systemic infection Intracranial infection or head injury Drug withdrawal Alcohol withdrawal Metabolic Hypoxia Vascular event Thiamine, B12 deficiency ```

Question 31

Which drugs' withdrawal causes delerium

Answer 31

Opiates Levodopa Sedatives Recreational

Question 32

Delerium differentials

Answer 32

Dementia Anxiety Epilepsy Primary mental illness- schizophrenia

Question 33

Delerium investigations

Answer 33

Bloods, ABG, Septic screen. ECG EEG LP CT

Question 34

Delerium treatment

Answer 34

``` Reorientate Encourage visitors Monitor fluid balance and oral intake Sleep hygeine Avoid catheters Watch out for discomfort Review medications ```

Question 35

Dementia vs delerium

Answer 35

Delerium is more inattention, distractability and disogranised thinking. Key thing is if there has been an acute decline from baseline

Question 36

Define depression

Answer 36

Low mood that is not usual and persists for over 2 weeks

Question 37

Symptoms of depression

Answer 37

``` Low mood Low energy Feeling worthless or guilty Poor concentration Recurrent thoughts of suicide or death Low self esteem Tearfulness Loss of interests Anhedonia ```

Question 38

Somatic symptoms of depression

Answer 38

``` Weight/ appetite loss Sleep problems (early morning waking, insomnia or over sleeping) Loss of libido Psychomotor agitation or retardation Change in mood with time of day ```

Question 39

Pyschotic symptoms of depression

Answer 39

Delusions | Hallucinations

Question 40

Signs of depression

Answer 40

Neglect, agitation, slowed speech or movement, poor eye contact

Question 41

Bereavement and depression

Answer 41

Dont diagnose depression within 2 months of bereavement. Be aware of cultural variations of grief. Depression likely if prolonged, sever functional impairment or psychomotor retardation

Question 42

Treatment options for Depression

Answer 42

Psychotherapy- CBT Antidepressants Electroconvulsive therapy

Question 43

When would you give electroconvulsive therapy

Answer 43

High risk (not eating or drinking) and or has failed to respond to medications

Question 44

First line antidepressants

Answer 44

SSRIs citalopram or fluoxetine

Question 45

Second line antidepressants

Answer 45

Venlafaxine

Question 46

Complications of depression

Answer 46

``` Deliberate self harm Unemployment Relationship break down Recurrence Suicide ```

Question 47

Antidepressant advice

Answer 47

2-3wks to start. up to 6 wks Suicide risk may increase in first few weeks Treatment should continue for 6 months after symptoms have stopped. Should be weaned not stopped suddenly

Question 48

Name 4 types of incontinence

Answer 48

Stress Urge Overflow Functional

Question 49

Define stress incontinence

Answer 49

Leakage on exercise/ coughing/ laughing

Question 50

Define urge incontinence

Answer 50

Severe and sudden urgency (often due to detrusor instability)

Question 51

Define overflow incontinence

Answer 51

Urine volume exceeds bladder capacity (e.g. in chronic retention)

Question 52

Define functional incontinence

Answer 52

Restricted mobility so unable to get to the toilet in time

Question 53

Causes of urinary incontinence

Answer 53

UTI, detrusor instability, MS, DM, diuretics + reduced mobility F- uterine prolapse, weak pelvic muscles, pelvic mass M- post prostate surgery

Question 54

Investigations for incontinence

Answer 54

MSU, BM, Urinary diary, PSA

Question 55

Treatment for general incontinence

Answer 55

Weight loss Less caffeine Stop smoking Treat prolapse

Question 56

Treatment for stress incontinence

Answer 56

Fluid restriction, pelvic floor exercises, transvaginal tape

Question 57

Treatment for detrusor instablity

Answer 57

Bladder drill, tolterodine

Question 58

Treatment for functional incontinence

Answer 58

Aid mobility

Question 59

Treatment for overflow incontinence (chronic urinary retention)

Answer 59

TURP, Finasteride (5-alpha reductase inhibitor), Tamsulosin (alpha blocker)

Question 60

Treatment for glaucoma

Answer 60

Prostaglandin eye drops