Elderly

Question 1

Antipsychotics for behavioural disturbance in dementia associated with what?

Answer 1

Death

Question 2

Sleep changes in the elderly

Answer 2

Decreased total sleep time
Increased sleep latency
Increased nocturnal wakenings
Decreased REM
Decreased amplitudes in the sleep-wake cycle
Decreased slow wave sleep

Question 3

Best antipsychotic for delirium in elderly people when pharmacotherapy is indicated

Answer 3

Haloperidol has the best evidence

Question 4

DSM-V criteria for frontotemporal dementia

Answer 4

A. Criteria for a NCD met
B. Insidious onset and gradual progression
C. 1 of the following

a. Behavioral Variant
i. Prominent decline in social cognition and/or executive abilities and 3+ of the following:
ii. Behavioral disinhibition
iii. Apathy or inertia
iv. Loss of sympathy or empathy
v. Perseverative, stereotyped, or compulsive/ritualistic behavior
vi. Hyperorality and dietary changes

b. Language variant
i. Prominent decline in language ability in form of speech production, word-finding, objectnaming, grammar, or word comprehension
ii. Relative sparing or learning, memory, and perceptual-motor function

D. Probable frontotemporal NCD if 1 of the following is present, otherwise it should be possible

a. Evidence of causative gene from family history or genetic testing
b. Evidence of disproportionate frontal/temporal involvement from neuroimaging

Question 5

Old age insomnia - Sedative hypnotics in older adults?

Answer 5

Not first line, risk of accidents, hip fractures. CBT and brief behavioural interventions are first line

Question 6

Genetic marker associated with late onset AD

Answer 6

APOE4

Question 7

What happens to the seizure threshold with advancing age?

Answer 7

It gets higher

Question 8

Investigation for an elderly person on high dose citalopram

Answer 8

ECG

Question 9

What’s the cutoff on the GDRS?

Answer 9

6

Question 10

Which is more sensitive, the MOCA or the MMSE?

Answer 10

MOCA

Question 11

Best scale for depression in dementia

Answer 11

Cornell Scale for Depression in Dementia

Question 12

Tool to assess pattern of agitation in dementia

Answer 12

Dementia observation scale DOS

Question 13

Minor delay in word finding is normal with age T/F

Answer 13

T

Question 14

Rate of conversion of mild NCD to major per year and rate of conversion to normal

Answer 14

5-10% to major 25-30% to normal

Question 15

Rate of Alzheimer’s In population

Answer 15

5%

Question 16

% of dementia that is vascular

Answer 16

15%

Question 17

Depression and apathy are common in vascular dementia T/F

Answer 17

T

Question 18

Family history is a RF for frontotemporal dementia T/F

Answer 18

T

Question 19

Profound apathy- which dementia most likely?

Answer 19

FTD

Question 20

Abnormal clock drawing shows exec dysfunction T/F

Answer 20

T

Question 21

Late onset delusional disorder has a good prognosis T/F

Answer 21

F

Question 22

Female sex has a better outcome in delusional disorder T/F

Answer 22

T

Question 23

Elderly people have decreased adrenergic receptor sensitivity T/F

Answer 23

T

Question 24

Late life depression more common in women T/F

Answer 24

T

Question 25

Suicide rates in the elderly are nearly twice as high T/F

Answer 25

T

Question 26

Why do elderly people get orthostatic hypotension?

Answer 26

Because of a decrease in adrenergic receptor sensitivity

Question 27

What’s the most prevalent anxiety disorder in the elderly?

Answer 27

Specific phobia 3-5%

Question 28

Features of melancholic depression

Answer 28

1. Early morning wakening 2. Morning mood worse 3. Psychomotor retardation 4. Morning awake 5. Excessive guilt 6. Loss of emotional reactivity 7. Anorexia 8. Anhedonia

Question 29

Which is the condition most assiciated with psychotic symptoms in the elderly?

Answer 29

Dementia

Question 30

Late onset depression is associated with higher rates of relapse T/F

Answer 30

T

Question 31

EEG changes in delirium

Answer 31

Diffuse slowing. Generalised theta or delta slow wave activity, poor organisation of background rhythm, loss of reactivity to eye opening and closing

Question 32

Indications for CT head in dementia

Answer 32

Indications for CT head in dementia o Age \<60y o Rapid decline in cognition (ie over 1-2m) o Duration of dementia \<2y o Recent significant head trauma o Unexplained neurological symptoms o History of cancer (especially locations that frequently metastasize to brain) o Use of anticoagulants or bleeding disorder o Symptoms of NPH o New localizing neurologic symptom o Unusual or atypical cognitive Sx (ie progressive aphasia) o Gait disturbance o If presence of undiagnosed CVD would change treatment

Question 33

Genetic testing in dementia is recommended when in terms of age at onset?

Answer 33

\<65y

Question 34

Treatment of choice for behavioural sx of LBD

Answer 34

Rivastigmine

Question 35

There is no increased rate of suicide in dementia T/F

Answer 35

T

Question 36

Prevalence of MCI over 65

Answer 36

10-20%

Question 37

Rate of conversion of MCI to dementia each year

Answer 37

10%

Question 38

Percentage of MCI that do not develop dementia

Answer 38

25%

Question 39

Cognitive impairment, fluctuations, frequent falls and visual hallucinations

Answer 39

LBD

Question 40

The nost frequently used tests of executive function in aging

Answer 40

1. Trail making test 2. Verbal fluency test 3. VFT animals category 4. Clock drawing test 5. Digits forward or backward subtest of WAIS 6. Stroop test 7. Wisconsin card sorting test

Question 41

What is the strongest risk factor for Alzheimer’s dementia?

Answer 41

Age

Question 42

Prevalence of AD at 90 years of age

Answer 42

21%

Question 43

EEG pattern of periodic synchronous bi- or triphasic sharp wave complexes is highly suggestive of what?

Answer 43

CJD

Question 44

The MMSE is good for what in dementia?

Answer 44

It has high sensitivity and specificity for separating moderate dementia from normal cognition

Question 45

Which type of dementia does not respond to ACEi

Answer 45

FTD

Question 46

Neurofibrillary tangles only occur in Alzheimer’s dementia T/F

Answer 46

F also in Down syndrome, dementia pugilistica (punch drunk syndrome). Not in vascular dementia though

Question 47

The most characteristic focal finding on MRI in AD

Answer 47

Reduced hippocampal volume

Question 48

What’s the one year mortality after an episode of delirium?

Answer 48

As high as 50% K&S

Question 49

Anticholinergics can precipitate delirium T/F

Answer 49

T frequently

Question 50

Subcortical NCDs

Answer 50

1. Parkinsons disease dementia 2. HIV dementia 3. Vascular lesions which are subcortical

Question 51

Delirium DSM V

Answer 51

DSM-5 A. Disturbance in **attention** (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment). B. The disturbance develops over a short period of time (usually hours to a few days), represents an acute change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day. C. An additional disturbance in cognition (e.g.memory deficit, disorientation, language, visuospatial ability, or perception). D. The disturbances in Criteria A and C are not better explained by a pre-existing, established or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal such as coma. E. There is evidence from the history, physical examination or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e. due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies.

Question 52

Risk factors for post op delirium

Answer 52

● **pre-existing dementia** (strongest) ● severe medical illness. (2nd strongest) ● Advanced age ● Little contact with family ● male sex ● depression ● alcohol abuse ● Electrolyte abnormalities ● Medication use ● hearing/visual impairment ● Limited pre-morbid activities ● pre-existing challenges with ADLs ● fracture on admission ● General anesthesia is NOT a RF for post-operative delirium

Question 53

APOE4 increases risk of earky onset AD T/F

Answer 53

F, its late onset

Question 54

LBD criteria DSM V

Answer 54

DSM-5 Diagnostic Criteria for Major or Mild Neurocognitive Disorder with Lewy Bodies The criteria are met for major or mild neurocognitive disorder AND The disorder has an insidious onset and gradual progression AND The disorder meets a combination of core diagnostic features and suggestive diagnostic features for either probable or possible neurocognitive disorder with Lewy bodies. For probable major or mild neurocognitive disorder with Lewy bodies, the individual has two core features or one suggestive feature with one or more core features. For possible major or mild neurocognitive disorder with Lewy bodies, the individual has only one core feature or one or more suggestive features. _Core diagnostic features of neurocognitive disorder with Lewy bodies include the following_: **fluctuating cognition** with pronounced variations in attention and alertness **recurrent visual hallucinations** that are well-formed and detailed **spontaneous features of parkinsonism**, with onset subsequent to the development of cognitive decline suggestive diagnostic features: meets criteria for **rapid eye movement sleep behavior disorder** severe neuroleptic sensitivity disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder

Question 55

AD has predominant PET changes in the temparo-parietal region T/F

Answer 55

T

Question 56

General anaesthesia is a risk factor for post op delirium T/F

Answer 56

F