Elderly patients Flashcards
(11 cards)
Alzheimer Disease
Most common cause of dementia
• Pathology: Accumulation of beta-amyloid plaques (extracellular) and neurofibrillary tangles (tau protein, intracellular)
• Clinical: Gradual memory loss, confusion, language problems, impaired daily functioning
• Lobar atrophy, especially in hippocampus and cortex
Tip: Look for an elderly patient with progressive memory loss + normal consciousness. Risk ↑ with age and ApoE4 allele.
Vascular Dementia
Second most common dementia
• Due to multiple infarcts or chronic ischemia
• Stepwise decline in cognitive function
• History of stroke, hypertension, or vascular disease
Tip: Watch for a history of multiple strokes or focal neurologic signs (e.g. hemiparesis) with cognitive decline.
Parkinson disease
Neurodegenerative disease with motor and cognitive involvement
• Loss of dopaminergic neurons in substantia nigra
• Classic features: Bradykinesia, rigidity, resting tremor, postural instability
• Lewy bodies (alpha-synuclein) in neurons
Tip: On Step 1, remember TRAP (Tremor, Rigidity, Akinesia, Postural instability) and dopaminergic depletion in the substantia nigra.
Normal Pressure Hydrocephalus (NPH)
Classic triad: Wet (urinary incontinence), Wobbly (gait disturbance), Wacky (dementia)
• Cause: Impaired CSF absorption → ventricular enlargement with normal opening pressure
Tip: Look for an elderly patient with magnetic gait + dementia + incontinence, and enlarged ventricles on imaging.
Delirium
Acute, fluctuating disturbance in attention and cognition
• Reversible; often due to medications (e.g., anticholinergics, benzodiazepines), infections (e.g., UTI), electrolyte imbalances
• EEG: Diffuse slowing
Tip: Delirium is acute and reversible, unlike dementia. A common presentation is sudden confusion in a hospitalized elderly patient.
Osteoporosis
• Increased bone resorption due to aging, decreased estrogen/testosterone, or decreased physical activity
• Common in postmenopausal women and elderly men
• Sites of fracture: Vertebrae (compression), hip (femoral neck), wrist (Colles)
Tip: No change in calcium, phosphate, or PTH in primary osteoporosis. Watch for sudden-onset back pain or decreased height.
Polypharmacy & Adverse Drug Reactions
Elderly patients often take multiple medications → ↑ risk of drug-drug interactions, falls, and cognitive changes
• Drugs with anticholinergic effects (e.g., diphenhydramine) → worsened cognition, delirium
Tip: Anticholinergic burden is a very common Step 1 question trigger in elderly confusion cases.
Depression in the elderly
May present as pseudodementia
• Reversible cognitive impairment
• Often underdiagnosed; may lack typical symptoms (e.g., may not report sadness)
Tip: Cognitive decline improves with treatment; MMSE may improve after antidepressants.
Prostate pathologies
Benign Prostatic Hyperplasia (BPH): Common in men >50
• Urinary frequency, nocturia, weak stream
• Risk of urinary retention and UTI
• Prostate Cancer: Often asymptomatic early; peripheral zone tumor
Tip: BPH affects the transitional zone, while cancer tends to arise in the peripheral zone.
Aortic stenosis
Common in elderly due to calcific degeneration
• Classic triad: Angina, syncope, dyspnea on exertion
• Harsh systolic ejection murmur, crescendo-decrescendo, radiating to carotids
Tip: Think of this when an elderly patient presents with exertional symptoms and a systolic murmur.
Other Commonly Tested Elderly Pathologies
Macular degeneration – central vision loss
• Glaucoma – peripheral vision loss
• Temporal arteritis – elderly woman with headache + jaw claudication + vision loss risk
• Shingles (reactivated VZV) – immunosenescence increases risk
