Gerontology

Question 1

Treatment with which drug class has been assoc. w. a reduced incidence of dementia?

Answer 1

Anti-hypertensives (spec. Indapamide/ enalapril)

Question 2

Which anti-psychotic is the best choice/ least harmful choice in demented elderly with severe behavioural problems?

Answer 2

Risperidone short term to 12 weeks (2006 systems review; it improves agitation and aggression therefore PBS listed for BPSD. haloperidol has effects on aggression but not agitation; olanzapine does not improve either)

Question 3

What helps with prophylaxis of delirium?

Answer 3

PRN oxycodone for pain (NOT haloperidol, NOT melatonin- doesn’t help w. post-op delerium; NOT dexmedetomidine). Least worst opiate to use for pain relief re. delirium is Oxycodone

Question 4

What changes to dopamine/acetylcholine do you get in delirium

Answer 4

Increased dopamine and decreased ACh

Question 5

Oral antibiotic prophylaxis prescribed for prevention of recurrent UTI in older adult MEN is assoc. w. :

Answer 5

Decreased risk of future UTI assoc. hospitalisation in men

Question 6

What is not an early indicator of frailty and what are 3 early indicators of frailty?

Answer 6

NOT: weight loss; ARE: slowed walking speed, weakness, reduced physical activity

Question 7

Barthel Index assesses

Answer 7

ADLs

Question 8

Vaccine in oldies that best reduces mortality

Answer 8

Influenza

Question 9

Order of meds to cease in Parkinson’s if psychotic symptoms

Answer 9

Anticholinergics (selegiline, amantadine)
Dopamine agonists
Levodopa

Question 10

NH resident risk of falling per year

Answer 10

50%

Question 11

Community >65yo risk of falling per year

Answer 11

30%

Question 12

Community >80yo risk of falling/year

Answer 12

50%

Question 13

Top 5 med classes contributing to falls

Answer 13

Anti-depressants
Anti-psych
Benzos
Sedatives
Anti-HTN

Question 14

What timed up and go = higher falls risk

Answer 14

> 13s

Question 15

BEST intervention to prevent falls in community

Answer 15

Exercise

Vit D supplement only if deplete

Question 16

Vision interventions to reduce falls

Answer 16

Cataract

Single lens glasses reduce outdoor falls

Question 17

Falls interventions in NH residents

Answer 17

?Vit D supplementation

Otherwise nothing

Question 18

Define frailty phenotype

Answer 18

3/5 of: weight loss >5%, ezhaustion, weakness, slow walking speed, reduced physical activity

Question 19

1 RF for dementia

Answer 19

Age

Question 20

3 variants of FTD

Answer 20

Progressive non-fluent aphasia
Semantic dementia
Behavioural variant

Question 21

Pathological hallmarks of AD

Answer 21

Extracellular amyloid plaques, intracellular NFTs of tau

Question 22

Pathological hallmark of FTD

Answer 22

Tau accumulation

Question 23

Pathological hallmark of DLB

Answer 23

Alpha-synuclein

Question 24

3 alpha-synucleinopathies

Answer 24

MSA, PD, LBD

Question 25

Tauopathies

Answer 25

FTD, PSP, FTD, CTE (chronic traumatic encephalop), PART (primary age related tauopathy) AD is secondary tau

Question 26

MOA memantine

Answer 26

Low affinity NMDA antag, inhibit excitatory neurotoxicity | MMSE 10-14

Question 27

Dementia that best responds to donepezil

Answer 27

LBD

Question 28

Donepezil AEs

Answer 28

Bradycardia, longQT, lowers seizure threshold, GI AEs, urinary frequency

Question 29

Major genetic risk for AD

Answer 29

ApoE4

Question 30

Define polypharm

Answer 30

5+ meds

Question 31

Most common delirium type

Answer 31

Mixed

Question 32

Delirium type with worst prognosis

Answer 32

Hypoactive

Question 33

% falls in hosp assoc w/ delirium

Answer 33

75-90%

Question 34

#1 RF for delirium

Answer 34

Cog impairment

Question 35

Restraints and malnutirion increase risk of delirium by...

Answer 35

4x

Question 36

Top 6 RFs delirium in >70yos

Answer 36

``` Cog impair Reduced sleep Immobility Visual impairment Hearing impairment Dehydration ```

Question 37

Relationship between opioids and delirium post-op

Answer 37

Lower dose = more pain = more delirium

Question 38

Sarcopaenia due to relative loss of:

Answer 38

Type 2 muscle fibres (fast twitch)