Geriatric Medicine
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| A mental state marked by the mingling of ideas w/consequent disturbance of comprehension/understanding, and bewilderment | confusion
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| chronic organic brain syndrome = | dementia
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| Acute organic brain syndrome, acute confusional state, acute dementia; "noisy restlessness" = | delirium
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| short term memory loss w/o delirium or dementia (Korsakov psychosis) | amnestic syndrome
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| Acute/subacute alteration in mental status, disorder of attention, improvement or normalization of mental function after underlying condition treated = | delirium
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| predisposing factors for delirium | decreased sensory function, sensory deprivation, sleep deprivation, immobilization, transfer to new environment, psychological disturbances, males, >3 new meds
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| 10 common causes of delirium | metabolic disorders, infections, decreased CO, stroke, drugs, intoxication, hypo/hyperthermia, acute psychoses, transfer to unfamiliar surroundings, fecal impaction/urinary retention
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| chronic deterioration of mental function sufficiently severe to interfere with daily living = | dementia
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| Onset: delirium vs dementia | delirium: acute; dementia: insidious
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| Disease course: delirium vs dementia | delirium: fluctuating ; dementia: generally stable
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| Duration: delirium vs dementia | delirium: hours to weeks; dementia: months to years
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| Awareness: delirium vs dementia | delirium: reduced; dementia: clear
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| Attention: delirium vs dementia | delirium: hypo/hyper alert; dementia: usually normal
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| orientation in delirium | mistakes familiar/unfamiliar
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| memory: delirium vs dementia | delirium: immediate/recent impaired; dementia: recent > remote impaired
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| thinking: delirium vs dementia | delirium: disorganized; dementia: impoverished
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| perception: delirium vs dementia | delirium: illusions/hallucinations; dementia: usually normal
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| speech: delirium vs dementia | delirium: incoherent/ hesitant/ slow/ rapid; dementia: word finding difficulty
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| sleep-wake cycle: delirium vs dementia | delirium: always disrupted, often reversed, short & fragmented; dementia: often fragmented
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| illness/toxicity in delirium vs dementia: | delirium: either or both present; dementia: often absent
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| tertiary syphilis can cause: | dementia
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| prevalence of dementia over age 65 | 5-10% have some level of dementia (50% in >85 yo)
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| How is Alzheimer's diagnosed? | clinical diagnosis of exclusion; post-mortem neurofibrillary tangles, plaques
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| Alzheimer's generally presents in the __ decade of life | 7-8th
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| mean survival associated with Alzheimer's | 8-10 years
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| DSMIV TR criteria for dementia of the Alzheimer's type | memory impairment and at least 1 of (aphasia, apraxia, agnosia, disturbance in executive function or occupational functioning) deficits do not occure exclusively during a delerium
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| __% of older adults in primary care settings suffer from depression | 37
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| Mild stage of Alzheimer's | symptoms suble and often undetected, decline of short term memory
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| Moderate stage of Alzheimer's | impaired language abilities and ability to think abstractly and exercise judgment (personality changes), decline of visual and spatial skills
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| Severe stage of Alzheimer's | loss of long term memory, problems sleeping, weak, unable to walk or talk, incontinent, completely dependent on the caregiver
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| Is emotional lability more common in primary degenerative dementia or vascular dementia | vascular
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| Are focal neuro signs/hx of stroke/TIA more common in primary degenerative dementia or vascular dementia | vascular
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| Is hypertension/hx more common in primary degenerative dementia or vascular dementia | vascular
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| Vascular dementia occurs more in men or women? | men
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| normal memory loss "forgetfulness" associated with aging, doesn't cause impairment, not progressive | benign senescent forgetfulness
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| important aspects of patient history when evaluating dementia | active medical problems, list drugs, cardiovascular and neurological, characterize the symptoms, assess the social situation, ask about special problems
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| Who has the highest rate of suicide? | older white males
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| important aspects of PE when evaluating dementia | BP, cardiovascular, neurologic, Folstein MMSE (<24/30)
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| management of dementia | cholinesterase inhibitors, treat underlying medical conditions, physical and mental activity, use memory aids, good nutrition, manage complications, provide ongoing care, patient and family education, social service info, family counseling
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| therapeutic effect of cholinesterase inhibitors | best for mild-moderate dementia, shown to slow progression
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| therapeutic use of NMDA antagonist | more for moderate-severe dementia; shown to slow decline in function
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| Is delirium preventable? | Yes: provide humane care, adequate light, warmth, familiar staff
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| Disturbance of consciousness in conjunction with reduced ability to focus, sustain or shift attention = | delirium
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| Deterioration of cognitive function, memory = | Dementia
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| Rapid onset of cognitive symptoms, mental status fluctuations, anxiety, irritability = | delirium
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| Delirium = | acute change in consciousness; serious medical condition (increased morbidity / mortality)
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| Mild cognitive impairment: pathogenesis = | hippocampal atrophy
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| Alzheimer dz pathophysiology | Extracellular deposition of amyloid-beta protein, intracellular neurofibrillary tangles, loss of neurons. 50-90% reduction in choline acetyltransferase in cortex & hippocampus
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| Most common causes of dementia | 1) Alzheimer. 2) Vascular dementia. 3) Cortical Lewy body disease
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| Vascular dementia clinical features | Stepwise / incremental progression. Often causes gait abnormalities / other focal deficits
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| Lewy body disease clinical features | Lewy bodies (as seen in PD). Quicker onset. Rigidity simultaneous with dementia. Visual hallucinations; paranoia. Avoid neuroleptics/antipsychotics
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| Alzheimer risk factors | Age, FH, hx head trauma, CVA, obesity, DM, APOE4 allele, Down syndrome
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| Tests to measure cognitive impairment | MMSE. Animal naming test. Clock drawing test. 7-minute neurocognitive screen.
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| Location of strokes most often associated with depression | Left frontal lobe
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| Drugs associated with increased incidence of depression | BB, CNS drugs, benzos, steroids, NSAIDs, cimetidine, centrally acting alpha agonists (clonidine, methyldopa)
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