Causes
These are the three most common causes of dementia.
What is Alzheimer's disease, vascular dementia, and dementia with Lewy bodies?
What is the utility of a rectal exam in dementia workup?
Assess for fecal impaction, enlarged prostate leading to constipation/urinary retention.
What are the antibiotics to treat a complicated UTI?
PO: ciprofloxacin, levofloxacin; cefpodoxime and augmentin are safer in pregnancy
IV: ceftriaxone, unasyn
True or False: Medicare covers both acute and long-term skilled nursing level care.
False: Medicare covers 100% of expenses for nursing home stay after hospitalization; long-term care is not covered at all.
This type of time course is a key differentiating factor between delirium vs dementia.
What is waxing and waning vs insidious/progressive?
These infections are common causes of delirium in elderly patients.
What are UTIs and respiratory tract infections?
Name at least 3 items that are asked about on the Geriatric Depression Scale.
What is: SIGECAPS, also -
- do you often get bored?
- are you in good spirits most of the time?
- are you afraid something bad is going to happen to you?
- do you often feel helpless?
- do you prefer to stay home?
- do you have more problems with memory?
- etc
What is the MOA for memantine?
NMDA receptor antagonist
The following are hospital interventions that can prevent or minimize delirium (name at least 3)
What are frequent reorientation and redirection, avoidance of delirium-causing medications (Beers criteria), provide early mobility, minimize unnecessary lines, provide increased stimulation.
What is upper motor neuron?
This is a defining feature of Huntington's disease.
What are choreiform movements?
These are common causes of nonspecific white matter changes on MRI.
HTN, smoking, obesity, aging.
Name 3 types of drugs that can cause delirium in elderly patients.
What are medications with anticholinergic effects, including: opioids, benzos, antihistamines, TCAs, antipsychotics, and some anti-nausea medications; or less commonly fluoroquinolones, beta blockers, and H2 blockers.
True or False: It is appropriate to treat asymptomatic bacteriuria in older adults because it increases the risk of developing delirium.
False: this is very common older adults and there is no evidence that treating it helps; as many as 50% of older people after a UTI will continue to have bacteriuria.
This scale is used to assess for caregiver strain.
What is the caregiver stress index?
What are other defining features of B12 deficiency?
Tingling in feet 2/2 peripheral neuropathy, fatigue, weakness, balance problems
What are the other lab tests that you'd recommend for someone with dementia?
CBC, BMP, calcium, thyroid, vitamin B12 level, folate level (rare); if strong suspicion, syphilis/HIV testing
These medications used to treat acute agitation in dementia have a black box warning for increased risk of death.
What are antipsychotics?
In which situations would you order neuroimaging for cognitive impairment?
Ruling out structural defects and vascular causes; the American Academy of Neurology does recommend either NCHCT or MRI for initial evaluation for dementia
Name 3 ADLs and 3 IADLS
ADLs: bathing, dressing, transferring, continence, toileting, feeding
IADLs: shopping, preparing meals, using the telephone, managing transportation needs, managing medications, managing finances, laundry, housekeeping
In addition to dementia, what are other defining symptoms of dementia with lewy bodies?
delirium, visual hallucinations, parkinsonism (bradykinesia, rigidity, tremors)
Name the features assessed in the confusion assessment method (CAM).
1. Acute onset and fluctuating course
2. Inattention
3. Disorganized thinking
4. Altered LOC
Describe the pathophys for why cholinesterase inhibitors (donepezil, rivastigmine) are helpful in dementia.
Alzheimers = lack of ACh-producing neurons
Cholinesterase inhibitors prevent breakdown of ACh in the synapse
What qualifies a person for SNF-level care?
Dependent on at least 3 ADLs
What are risk factors for developing a complicated UTI?
pregnancy, pts with urinary obstruction, immunosuppression, indwelling catheters, or calculi