1
What are the two types of delirium
Hypoactive
Hyperactive
What is the most common type of dementia
What neurotransmitter is deficient in dementia
Ach
What percentage loss of body weight over 6 months is a red flag in the elderly
10%
What is the main region of the diffuse modulatory system for controlling sleep
Ascending reticular activating system
Define delirium
Acute Global impairment of cognitive function, disorder of attention
Characterized by an inability to fix, maintain, or shift attention – reduced awareness of environment)
List three anthropometric measurements of nutritional status
Skin fold thickness
Hip/waist ratio
Waist circumference
BMI
What are the main macro and micronutrient needs of the elderly person
Protein (20% more than young person)
Calcium
Vitamin D
The tuberoinfundibular pathway inhibits what hormone
Prolactin
What is the reticular activating system
A network within the brainstem between the midbrain and pons that connects the brainstem to the cortex and plays a role in regulating alertness/arousal
List the five types of dementia (4 to win)
History - Change in weight
Anthropometric measurements - BMI
Biochemical tests - iron studies
Validated tools - 24hr diet log
What are the three functional components/zones of the reticular formation and what is their main function?
1. Lateral zone – processes afferent sensory information
2. Medial zone – Processes efferent motor information
3. Diffuse modulatory systems - Neurotransmitter systems that project to many areas of the CNS
What is thought as the 'switch' for sleep in the reticular formation, and where is it found
the ventrolateral preoptic nucleus in the hypothalamus
What is protein-energy malnutrition and what situations increase the risk of protein-energy malnutrition
Insufficient intake of protein and calories
Inflammation
Wound healing
Immobility
Medical conditions
List four potential causes of delirium
PINCH ME
Pain
Infection
Nutrition
Constipation
Hydration
Medication
Electrolytes
Compare Dementia and delirium: Onset, Reversibility, Consciousness, course, and duration
Dementia: insidious, non-reversible, usually no altered conscious, progressive, years
Delerium: Acute, fluctuating, usually reversible, altered conscious, hours to days
Biological barriers to good nutrition in the elderly
1. Reduced ability to absorb and utilise nutrients
2. Disease and polypharmacy
3. Difficulty chewing
4. Delayed gastric emptying
5. Oesophageal dysmotility
Risk factors for malnutrition
1. Increased age
2. Prior nutritional status
3. Medical conditions which increase demand or influence intake
a. Infection
b. Cancer
c. IBD
d. Surgeries.
When monoaminergic and cholinergic NTs of the diffuse modulatory system bind to receptors what effect do they cause
They do not evoke a typical excitatory or inhibitory effects on the cell, instead they modify the input to the cell to influence how excitable, inhibitory, or synchronous it is.
List five barriers to optimal nutrition in the elderly
Finances
Functional or cognitive decline
depression
Therapeutic diet restrictions
Parietal dysfunction (dominant hemisphere) - three main potential findings
Aphasia – receptive language loss/impairment
Apraxia = inability to carry out complex motor acts with a tool
Acalculia = inability to comprehend or write numbers
Outline the three main prefrontal syndromes
1. Dorsolateral – Metacognitive dysfunction (problem solving, poor planning, ridged perseverance)
2. Orbitofrontal – Personality change/emotional dysregulation, Impulsive, poor social insight and inawareness of social cues, no empathy)
3. Medial – reduced motivation
Parietal dysfunction (non-dominant)
1. Neglect
2. Agnosia - non-recognition of objects (is this your hand?)
a. Anosognosia – cant recognise their disability
b. Prosopagnosia – cant recognise their face
c. Astereognosis – cant identify what they thought
Parietal dysfunction (non-dominant)
1. Secure – welcomes mother and seeks closeness
2. Avoidant – ignores mother
3. Ambivalent – exhibits anger to mother while seeking to be close
4. Disorganised – may approach mother but gaze away and show off motor behaviours and dazed appearance.