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17 Cards in this Set
- Front
- Back
DDD DDX?
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Demetia
Delirium Depression These are your DDXs in preventative care in geriatrics |
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Slow decline in cognitive and functional abilities, associated with psych disturbances
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Dementia
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Major causes of dementia
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Alzheimers
Lewy body Strokes/vascular Parkinson's Pick's (frontotemporal) CNS malignancy or infxn Normal pressure hydrocephalus EtOH Digoxin, other drugs Metabolic things Depression |
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MCC dementia
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Alzheimer's disease: extracellular amyloid plaques and intranuclear fibrillary tangles
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COD in Alzheimer's disease
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Infection
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Visual hallucinations, Parkinsonian features, waxing and waning mental status, dementia
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Lewy Body Demetia
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Types of vascular dementia
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Multi-infarct
Strategic infarct--subcortical Lacunar infarct Subdural hematoma Subarachnoid bleed |
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Reversible causes of dementia
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Hypothyroidism (test TSH, free T4)
Vitamin B12 deficiency (order MMA--B12 needed to metabolize, so MMA will be high) HIV (ELISA and Western blot) Syphilis (RPR/VRDL, followed by MHA-TP or FTA-Abs to confirm) |
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Dx of Dementia
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1. Mini mental status exam (MMSE)
-Limited due to educational and language bias 2. Clock test -more sensitive than MMSE 3. Geriatric depression scale |
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Treatment of dementia
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Cholinesterase inhibitors (Donezepil, Rivastigmine
NMDA antagonist (Memantine) Vitamine E Seroquel for psychotic sx |
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How is Mematidine neuroprotective? (NMDA antagonist)
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Prevents overstimulation and eliminates background noise
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Which dementia drugs work best with AD?
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Cholinesterase inhibitors (Denezepil, Rivastigmine)
NMDA antagonists (Memantine) |
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Causes of delirium
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Drugs
Infection Metabolic (glc, Na, Ca) CVA/subdural hematoma CAD/CHF Hypoxia Pain Bladder outlet obstruction/impaction Sundowning |
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Dx of delirium
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Confusion assessment method (CAM):
1. Acute change in mental status AND 2. Inattention AND EITHER 3. Disorganized thinking OR 4. Altered level of consciousness |
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You just Dx'd depression in an old person-what lab test should you order?
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Order TSH! This could just be a thyroid problem
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Treatment of depression in old ppl
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SSRIs
Maybe Anti-psychotics (those with psychosis have increased risk of dementia later on) Watch out for beta blockers; they can cause depression |
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Drug dosing adjustment based on renal function: memorize this formula
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Creatinine clearance, in mL/min =
(140-age) x lean body wt [kg] -------------------------------- PCr [mg/dL] x 72 |