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17 Cards in this Set

  • Front
  • Back
DDD DDX?
Demetia
Delirium
Depression

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