elderly

Question 1

indication for risperidone for behavioural management in vascular dementia

Answer 1

if aggression ongoing for 6 weeks which has not responded to initial behavioural approaches.

Behavioural management is first line for behavioural problems in dementia

small doses of lorazepam can also be used with close supervison.

Question 2

what percentage of elderly people who fall in a given year get a fracture or hospitalisation

Answer 2

5%

Question 3

what drugs are licensed for dementia

Answer 3

Donepazil, memantine, galantamine are licensed for Alzheimer’s disease

Rivastigmine licensed for mild to mod parkinsons dementia

Question 4

should you use antipsychotic drugs in patients with dementia

Answer 4

antipsychotics such as risperidone have a small increased risk of mortality and stroke or TIA.

Question 5

DVLA for dementia

Answer 5

driving may continue in those with early and slow-to-progress dementia subject to annual review. There is no single assessment for ability to drive in cognitive impairment and early dementia; however, in-car assessments may be used to assess driving ability/safety. Those with poor short-term memory, disorientation and lack of insight are almost certainly not fit to drive.

Question 6

reversible causes of congnitive impairment

Answer 6

hypercalcaemia, hyponatraemia, thyroid dysfunction, hypogylcaemia, B12 folate deficiency, delirium, depression, wernickes encephalopathy, drug toxicity eg lithium.

Question 7

What is PRISMA7

Answer 7

7 item postal questionnaire to assess for frailty/disability, score of 3 or more identifies frailty.

Question 8

what medical treatment can be used for refractory orthostatic hypotension

Answer 8

midodrine.
also desmopressin and fludrocortisone under specialist supervision.
but first line is increasing fluid and salt intake.

Question 9

What tool can be used to identify frail patients based on routine information in the patients electronic record

Answer 9

This is the electronic frailty index.
This uses presentations of frailty syndromes and other conditions and a score categorises into fit, mildly frail, mod frail or sev frail. This is a stratification tool not a diagnostic tool.

Then assessment of frailty can be made using other tools such as the Clinical frailty scale, fait speed test, timed get up and go.

Question 11

What is osteoporosis

Answer 11

T score of <-2.5 at femoral neck.

Severe OP if also history of fragility fracture

T score is number of standard deviations below healthy woman.

Osteopenia is -1 to -2.5

Question 12

What is post operative delirium

Answer 12

Post operative delirium develops in the few days after surgery with fluctuating consciousness, cognition and awareness.

Question 13

What is post operative cognitive decline

Answer 13

Cause is unclear - likely inclused reduction in blood pressure during surgery, increased stress levels in hospital, genetic susceptibility and increased inflammation in the body. Recovery can take months to years.

Manage with reassurance, consider social problem, offer formal assessment of cognition with onward referral to memory clinic if necessary.