Elderly

Question 1

How many falls is commonly recognised to increase future risk?

Answer 1

2 or more in 12m.

Question 2

What is the timed up and go assessment and what does the score mean

Answer 2

Time how long it takes for a patient to get up, walk 3m, turn around and come sit back down. Clinician observes safety of movements

Normal is 8-11s
Impaired is >12s
But everywhere you look says a different number :) This is what NICE says.

Question 3

What is the turn 180 test

Answer 3

Stand up and turn 180 degrees. If it takes more than 5 steps this is impaired

Question 4

Who would you offer a comprehensive falls assessment to?

Answer 4

FLIGT
- Anyone living with FRAILTY
- Have experienced a LOC related to a fall.
- Were INJURED in a fall and needed medical treatment.
- Have been unable to GET UP independently after a fall.
- Have had TWO or more falls in the last year.

Question 5

Who would you assess balance and gait for but not comprehensive falls ax
What would you do if theres impairment?

Answer 5

Anyone who’s fallen in the past year but doesn’t meet criteria for comprehensive ax

If impairment Offer
- falls prevention exercise programme
* Consider a home hazard assessment

Question 6

Definition of early onset dementia

Answer 6

Dementia that occurs under 65.

Question 7

Whats the difference between dementia with Lewy bodies and Parkinson’s dementia

Answer 7

in DLB Dementia and Parkinsonism occur within a year of each other

Question 8

Which genes might be involved in the development of early onset dementia

Answer 8

APP or the presenilin genes (PSEN1 or PSEN2)

Question 9

What is the strongest genetic risk factor for Alzheimers

Answer 9

Having ApoE 4.

Question 10

Leading cause of death in the UK

Answer 10

dementia

Question 11

What cognitive screening tools does NICE recommend

Dont recall just recognise

Answer 11

10-point Cognitive Screener (10-CS)
6 CIT
6 item screener
Memory impairment screen (MIS)
Mini-cog
Test your memory

Question 12

What Imaging if you think a patient has FTD

What about DLB

Answer 12

SPECT CT or FDG PET

I-FP-CIT SPECT (DaT scan)

Question 13

Drug tx for Alzheimer’s

Answer 13

Specialist initiated
Acetylcholinesterase inhibitors for mild-mod
Galantamine
rivastigmine
donepazil

If dementia is mod/severe then
Memantine could be used as mono therapy or for people who cant have the others

GP could initiate memantine in addition to ACEsterasei if mod-severe

Question 14

What drugs might be px by specialist for DLB

Answer 14

Donepazil/ rivastigmine

Question 15

Are AChE inhibitors / memantine recommended in FTD?

What about in vascular dementia?

Answer 15

No

In vascular only if comorbid Alzheimers

Question 16

Side effect of AChE inhibitor

Answer 16

bradycardia so careful if any cardiac issues

GI upset inc ulcers

Question 17

If a patient is having visual hallucinations what subtype of dementia would you think

Answer 17

DLB

Question 18

How does NICE recommend frailty is assessed?

Answer 18

Evaluation of gait speed, self-reported health status, or the PRISMA-7 questionnaire

Question 19

What do MMSE scores mean

Answer 19

24–30: Normal cognition

19–23: Mild cognitive impairment

10–18: Moderate cognitive impairment

0–9: Severe cognitive impairment

Question 20

What dementia are patients with MND most likely to get

Answer 20

FTD (in 15%)