geriatric
Terms
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- The 3 D’s of geriatric psychopathology
-
Dementia
Depression
Delirium - Dementia Work-Up
-
Thorough H and P, Neuro exam for focality, vital signs
ETOH Hx***
Thyroid
B12 or Homocysteine level, Folate
CBC and Diff, Chem Screen
RPR
HIV Risk?
?Imaging of the brain - Dementia Types
-
60 % Alzheimer’s Disease
15% Multi-infarct dementia
25% mix of degenerative diseases, alcohol, metabolic and infectious etiologies -
Alzheimer’s Disease
Plaques & tangles -
Plaques: beta amyloid w inflammation
Tangles: pleated sheets of abnl. Tau Protein - Alzheimer’s Disease genes
- AP0 E4 risk genes
-
Differentiation of Dimentia
-Alzeimers
-Multi-infarct
-Parkinsons
-Lewy body dementia
-Fronto-temporal -
AD: slow progressive
MI: rapid, stepwise
P: 35% get dementia
LB: visual hal, parkinsons
FT: personality change -
Dementia Meds
Class and examples -
Anticholinesterase Inhibitors
- donepezil (Aricept)
- Rivastigmine (Exelon)
- Galantamine (Reminyl)
NMDA (N-methyl-D-Aspartate) receptor blocker
- Memantine (Namenda) - Dementia Meds efficacy
- Delays NH placement by 6 months
- Risks for Depression in elderly
-
Loss of spouse
Functional disability
Low perceived support
Female sex
Cerebrovascular changes in late onset depression -
Late onset mania is usually associated with brain disease or drugs
T/F - T
- White males over age 65 account for ____ of all completed suicides in U.S.A.
- 81%
- Correlates of Elderly Suicide
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Social Isolation
Stressful life events
Physical Illness
Personality and Coping Style
Neurobiology
Substance Abuse -
Suicide Completers
_____ saw their PCP during the week prior - 40%
- Anxiety in Late-Life
-
muscle tension, restlessness, fatigue, difficulty concentrating, irritability, and insomnia
most cases are secondary to Major Depression(70% of GAD)
20-40% of Late-Life MDD have GAD
resolves with Rx of the depression - Delirium: Acute Brain Failure
-
Decreased attention: focus, sustain or shift
Altered memory, orientation, language, mood, perception or reality testing
Waxing and waning
Onset over hours to days
Suspicion of medical cause: commonly UTI, alcohol/sedative withdrawal or drug toxicity - Delirium EEG
- shows generalized slowing
- _____ of elders who present with delirium in the hospital are Dx’d w dementia in 6 mo.
- 50%
- Treating Delirium
-
Treat the underlying cause
Protect the patient and others from harm
haloperidol for psychosis/agitation (may give IV)
Monitor fluids and electrolytes
Usually takes days to resolve