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ELDERLY MEDICINE TEACHINGCONFUSION   -Delirium:An acute state of disorientation   -Hyperactive Delirium: restlessness, hypervigilance, rapid speech, irritability   -Hypoactive Delirium psychomotor retardation, apathy, reduced alertnessCONFUSION   -What can we do about delirium?   -Managing it when it happens   -Assessing capacity   -Deprivation of liberty safeguard (DoLS)  CONFUSION   -CAM https://oxfordmedicaleducation.com/geriatrics/cam/   -AMTS https://patient.info/doctor/abbreviated-mental-test-amt   -AMT4 https://www.mdcalc.com/calc/3995/abbreviated-mental-test-4-amt-4   -4AT https://www.the4at.com/4at-download  FALLS   -In 2017-2018neary 100,000 older people suffered hip fractures from falls in 2017   -DAME criteria   -FRAX scoreFALLS   Cause specific   Walking aids and confidence   Bone protection IDIOP ATHIC PARKINSON'S Neurodegenerativecondition caused by degeneration of the dopaminergic neurons in the substantia nigraNOTQUITEIDIOP ATHIC P ARKINSON'S DISEASE   -Drug induced Parkinson’s disease   -Parkinson’s plus syndromes (progressive supranuclear palsy,corticobasal syndrome, multiple system atrophy etc)   -Vascular Parkinsonism   -Dementia with Lewy bodies   -Normal pressure hydrocephalusP ARKINSON'S MANAGEMENT   -Parkinson’s can only be diagnosed and initially managed by a specialist in movement disorders so refer to the movement disorder team   1st line: co-careldopa   -Other adjuncts include dopamine agonists (eg cabergoline), MAO-B inhibitors, donperidone  79YEAROLD MALEIN ED   -You’re in ED and are called to see a 79 year old gentleman   -His wife tells you that he’s had a tummy bug but he seems to have suddenly become extremely unwell   -He is running a fever, incredibly confused and disorientated (this is unlike him)   -Observations show hypertension,tachycardia and tachypnoea   -He has incredibly high tone   -He has a history of Parkinson’s disease  DEMENTIA   -Alzheimer’s dementia   -Vascular dementia   -Lewy body dementia   -Fronto-temporal dementia  NON-PHARMACOLOGICAL MANAGEMENT   -Cognitive stimulation programmes eg memory cafe   -Music therapy   -Art therapy   -Dancing and exercise programmes   -Animal assisted therapy   -Advanced statements, advanced decisions, lasting power of attorney etc  CHALLENGING BEHAVIOURIN DEMENTIA   Factors that increase the risk of harmnto themselves or others:   -Overcrowding   -Lack of privacy   -Boredom   -Poor communication and frustration   -Conflict   -Unmet needs  NUTRITION   -Common to lose interest in food, they may refuse to eat it, spit it out or even choke on it accidentally   -This can contribute to frailty   -Smaller portions of food they like   -In later stages they can forget they’re supposed to be chewing so they may need supervision  ALZHEIMER'S DEMENTIA   -Most common   -Degeneration of the cerebral cortex with cortical atrophy, neurofibrillary tangles, amyloid plaque formation and reduction in acetylcholine production from affected neurons.   -Early symptoms   -Mid stage symptoms   -Late stage symptoms   -Acetylcholinesterase (AChE) inhibitors eg donepezil  VASCULARDEMENTIA   -Accounts for about 15% of dementias   -Brain damage due to cerebrovascular disease   -Stroke, multipleTIAs or chronic changes in smaller vessels (subcortical dementia)   -Mixed dementia is when there are Alzheimers andVaD changes in the brain, they both have vascular risk factors   -Manage vascular risk factors  DEMENTIAWITH LEWYBODIES   -About 15% of dementias   -Deposition of abnormal protein within neurons in the brain stem and neocortex   -This spectrum includes dementia with Lewy bodies (dementia first), pure Parkinson’s disease and Parkinson’s disease-associated dementia   -Visual hallucinations are more common earlier on   -Sleep disorders   -Motor symptoms   -Parkinson’s medications can actually worsen psychosis  FRONTOTEMPORAL DEMENTIA   -Seen in younger patients (generally presents in 60s)   -Atrophy of frontal and temporal lobes (rather than diffuse atrophy in Alzheimer’s)   -Behavioural variant   -Progressive non-fluent aphasia   -Semantic dementia