In the pharmacological management of delirium, haloperidol is the preferred agent from the available antipsychotic drugs.
All of the following explain the above except:
B. Many practice guidelines for the treatment of patients with delirium support the use of antipsychotics as the drugs of choice in delirium. Haloperidol is the most frequently used due to the different available routes of administration, a lack of anticholinergic side-effects, few active metabolites, and the low likelihood of causing adverse effects such as sedation and hypotension, which can be difficult to manage in an acute confusional state. But as QT prolongation is a possible side-effect, it is advisable to have a baseline ECG before such use is attempted in high risk patients. These recommendations do not have much evidence base but are largely driven by retrospective chart surveys; hence, there is a dearth of data on dosage guidance. It is suggested that haloperidol is given at half the adult dose in elderly people.
Reference:
Which of the following over-the-counter prescriptions used to enhance cognition is associated with coagulation dysfunction as a side-effect?
B. Gingko biloba extract is widely used as a herbal preparation for dementia and other cognitive difficulties. Gingko has a significant effect on prostaglandin metabolism and it antagonizes the platelet aggregating factor. As a result platelet function may be compromised especially when other anticoagulants like warfarin are co-administered. Many cases of internal bleeding and postoperative bleeding have been attributed to Gingko. Monitoring bleeding time may be an option in high-risk patients, but this is only a crude measure of platelet dysfunction.
In elderly people with failing eyesight Charles Bonnet syndrome is not uncommon.
Which of the following features if present support the diagnosis?
C. Charles Bonnet syndrome is a common cause of complex visual hallucination in elderly people. 10% to 15% of visually impaired elderly patients may have this syndrome. The eponym comes from the Swiss naturalist and philosopher Charles Bonnet, who reported the hallucinations of his 89-year-old grandfather, who was blind with cataracts but saw multiple animated objects. Core features of Charles Bonnet syndrome include the occurrence of recurrent well-formed, vivid, elaborate, and often stereotyped visual hallucinations in a partially sighted person. The patient usually retains insight into the unreal nature of the images. It is important to consider other differential diagnoses, such as Lewy body dementia, psychosis, delirium, neurological illness, and intoxication.
Senile self-neglect with significant reclusiveness in elderly people is called Diogenes syndrome.
Which of the following is false with respect to this condition?
B. Patients with so-called Diogenes syndrome are characterized by aloofness and breakdown of self-care to a severe extent; in some cases they may pose an environmental health hazard. Many of them are resistant to intervention from any agency, including relatives. Men and women are equally affected, but the condition is rare. An annual incidence of 0.5 per 1000 of the population aged over 60 years is reported. Diogenes syndrome is not a diagnostic category and patients form a heterogeneous group with respect to diagnoses. Some of them may have personality disorders, some have dementia while some are diagnosed with late-onset schizophrenia. Overall mortality is high for such patients.
The prevalence of potentially reversible dementia among all cases diagnosed with dementia is estimated to be around:
D. Traditionally an optimistically high rate of 10–20% of diagnosed dementia was thought to be due to reversible causes. A systematic review and meta-analysis of evidence in this regard shows a much lower rate of dementia due to potentially reversible causes to be 9% and actual (partial or full) reversal takes place in only 0.6%. Potentially reversible causes tend to be seen more in relatively young patients or in those with more recent onset of symptoms. It is not clear if an improvement in diagnostic practices in primary care has contributed to a lower proportion of patients with reversible dementia being referred. Depression being wrongly diagnosed as dementia forms the major proportion of reversible dementia; metabolic and endocrine issues such as hypothyroidism, vitamin B12 deficiency are other common causes. Subdural haematoma, cerebral tumours, and normal pressure hydrocephalus can cause potentially reversible dementias, although the degree of reversibility is controversial.
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