Geriatric Neurology and Mental Health: Aging, Parkinson's, Stroke, Dementia, Delirium, Depression, Anxiety, Substance Abuse

A comprehensive set of practice flashcards covering normal aging, Parkinson's disease, stroke, delirium, dementia, depression, suicide risk, substance abuse, and related nursing considerations in older adults.

What are normal aging changes in the brain (non-pathological) for older adults?

Gradual loss of nerve cells with age, fewer neurotransmitters, slower nerve conduction, brain atrophy, plaques in nerve cell bodies, slower cerebral blood flow, hippocampal changes affecting memory, and declines in sensory receptors and cranial nerve function.

Which brain structure is central to memory retrieval and storage and is affected by aging?

The hippocampus.

Which sleep stage tends to be reduced in older adults, impacting memory consolidation?

REM sleep; older adults spend more time in stages 1-2 and have lighter, more fragmented sleep.

Name two sensory or cerebrally connected changes common with aging.

Decreased vision and hearing, plus reductions in taste, smell, and vibratory sensation (and age-related cranial nerve changes).

What medication-related factor can cause postural hypotension in older adults?

Antihypertensive drugs (especially diuretics) can cause orthostatic/postural hypertension leading to falls.

What is the core pathophysiology behind Parkinson's disease symptoms?

Decreased dopamine in the basal ganglia with relative excess acetylcholine, causing impaired smooth movements and tremors.

What is typically the first motor symptom of Parkinson's disease?

Tremor at rest, usually beginning in one hand.

What is the primary pharmacologic treatment for Parkinson's and how does it work?

Carbidopa-levodopa (Sinemet); levodopa is a dopamine precursor and carbidopa inhibits peripheral breakdown, increasing brain dopamine.

Name two other drug classes used to manage Parkinson's symptoms besides levodopa.

Dopamine agonists; anticholinergics (and COMT inhibitors) to enhance or balance dopamine effects.

Can Parkinson's disease be cured?

No; treatments aim to manage symptoms and maintain function; the disease typically progresses.

What are the two main types of stroke and their basic mechanisms?

Hemorrhagic stroke (bleeding in the brain due to vessel rupture) and ischemic/thrombotic stroke (blood flow blocked by a clot).

List common acute stroke symptoms.

Sudden unilateral numbness/weakness (face/arm/leg), confusion, trouble speaking or understanding, vision problems, dizziness or loss of balance, and severe headache; sometimes hemianopsia.

What is the most important modifiable risk factor for stroke?

Hypertension.

What is the ‘time is brain’ principle in stroke care?

Stroke treatment is time-sensitive; in ischemic stroke, thrombolytics are most effective within about 3 hours of onset after ED evaluation and imaging (CT).

What is the NIH Stroke Scale used for?

Assessing stroke severity and monitoring changes over time to guide treatment and prognosis.

How does delirium differ from dementia in onset and course?

Delirium is an abrupt, fluctuating, global cognitive impairment often reversible; dementia is a chronic, gradual decline.

List common delirium precipitants.

Drugs, electrolyte imbalances, oxygen deprivation/hypoxia, hypothyroidism, infections, bladder/bowel retention, hypoglycemia/hyperglycemia, sleep deprivation, and overstimulation/understimulation.

What is the primary nursing approach to delirium management?

Identify and treat the underlying cause; reorient the patient, reduce stimuli, ensure safety; involve family; use antipsychotics only as a last resort.

What is dementia, and how is it different from delirium?

Dementia is progressive, irreversible cognitive decline with functional impairment; it is a syndrome with multiple etiologies, unlike the acute, reversible delirium.

Name the major types of dementia and approximate prevalence.

Alzheimer's disease (60-80%), Lewy body dementia (5-10%), vascular dementia (5-10%), frontotemporal dementia (5-10%).

What neuropathological changes characterize Alzheimer's disease?

Amyloid plaques (beta-amyloid) and neurofibrillary tangles (tau) that damage neurons and disrupt neurotransmission.

How does vascular dementia typically progress compared with Alzheimer's disease?

Vascular dementia often progresses in a stepwise (staircase) fashion after strokes; Alzheimer's shows a more gradual, continuous decline.

List modifiable dementia risk factors and their impact.

Less education; hearing loss (correctable with hearing aids); hypertension; physical inactivity; diabetes; obesity; depression; social isolation; smoking; head injury. Addressing these may reduce dementia risk by about 40%.

What screening tools are commonly used for dementia in primary care?

MMSE, MoCA (Montreal Cognitive Assessment), and Mini-Cog; screening is not diagnostic; family reports and further evaluation are essential.

What are the ‘three d’s’ in geriatric cognitive care?

Delirium, Dementia, Depression (depression can mimic dementia or co-exist with it).

What are common dementia medications and their limitations?

Cholinesterase inhibitors (e.g., donepezil) and memantine; disease-modifying antibodies like donanemab and lecanemab may reduce plaques and slow decline but carry ARIA risk and require monitoring; accessibility varies.

What nonpharmacological therapies are used for dementia?

Cognitive stimulation therapy; reality orientation; validation and reminiscence therapies; behavioral therapy; safety measures; regular routines; meaningful activities; caregiver support.

What are common neuropsychiatric symptoms in dementia and how should they be managed?

Delusions, hallucinations, aggression, wandering, repetitive actions; prioritize nonpharmacologic approaches and safety; antipsychotics have increased mortality risk and should be avoided if possible.

What is a recommended approach to dementia-related aggression in care settings?

Identify triggers, provide calm, structured environment, set boundaries, reassure the patient, and involve family; use de-escalation rather than punitive measures.

What are essential elements of comprehensive dementia care planning?

Safety, routine, balance between independence and assistance, clear/simple communication, engaging activities, caregiver support, and coordination with community resources.

What tool is discussed for assessing elder suicide risk and what factors does it address?

National Institute of Mental Health (NIMH) suicide risk assessment; evaluates frequency of suicidal thoughts, plans, means, past attempts, and safety/disposition decisions.

What screening tool assesses alcohol abuse in older adults and what indicates a problem?

Short Michigan Alcoholism Screening Test – Geriatric version (MAST-G); 2 or more “yes” answers suggest an alcohol problem and warrant referral.

What risks do benzodiazepines pose for older adults with delirium or dementia?

Benzodiazepines can be toxic and worsen cognitive impairment and delirium; use is generally avoided or minimized in older adults.

What is the pharmacologic principle of starting psychotropic medications in older adults?

Start low, go slow; anticipate slower onset (e.g., SSRIs may take 2+ weeks); monitor for sedation and falls; minimize anticholinergic burden.