College aantekeningen cardiovascular ageing (week 5-8) Minor Clinical Research in Internal Medicine , met uitgeschreven leerdoelen per college
Underline = leerdoel
Groen = belangrijk
10/10/2022................................................................................................................................................... 8
Hypertension and treatment in the old................................................................................................................8
Deprescribing in the old.....................................................................................................................................10
11/10/2022.................................................................................................................................................. 11
Statin treatment in old age................................................................................................................................11
Diabetes treatment in the old............................................................................................................................12
14/10/2022.................................................................................................................................................. 14
Aging of the heart..............................................................................................................................................14
17/10/2022.................................................................................................................................................. 15
TAVI in the older patient....................................................................................................................................15
17/10/2022.................................................................................................................................................. 17
(Vascular) cognitive impairment........................................................................................................................17
Imaging in an outpatient memory clinic............................................................................................................18
20/10/2022.................................................................................................................................................. 20
Clinical reasoning and treatment.......................................................................................................................20
Farmacotherapie bij CVA...................................................................................................................................20
24/10/2022.................................................................................................................................................. 22
Ethical dilemmas in treating the frail patient....................................................................................................22
25/10/2022.................................................................................................................................................. 23
Advanced care planning.....................................................................................................................................23
1
,03/10/2022
Theories of ageing
The students knows the different organic pathways of the ageing process
Biological vs. chronological ageing
Chronological depends on
- Cumulative exposure to endogenous and exogenous risk factors
o Genetic predisposition
o Life-style factors
o Vascular risk factors
o Inflammation
o DNA repair DNA damage
o Genomic instability, cellular senescence, cell dysfunction, cell death
Biological
- Fits can be undertreated
- Frails can be overtreated
Medical innovation and diagnosing are improving, but prevention could be better
The student knows which factors affect the biological ageing process
Hayflick limit = max number of times a cell can go into mitosis
Hallmarks of ageing
-
- If you are able to stop ageing increase of healthy life span
2
, - Experimental increase accelerates aging
Genetic diseases of premature aging: progeria and Wener syndrome
Senescent cells = cells that don’t divide but also don’t go into apoptosis
Immunosenescence = immuunsysteem gaat achteruit naarmate je ouder wordt
DNA damage during life: point mutations, translocations, chromosome increase and loss,
telomere shortening
Measuring aging with skin and muscle biopsies
Epidemiology of aging
Worldwide trend that women reach higher age than men
Japan has world’s highest life expectancy
- 80 years for men
- 87 years for women
Influence of lifestyle factos on aging
Negative lifestyle factors: smoking alcohol, sleeping disturbances, sedentary behaviour,
stress, unhealthy diet
Positive lifestyle factors: physical activity, healthy diet, good sleeping pattern, positive
attitude
Caloric restriction
- No increase in life expectancy, but:
- 20% less cancer, diabetes, myocardial infarction
04/10/2022
Comprehensive geriatric assessment
What domains the complete geriatric assessment exists of
Fried criteria for frialty:
- Weight loss – unintentional 10% since age 60 or BMI < 18
- Slowness – time to walk 4 meters
- Weakness – grip strength
- Exhaustion – feeling of low energy levels
- Low physical activity – questionnaire
1. Somatic domain -> medical history, comorbidity (charlson comorbidity index),
polypharmacy (START/STOPP)
2. Cognitive/psychic domain -> MMSE, MOCA, perspective of a relative, CT-scan or MRI-
scan
3
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