Delirium, Dementia and Other Cognitive Disorders

Question 1

Features of Dementia

Answer 1

Slow to develop
Progressive
Irreversible in most cases

Question 2

Pseudodementia

Answer 2

Condition caused by another psychiatric disorder that mimics dementia (confabulatory)

Question 3

Delirious pt response to questions

Answer 3

Unable to answer
Confused
Frightened
Angry

Question 4

Demented pt response to questions

Answer 4

Tries to answer

Will say, “I don’t know.”

Question 5

Pseudodemented pt’s response to questioning

Answer 5

Will not try to answer

Will say, “I don’t know.”

Question 6

Amnesic disorder

Answer 6

Memory impairment caused by:
A general medical condition
Persisting effects of substance use.

Question 7

Amnesia

Answer 7

Inability to learn new information or recall old

Question 8

Agnosia

Answer 8

An impaired ability to recognize familiar objects or people

Question 9

Aphasia

Answer 9

Language disturbance in expressing and understanding spoken words

Question 10

Apraxia:

Answer 10

Inability to carry out motor activities despite intact motor function

Question 11

4 early signs of dementia

Answer 11

Amnesia
Agnosia
Aphasia
Apraxia

Question 12

Most common type of dementia

Answer 12

Alzheimer’s

Question 13

Predisposing factors for dementia

Answer 13

Familial form of Alz
Huntington’s is autosomal dominant on Chromosome 4:
-Risk for children is 50%
Creutzfeldt-Jakob Disease
-Genetic component appears in 10-15% of cases
Pick’s Disease
-Linked to genes on chromosomes 3 and 17

Question 14

Vascular Dementia

Answer 14

Caused by TIAs and strokes
Vascular changes related to a number of diseases with known genetic links:
-HTN
-DM
-High cholesterol

Question 15

Alz Neurobiology

Answer 15

Progressive, widespread brain atrophy
Dec availability of ACh
Markedly increased neuritic plaques and neurofibrillary tangles

Question 16

Vascular Dementia Neurobiology

Answer 16

Brain has multiple vascular lesions in the cortex and subcortical areas

Question 17

Pick’s Disease Neurobiology

Answer 17

Atrophy of the frontal and anterior temporal lobs of the brain
Swollen neurons with well-defined “Pick’s Bodies.”

Question 18

Normal Pressure Hydrocephalus Neurobiology

Answer 18

Impaired return of cerebral spinal fluid to the brain from the spinal column
Enlarged ventricles seen on CT or MRI
Reversible if surgery performed soon enough

Question 19

Vitamin B12 deficiency dementia neurobiology

Answer 19

Rare but potentially reversible

Inadequate B12 causes demyelination and axon loss

Question 20

Parkinson’s Disease Neurobioloty

Answer 20

50% reduction in neurons in the substantia nigra

Remaining cells containing Lewy bodies

Question 21

Diffuse Lewy Body Disease Neurobiology

Answer 21

Lew bodies in the frontal and temporal cortex primarily

Presence but in lesser frequency in the hippocampus and substantia nigra

Question 22

Creutzfeld-Jakob’s Disease Neurobiology

Answer 22

Infecting agent known as a prion that causes spongiform Encephalopathy in which cells are stripped of intracellular material
Transmissible by blood and body fluid
Bovine spongiform encephalopathy is a variant

Question 23

Environmental factors in dementia

Answer 23

Head injury
Down Syndrome
Chronic alcoholism
"Huffing"
Long-term use of BZOs and barbiturates
"Rave" drugs

Question 24

Nun study

Answer 24

Nuns donated brains to science:

• Plaques and tangles present, but no Alz
• Plaques and tangles not enough to explain Alz

Question 25

Order of Sx: Alz

Answer 25

Memory loss Inability to problem solve in new situations Decline is gradual

Question 26

Order of Sx: Vascular Dementia

Answer 26

Symptom appearance is more abrupt Coupled with neurological symptoms Usually stair-step detioriation

Question 27

Order of Sx: Pick's Dz

Answer 27

Behavioral changes appear first

Question 28

Order of Sx: CJD

Answer 28

Personality changes Szrs Myoclonic movements Course is rapid, death within a year

Question 29

Order of Sx: Lewy Body Dz

Answer 29

Hallucinations Fluctuating alertness Tendency to fall appear early in 80% of those with EPS

Question 30

Order of Sx: Huntington's

Answer 30

Insidious behavioral changes Disruption of attention Personality Choreiform movements

Question 31

Order of Sx: Korsakoff's

Answer 31

Wernicke's (reversible with thiamine) Ataxia Nystagmus Confabulation

Question 32

AIDS/Dementia Complex

Answer 32

Subcortical Dementia with infiltration of infected macrophages or microglial cell into the brain

Question 33

AIDS/Dementia Complex: Cognitive Deficits

Answer 33

Memory loss, speech problems

Question 34

ADC: Motor Deficits

Answer 34

``` Loss of bladder tone is early indication Paraparesis Lower-extremity spasticity Ataxia Extensor-plantar responses in the absence of spinal cord abnormalities ```

Question 35

ADC: Behavioral Sx

Answer 35

Early presentation with inability to conduct ADLs

Question 36

ADC: Mood Sx

Answer 36

Severe changes in usual mood, with wide variation from psychosis, or mania, or depression

Question 37

ADC: Differential Dx

Answer 37

``` Syphilis B12 and folate Thyroid Electrolytes BUN/Cr ```

Question 38

Non-pharm interventions in post-TBI dementia

Answer 38

Safety Plan Follow-up for one year after any suicide attempts PT for the vestibular dysfunction OT for traumatic vision syndrome, characterized by scanning and accommodation difficulties

Question 39

Rules for treating depression in persons with dementia (or the elderly in general)

Answer 39

Start low and go slow | TCAs work well in the elderly, but a lot of anticholinergic activity

Question 40

Fluoxetine in the elderly

Answer 40

Don't use it

Question 41

SIADH

Answer 41

Syndrome of inappropriate antidiuretic hormone: | Possible side effect of SSRIs in the elderly

Question 42

EPS with SSRIs

Answer 42

Rare, but can occur

Question 43

First-line drug therapy

Answer 43

Donepezil (Aricept) 5mg orally daily (max 10mg/day)

Question 44

Features of Delirium

Answer 44

``` Rapid onset Altered state of consciousness Presence of a general medical condition Presence or withdrawal of a substance Generally reversible Acute medical emergency ```