Dementia & delirium

Question 1

Definition of dementia

Answer 1

An acquired and irreversible CNS neurodegenerative process that affects Cognition:
memory, apraxia, agnosia, visual-spatial, aphasia, executive function

Question 2

what can dementia cause?

Answer 2

Neuropsychiatric symptoms: depression, psychosis, wandering, physically assaultive, sleep disturbances

Question 3

Epidemiology of dementia

Answer 3

5.4 million Americans with Dementia
13% >60 years of age
50% >85 years of age
every 68 seconds someone is diagnosed with dementia

Question 4

What is the most common subtype of dementia?

Answer 4

Alzheimers
>50%prevalence among pts w/ dementia
Most common type of dementia

Question 5

What are two other subtypes of dementia besides alzheimers?

Answer 5

Vascular: 10-20%
Multi-infarct
Lacunar infarct
Mixed Dementia

Question 6

Lewy Body dementia is what percentage of dementia cases?

Answer 6

10-20% of dementia cases

Question 7

Parkinson’s Dz has what percentage of dementia?

Answer 7

41% dementia prevalence

Needs to be distinguished from LBD but its very difficult

Question 8

Frontal temporal dementia

Answer 8

May account for 25% of presenile dementia (<65 yo)
Range of onset 20-80 year old, average 58
Progresses more rapidly than AD
Loss of social boundaries/awareness

Question 9

What is the hallmark of alzheimers?

Answer 9

Neurofibrillary tangles

Question 10

3 neurotransmitter deficit found with alzheimers

Answer 10

Acetylcholine
Norepinephrine
Serotonin

Question 11

Epidemiology of alzheimers

Answer 11

as early as in 4th decade
10% of 70 y/o have AD dementia
>50% of 80 y/o have AD dementia

Question 12

Risk factors for alzheimers

Answer 12

genetics
Age
Sex  
Prior head trauma 
Education
Vascular disease
DM
HTN
Down Syndrome
Smoking
Sedentary life style
Obesity

Question 13

what are the 3 realm of symptoms associated with alzheimers

Answer 13

emotional
behavioral
perceptual

Question 14

3 emotional symptoms of alzheimers

Answer 14

Depression
Apathy
Anger

Question 15

2 perceptual symptoms of alzheimers

Answer 15

Delusions
Hallucinations
Sensory

Question 16

5 behavioral symptoms of alzheimers

Answer 16

Problems at work*
Irritability
Lack of sleep
Eating disruption
Euphoria

Question 17

Deceased function in memory, language, learning and ADLs, iADLS is considered what?

Answer 17

advanced neurocognitive disorder

Question 18

Vascular dementia risk factors

Answer 18

Hypertension
T2 DM
Presents with cognitive deficits (infarts= globally)

Question 19

Huntington’s disease

Answer 19

CHOREIFORM MOVEMENTS it’s dementia does not feature Agnosia, aphasia or apraxia
PD and Huntington’s are subcortical dementia: decreased Executive function, memory retrieval, visual-spatial, movement

Question 20

symptoms of frontal temporal dementia

Answer 20

Sociopathic tendencies, Pt has little insight
Obsessions
Psychosis
Motor apraxis
Progressive aphasia

Question 21

Must Rule out Reversible Dementias like what?

Answer 21

Normal Pressure Hydrocephalus (NPH)
Depression (pseudodementia)
Medication induced 
CNS neoplasm
Chronic Subdural hematomas

Question 22

symptoms of sundowning syndrome

Answer 22

Confusion, drowsiness, ataxia, accidental falls, agitation, restlessness

Question 23

etiology of sundowning syndrome

Answer 23

Dementia symptoms are exacerbated:
external stimuli, such as light and personal orienting are diminished
Other risk factors: VasDementia, Lewy Body Dementia
Overly sedated elderly (paradoxical effect of BZD
Dementia w/ delirium

Question 24

How do you prevent complications of dementia

Answer 24

Exercise!!!!
Meditation/stress reduction
Improved cardiovascular health improves cognition
Nutrition—Mediterranean Diet
Low level wine consumption
New learning!
HTN/DM and lipid control
Smoking cessation

Question 25

Non-cognitive Behavioral Symptoms and reason for most psych consultations

Answer 25

``` depression** Apathy Mood changes Inappropriate sexual behaviors Sleep disorders Psychosis (delusions, hallucinations, paranoia) Agitation Aggression Suicidal ideation Homocidal ideation Disruptive vocalization weight loss Decision incapability ```

Question 26

anticholinesterase inhibitor treatment for dementia

Answer 26

Aricept Good for mild to severe AD Razadyne Exelon

Question 27

Namenda treatment for dementia

Answer 27

moderate to severe AD | side effects: Headaches, Constipation, Confusion

Question 28

complications of dementia

Answer 28

``` Urosepsis Aspiration pneumonia Decubitus Ulcers w/bacteria Bacteremia Sepsis Osteomyelitis ```

Question 29

Prognosis for AD

Answer 29

~ 10 yrs after dx is made | Symptoms appear yrs before

Question 30

What is delirium

Answer 30

An acute change in consciousness, fluctuating between lucidity, confusion and mental obtundation, hallucinations

Question 31

Who is most often seen with delirium

Answer 31

high morbidity/mortality | Occurs in the older population most often

Question 32

risk factors for delirium

Answer 32

``` CVA, Dementia, TBI, Neoplasm Elderly Polypharmacy Withdrawing from addictive Rxs Alcohol misuse Medically compromised ```

Question 33

treatment of delirium

Answer 33

treat the cause