Dementia, Delirium, Depression

Question 1

Describe Dementia

Answer 1

• Acquired, persistent & progressive decline in cognition
• Involves deficit in 1 or more cognitive domains

Learning & memory
Language
Executive funciton
Complex attention
Perceptual motor
Social cognition

-deficit must represent a decline from prev lvl of function

Question 2

What is the most common form of Dementia?

Answer 2

Alzheimer’s Dementia

Question 3

Clinical Presentation Dementia

Answer 3

Difficult w/ 1 or more of the following:

• retaining new info
• handling complex task (balancing checkbook)
• reasoning
• spatial ability & orientation (lost in familiar place)
• lagnuage (word finding)
• behavior

Question 4

What do most Dementia pt NOT present with complaint of?

Answer 4

Memory loss

Question 5

Is self-reported or informant-reported memory loss a good predictor of later development of dementia?

Answer 5

Informant reported

Question 6

Who is more likely to complain of memory loss? Depressed or dementia pt?

Answer 6

Depressed pt

Question 7

Who is more likely to give up on a test? Depressed or dementia pt?

Answer 7

Depressed pt

Dementia pt often try hard to respond but w/ incorrect answers

Question 8

Can dementia and depression occur in the same patient?

Answer 8

Yes

Question 9

What type of neuroimaging should all dementia pt get during initial eval?

Answer 9

Non contrast head CT or MRI

Question 10

Agreement between (blank) and (blank) exam is strongly suggestive of dementia

Answer 10

Agreement between History & mental status exam is strongly suggestive of dementia

Question 11

What score of a Mini Mental Status Exam is suugestive of dementia/delirium?

Answer 11

<24

Question 12

What is a mini-cog test?

Answer 12

consist of clock drawing task (CDT) and an uncued recall of 3 unrelated words

Question 13

On a mini-cog test, what does recall of none of the words indicate?

Answer 13

Dementia

Question 14

On a mini-cog test, what does recall of all 3 words indicate?

Answer 14

No dementia

Question 15

On a mini-cog test, what does recall of 1 or 2of the words indicate?

Answer 15

Need to do clock drawing task

abnormal = demented
normal = not demented

Question 16

How do you manage a dementia pt?

Answer 16

Symptomatically

• oral nutritional supp w/ appetite stimulants, assisted feeding
• cognitive rehab (help to maintain memory and high cognitive function)
• exercise program (improve physical functioning or slow progression of functional decline)

Question 17

What are 3 classes of drugs do you NOT want to give a dementia pt as a 1st choice option?

Answer 17

• Antipsychotics
• Benzo
• sedative/hypnotics

Question 18

What is the classic triad of sx for alzheimer dementia (AD)?

Answer 18

Memory impairment**–insidious loss of memory
Visuospatial problems
Language impairment

Question 19

What is spared in AD?

Answer 19

Motor/sensory function spared until later stages

Question 20

What are some behavioral changes seen in AD pts?

Answer 20

• Apathy and irritability
• Depression
• Agitation
• Psychotic sx (delusions, hallucination, paranoia)

Question 21

Vascular Dementia presentation

Answer 21

• Step-wise decline in functioning
• sudden onset after stroke
• focal neuro sign on PE

Question 22

Which subtype of dementia is assoc w/ stroke?

A. alzheimer dementia
B. vascular dementia
C. lewy body dementia
D. frontotemporal dementia

Answer 22

Vascular dementia

each insult causes a step-wise decline in functioning

Question 23

What are the core features of lewy body dementia?

Answer 23

• PARKINSONISM
• Fluctuation in cognitive impairment
• Detailed visual hallucinations

Question 24

What are features of frontotemporal dementia?

Answer 24

• develops at early age (40’s)
• early changes in PERSONALITY AND BEHAVIOR
• spares memory

Question 25

Which subtype of dementia is assoc w/ parkinsonism? A. alzheimer dementia B. vascular dementia C. lewy body dementia D. frontotemporal dementia

Answer 25

C. Lewy body dementia

Question 26

Which subtype of dementia is assoc w/ personality changes? A. alzheimer dementia B. vascular dementia C. lewy body dementia D. frontotemporal dementia

Answer 26

Frontotemporal dementia

Question 27

Which subtype of dementia spares memory? A. alzheimer dementia B. vascular dementia C. lewy body dementia D. frontotemporal dementia

Answer 27

Frontotemporal dementia

Question 28

True or false, level of consciousness in dementia pt are impaired?

Answer 28

FALSE They have normal lvl of consciousness Delirium pt have fluctuating/reduced LOC

Question 29

What is the difference between the onset of delirium vs dementia?

Answer 29

``` Delirium = abrupt (hrs to day) Dementia = insidious, progressive ```

Question 30

What is the difference between the attention and orientation of delirium vs dementia?

Answer 30

``` Delirium = impaired Dementia = preserved (can be altered in later stages) ```

Question 31

What is the definiition of delirium?

Answer 31

Acute changes in mentation w/ fluctuating course Characterized by: - inattention - disorganized thinking - and/or altered LOC

Question 32

What is the #1 risk factor for delirium?

Answer 32

Dementia/cognitive impairment

Question 33

What is the most common reversible cause of delirium?

Answer 33

Medications

Question 34

What medication classes is NOT at high risk of causing delirium? A. Anticholinergics B. Benzo C. Beta-blockers D. Dopamine agonist

Answer 34

C. Beta-blockers

Question 35

What is the hallmark sign of delirium?

Answer 35

DISTRACTIBILITY | -can be seen in conversation

Question 36

True or false, delirium pt can appear quiet and withdrawn?

Answer 36

TRUE

Question 37

What assessment test is diagnostic for delirium? A. MMSE B. Mini-Cog C. Glasgow D. CAM

Answer 37

D. CAM (confusion assessment method)

Question 38

What should you do first, before giving pharmacologic therapy when managing a pt w/ delirium?

Answer 38

Try to "redirect pt" w/ behavioral/environemental strategies - reorientation, calendars, clocks - lights on/off during day/night - windows - family - hearing aids, glasses - avoid restraints

Question 39

What Pharm therapy do you want to use on a delirious pt?

Answer 39

Haloperidol

Question 40

Why do you want to be careful w/ using haloperidol? What can it cause?

Answer 40

Drug induced Parkinsonism

Question 41

What pt population is at highest risk for completing suicides?

Answer 41

White Men >65yo

Question 42

What are the 2 question used during screening that should be asked to assess for depression?

Answer 42

1. during past mo, have you been bothered by feeling down, depressed or hopeless? 2. during the past mo, have you been bothered by little interest or pleasure in doing things?

Question 43

What is the criteria for depression?

Answer 43

Persistence of anhedonia or depressed mood for 2wks w/ 4 or more of the following: - worthlessness or guilt - decrease ability to concentrate - fatigue - psychomotor agitation or retardation - insomnia or hypersomnia - changes in appetite or weight - recurrent thoughts or suicide or death

Question 44

What is the preferred class of meds to treat depression?

Answer 44

SSRIs - citalopram - escitalopram - setraline

Question 45

What is 1st line tx of depression before SSRIs?

Answer 45

Psychotherapy (CBT) and somatic therapy

Question 46

What is 1st line tx for pt at serious risk of suicide?

Answer 46

Electroconvulsive therapy | -highly effective in major depressive disorder and mania in older adults