Dementia, Delirium, Depression Flashcards Preview

Cin Med IV Exam 2 > Dementia, Delirium, Depression > Flashcards

Flashcards in Dementia, Delirium, Depression Deck (46):
1

Describe Dementia

-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

2

What is the most common form of Dementia?

Alzheimer's Dementia

3

Clinical Presentation Dementia

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

4

What do most Dementia pt NOT present with complaint of?

Memory loss

5

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

Informant reported

6

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

Depressed pt

7

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

Depressed pt

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

8

Can dementia and depression occur in the same patient?

Yes

9

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

Non contrast head CT or MRI

10

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

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

11

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

<24

12

What is a mini-cog test?

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

13

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

Dementia

14

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

No dementia

15

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

Need to do clock drawing task

abnormal = demented
normal = not demented

16

How do you manage a dementia pt?

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)

17

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

-Antipsychotics
-Benzo
-sedative/hypnotics

18

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

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

19

What is spared in AD?

Motor/sensory function spared until later stages

20

What are some behavioral changes seen in AD pts?

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

21

Vascular Dementia presentation

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

22

Which subtype of dementia is assoc w/ stroke?

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

Vascular dementia

each insult causes a step-wise decline in functioning

23

What are the core features of lewy body dementia?

-PARKINSONISM
-Fluctuation in cognitive impairment
-Detailed visual hallucinations

24

What are features of frontotemporal dementia?

-develops at early age (40's)
-early changes in PERSONALITY AND BEHAVIOR
-spares memory

25

Which subtype of dementia is assoc w/ parkinsonism?

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

C. Lewy body dementia

26

Which subtype of dementia is assoc w/ personality changes?

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

Frontotemporal dementia

27

Which subtype of dementia spares memory?

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

Frontotemporal dementia

28

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

FALSE

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

29

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

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

30

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

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

31

What is the definiition of delirium?

Acute changes in mentation w/ fluctuating course

Characterized by:
-inattention
-disorganized thinking
-and/or altered LOC

32

What is the #1 risk factor for delirium?

Dementia/cognitive impairment

33

What is the most common reversible cause of delirium?

Medications

34

What medication classes is NOT at high risk of causing delirium?

A. Anticholinergics
B. Benzo
C. Beta-blockers
D. Dopamine agonist

C. Beta-blockers

35

What is the hallmark sign of delirium?

DISTRACTIBILITY
-can be seen in conversation

36

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

TRUE

37

What assessment test is diagnostic for delirium?

A. MMSE
B. Mini-Cog
C. Glasgow
D. CAM

D. CAM (confusion assessment method)

38

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

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

39

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

Haloperidol

40

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

Drug induced Parkinsonism

41

What pt population is at highest risk for completing suicides?

White Men >65yo

42

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

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?

43

What is the criteria for depression?

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

44

What is the preferred class of meds to treat depression?

SSRIs
-citalopram
-escitalopram
-setraline

45

What is 1st line tx of depression before SSRIs?

Psychotherapy (CBT) and somatic therapy

46

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

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