29-dementia

Question 1

DSM V Criteria for Major Neurocognitive Disorder (previously termed “dementia”)

Answer 1

A. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains: attention, , learning/memory, language, social cog, perceptual -motor

B. interfere with at least IADLS

C. not in context of delirium

D. not better explained by another mental disorder

Question 2

labs to order to rule out physical causes of dementia

Answer 2

CBC, CMP
calcium
thyroid
vitamin B12 deficiency testing
Folate deficiency 
RPR

CT or MRI

Question 3

what do white matter changes found on MRI indicate?

Answer 3

They represent microvascular disease, which may be caused by hypertension, smoking, obesity or simply by aging.

Commonly found in asymptomatic individuals and are often felt to be clinically irrelevant.

Question 4

Clinical Dementia Rating 5 point scale (0-3)

Answer 4

0: No cognitive impairment
0. 5: Very mild dementia
1: Mild dementia
2: Moderate dementia
3: Severe dementia

Question 5

Which bedside instruments used for diagnosing delirium does evidence best support?

Answer 5

Confusion Assessment Method (CAM)

Question 6

Causes of delirium

Answer 6

UTI
Urinary retention (BPH)
Resp infection
electrolyte dysfunction
Pain
Depression
CV events
Adverse drug effects
withdrawal

Question 7

air-bronchograms are pathognomonic for

Answer 7

pneumonia

Question 8

Hospital Interventions That Can Prevent or Minimize Delirium

Answer 8

Frequent reorientation and redirection by a familiar provider (eg. one-to-one sitter instead of restraints)

Avoid medications that can lead to delirium

Provide early mobility and range of motion exercises

Minimize unnecessary lines, cables, and catheters

Provide increased stimulation- lighting! hearing aids!

Question 9

max of acetaminophe dose

Answer 9

3-4 g

Question 10

meds to help with Alzheimer’s

Answer 10

Four cholinesterase inhibitors (donepezil, rivastigmine, tacrine and galantamine)

memantine

atypical antipsychotics for behavioral disturbance

Question 11

vitamin E and AD

Answer 11

controversial

delay in the onset of death, institutionalization, or progression to severe dementia

Question 12

memantine MOA

Answer 12

NMDA receptor antagonist

Question 13

does Cognitive rehabilitation therapy help AD?

Answer 13

no evidence