5.3 - Diagnosing Dementia Flashcards
How do Physicians diagnose dementia?
4
Taking and extensive history from the patient and his/her family
Closely observing the patient
Performing a physical exam
Performing mental status and psychological tests
What 4 things are included in a Patient History in patients with Dementia?
ADL’s
IADL’s
Independent family functioning – community affairs
Other
What are 2 examples of IADL’s?
Everyday problem solving
Business and financial affairs
What are 4 examples of Independent Family Functioning – Community Affairs?
Job responsibilities
Shopping
Volunteer
Social groups
What are 2 Other Subjects that we might patients during a patient history for dementia?
Hobbies
Personal care
What 5 things are included in an Exam when diagnosing dementia?
Cognitive domains
Aphasia
Apraxia
Agnosia
Executive functioning
What are 2 Diagnostic Approaches to Dementia?
Neuroradiologic Studies
Clinical Neurobehavioral Exams (Primary data for diagnosis)
Who can assist in Differentiation of Dementias?
5
Clinicians
Neuroradiologists
Neuropathologists
Geneticisits
Microbiologists
How do Clinicians assist in differentiation of dementias?
Clinical signs and symptoms
How do Neuroradiologists assist in differentiation of dementias?
Static images of brain structure and dynamic images of brain metabolism
How do Neuropathologists assist in differentiation of dementias?
Postmortem analysis of brain tissue
How do Geneticisits assist in differentiation of dementias?
Families where disease or disease cluster appear
How do Microbiologists assist in differentiation of dementias?
Chromosomes to mutations in specific genes
What are 5 categories of symptoms that are used to evaluate Dementia?
Impaired cognition
Impaired function
Mood/mental Phenomena
Behaviors
Drives
What kinds of items are included in the Impaired Cognition category when evaluating dementia?
(12)
Memory
Language
Orientation
Writing + Reading
Calculating
Recognizing
Attention
Concentration
Planning + Organizing
Personality Change
Executing
Social Rules
What kinds of items are included in the Impaired Function category when evaluating dementia?
(11)
Cooking
Finances
Housekeeping
Shopping
Driving
Hearing + Sight
Dressing
Mobility (Falls)
Bathing + Grooming
Feeding
Continence
What kinds of items are included in the Mood/Mental Phenomena category when evaluating dementia?
(21)
Depression
Self-Deprecation
Somatic Complaints
Crying Spells
Diurnal Variation
Withdrawn
Anxiety
Fatigues Easily
Death/Suicidal
Disinterest
Anhedonic (unable to find pleasure in activities)
Low Energy Level
Apathy
Panic
Lability
Irritable
Euphoria
Delusions
Illusions
Rapid Speech
Hallucinations
Acute Confusion
What kinds of items are included in the Behaviors category when evaluating dementia?
(12)
Verbal Abuse
Uncooperation
Physically Aggressive
“Sundowning” (confusion seen late in the day)
Demands Interaction
Outbursts
Catastrophic
Noisy
Wandering
Hoarding + Rummaging
Sexual Aggression
Intrusive
What kinds of items are included in the Drives category when evaluating dementia?
(8)
Poor Appetite
Weight Loss
Excessive Appetite
Hypersexuality
Hyposexuality
Sleeping Poorly
Excessive Sleep
Out of Bed at Night
What are 4 Standardized Screening Tools for Dementia?
Mini Mental Status Exam (MMSE)
Clinical Dementia Rating Scale
Blessed Dementia Scale
Global Deterioration Scale
What is the Gold Standard for screening dementia?
Mini Mental Status Exam (MMSE)
What is the Mini Mental Status Exam (MMSE)?
Brief, standardized exam of cognitive status
How long does it take to administer the Mini Mental Status Exam (MMSE)?
~ 10 minutes
What does the Mini Mental Status Exam (MMSE) assess?
5
Orientation
Attention
Immediate and short term recall
Language
Ability to follow simple verbal + written commands
What score on the Mini Mental Status Exam (MMSE) indicates cognitive impairment?
Less than 24
What is the Clinical Dementia Rating Scale?
A 5-point scale used to characterize six domains of cognitive + functional performance
What are the 6 domains examined in the Clinical Dementia Rating Scale?
Memory
Orientation
Judgement + Problem Solving
Community Affairs
Home + Hobbies
Personal Care
How are the 6 domains rated in the Clinical Dementia Rating Scale?
By the clinician based on a patient interview
What are the final scores that can be given on the Clinical Dementia Rating Scale?
0 = Normal 0.5 = Very Mild Dementia 1 = Mild Dementia 2 = Moderate Dementia 3 = Severe Dementia
What is the Blessed Dementia Scale?
2
Family member report
Estimation of ADL ability in 8 areas
How is the Blessed Dementia Scale scored?
Behavior + personality ratings
What is the maximum score on the Blessed Dementia Scale?
28
What is an unimpaired rating on the Blessed Dementia Scale?
Mild impairment?
Moderate to severe impairment?
<4=unimpaired
4-9= mild
10 or greater = mod - severe
used
What is the Global Deterioration Scale?
A rating of 7 levels of dementia
How is the Global Deterioration Scale scored?
2
Rating completed by a clinician after patient interview
Ratings based on general descriptions
What 3 assessments can be used to evaluate dementia?
Arizona Battery for Communication Disorders of Dementia (ABCD)
Cognitive-Linguistic Quick Test
Functional Linguistic Communication Inventory
How many Screening Subtests are in the Arizona Battery for Communication Disorders of Dementia (ABCD)?
4
What are the 4 Screening Subtests in the Arizona Battery for Communication Disorders of Dementia (ABCD)?
Speech Discrimination
Visual Perception and Literacy
Visual Field
Visual Agnosia
How many Subtests are in the Arizona Battery for Communication Disorders of Dementia (ABCD)?
14
Can the Subtests in the Arizona Battery for Communication Disorders of Dementia (ABCD) be administered in isolation?
Yes
How does the Arizona Battery for Communication Disorders of Dementia (ABCD) need to be administered when the whole test is given?
In the order presented in
manual
How long does the Arizona Battery for Communication Disorders of Dementia (ABCD) take to administer?
45-90 minutes
Who is the Arizona Battery for Communication Disorders of Dementia (ABCD) recommended for?
Individuals with mild dementia
What is the Cognitive-Linguistic Quick Test used for?
To quickly I.D. strengths and weaknesses in five cognitive domains
What 5 cognitive domains are assessed in the Cognitive-Linguistic Quick Test?
Attention
Memory
Executive functions
Language
Visuospatial skills
How long does the Cognitive-Linguistic Quick Test take to administer?
5 to 30 minutes
Where can the Cognitive-Linguistic Quick Test be administered?
At a table or bedside
What is one benefit of the Cognitive-Linguistic Quick Test?
It is available in both English and Spanish
What was the Functional Linguistic Communication Inventory designed to quantify?
Functional linguistic communication skills in moderately and severely demented individuals
How many areas are targeted in the Functional Linguistic Communication Inventory?
10
How long does it take to administer the Functional Linguistic Communication Inventory?
~30 minutes
What tests can we use to test Language Ability in patients with Dementia?
BDAE (Boston Diagnostic Aphasia Examination)
BNT (Boston Naming Test)
PPVT (Peabody Picture Vocabulary Test)
TACL (Test for Auditory Comprehension of Language)
DCT (Discourse Completion Test)
Do we use language tests to diagnose dementia?
No. Only to test specific language domains.
