5.3 - Diagnosing Dementia Flashcards by Keco Voco

How do Physicians diagnose dementia?

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

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What 4 things are included in a Patient History in patients with Dementia?

ADL’s

IADL’s

Independent family functioning – community affairs

Other

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What are 2 examples of IADL’s?

Everyday problem solving

Business and financial affairs

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What are 4 examples of Independent Family Functioning – Community Affairs?

Job responsibilities

Shopping

Volunteer

Social groups

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What are 2 Other Subjects that we might patients during a patient history for dementia?

Hobbies

Personal care

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What 5 things are included in an Exam when diagnosing dementia?

Cognitive domains

Aphasia

Apraxia

Agnosia

Executive functioning

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What are 2 Diagnostic Approaches to Dementia?

Neuroradiologic Studies

Clinical Neurobehavioral Exams (Primary data for diagnosis)

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Who can assist in Differentiation of Dementias?

Clinicians

Neuroradiologists

Neuropathologists

Geneticisits

Microbiologists

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How do Clinicians assist in differentiation of dementias?

Clinical signs and symptoms

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How do Neuroradiologists assist in differentiation of dementias?

Static images of brain structure and dynamic images of brain metabolism

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How do Neuropathologists assist in differentiation of dementias?

Postmortem analysis of brain tissue

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How do Geneticisits assist in differentiation of dementias?

Families where disease or disease cluster appear

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How do Microbiologists assist in differentiation of dementias?

Chromosomes to mutations in specific genes

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What are 5 categories of symptoms that are used to evaluate Dementia?

Impaired cognition

Impaired function

Mood/mental Phenomena

Behaviors

Drives

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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

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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

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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

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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

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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

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What are 4 Standardized Screening Tools for Dementia?

Mini Mental Status Exam (MMSE)

Clinical Dementia Rating Scale

Blessed Dementia Scale

Global Deterioration Scale

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What is the Gold Standard for screening dementia?

Mini Mental Status Exam (MMSE)

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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?

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?

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)?

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)?

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?

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.