B2.020 Big Case Mr. D

Question 1

what are the 3 d’s in differential diagnosis for ‘confusion’

Answer 1

delirium, dementia, depression

Question 2

what are the domains of normal aging?

Answer 2

attention, executive function, memory, language, visuospatial, psychomotor

Question 3

what is executive function?

Answer 3

tasks/judgements with complex sequences

i.e. finances, cooking a famous roast

Question 4

what does BADLs stand for?

Answer 4

basic activities of daily living

Question 5

what are the BADLs?

Answer 5

dressing, eating, ambulating, transferring, toileting, hygeine

Question 6

what does IADL stand for?

Answer 6

instrumental activities of daily living

Question 7

what are the IADLs?

Answer 7

shopping, housekeeping, accounting, food preparation/medications, transportation, telephone

Question 8

define delirium

Answer 8

acute disorder of attention and global cognitive function

Question 9

what percentage of delirium is estimated to go unrecognized?

Answer 9

70%

Question 10

where is delirium most commonly seen?

Answer 10

ICUs, inpatient units, nursing facilities

Question 11

what is the 1 year mortality after hospitalization that includes delirium?

Answer 11

35-40%

Question 12

what are the 4 features of the CAM criteria?

Answer 12

1: acute onset and fluctuating course
2: inattention
3: disorganized thinking
4: altered conciousness

Question 13

what are the 3 types of delirium?

Answer 13

hypoactive, hyperactive, mixed

Question 14

what is the primary etiology of delirium?

Answer 14

dysfunction of multiple brain regions and neurotransmitter systems

Question 15

what makes older adults more vulnerable to delirium?

Answer 15

age related changes in central neurotransmission, stress management, hormonal regulation, immune response

Question 16

what are some predisposing factors for delirium?

Answer 16

severe dementia, severe illness, major depression, sensory impairment, advanced age, history of delirium, depression, functional impairment

Question 17

what are precipitating factors for delirium?

Answer 17

major surgery, ICU stay, physical restraints, multiple psychoactive meds, metabolic derangement or infection, prolonged sleep deprivation, sleep meds

Question 18

what are some nonpharmacologic strategies for delirium treatment?

Answer 18

reorientation, family involvement, eyeglasses/hearing aides, sleep protocol, avoid physical restraints and immobilizations, ensure hydration

Question 19

is delirium reversible?

Answer 19

yes; can take several weeks

Question 20

define dementia

Answer 20

a progressive disease with cognitive or behavioral symptoms that interfere with function/ represent a decline in function and/or cannot be explained by delirium or another psychiatric disorder

Question 21

what are the domains of dementia?

Answer 21

memory, attention and executive function, language, visuospatial function, motor function, behavioral changes

Question 22

what are the primary types of dementia?

Answer 22

Alzheimers
vascular dementia
lewy body dementia
frontotemporal dementia
alcohol related dementia
normal pressure hydrocephalous
pseudodementia

Question 23

what is MCI?

Answer 23

mild cognitive impairment, can precede dementia

Question 24

what characterizes Alzheimer?

Answer 24

insidious onset, amnesia + language presentation/visuospatial presentation/executive dysfunction

Question 25

what characterizes depression?

Answer 25

high prevalence and underdiagnosed, risk factors: loss of social support, death of family/friends, changing social roles, physical limitations

Question 26

how does depression impact dementia?

Answer 26

an independent risk factor

Question 27

what is the gold standard in depression treatment?

Answer 27

medication and cognitive behavioral therapy