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Geriatrics 1 > Cognitive Assessment > Flashcards

Cognitive Assessment Flashcards

1
Q

______ is defined as a syndrome characterized by a decline in cognitive function sufficiency to cause impairment in social and occupational performance

A

Dementia

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2
Q

Another term for dementia

A

Major neurocognitive disorder

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3
Q

DSM-IV criteria for dementia

A

A1. Memory impairment
A2. At least one of the following: aphasia, apraxia, agnosia, disturbance in executive functioning
B. Above deficits cause significant impairment in social or occupational functioning & a significant decline from previous functioning
C. The cognitive effects do not occur exclusively during periods of delirium

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4
Q

DSM-V criteria for major neurocognitive disorder

A

A. Evidence of decline from previous level in the following:
- Learning & memory
- Language
- Executive function
- Complex attention
- Perceptual-motor
- Social cognition
B. The above interferes w/ ADLs
C. Deficits do not only occur in the context of delirium
D. Deficits not better explained by another mental disorder (e.g. MDD)

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5
Q

Will we always be able to tell between dementia & delirium?

A

No

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6
Q

Complaint of memory loss is likely associated with

A

Depression

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7
Q

What is an informant interview?

A

A brief eight-item questionnaire for informants (family)

- Appears to be sensitive for detecting dementia & cognitive impairment

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8
Q

8 components of the informant interview

A
  • Problems w/ judgement
  • Reduced interest in activities
  • Repeated questions, stories
  • Trouble learning how to use a tool or appliance
  • Forget correct month or year
  • Difficulty handling financial affairs
  • Difficulty remembering appts
  • Consistent problems with thinking or memory
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9
Q

Is the Informant interview more sensitive or specific

A

Sensitive

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10
Q

Diagnostic evaluation of dementia

A
  • CBC, glucose, urea nitrogen, electrolyte, Ca+, PO4, LFTs, TSH, serologic test for syphilis, HIV
  • CT of head
  • Neuropsych testing
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11
Q

Causes of REVERSIBLE dementia

A
  • Drugs
  • Neoplasm
  • Metabolic disorder
  • Depression
  • Trauma
  • Toxin
  • Alcoholism
  • Infection (HIV)
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12
Q

Causes of IRREVERSIBLE dementia

A
  • Alzheimer dz
  • Lewy body dementia
  • PD
  • Huntington
  • Vascular dementia
  • Infection
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13
Q

What causes 65% of dementia?

A

Alzheimer’s (AD)

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14
Q

At age ___, 53% of people have AD

A

95+

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15
Q

Is AD projected to increase or decrease

A

Increase (double by 2050)

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16
Q

What increases risk of delirium? (one thing)

A

Elective surgery

17
Q

DSM-V definition of delirium

A
  • Disturbance in attention & awareness
  • Develops acutely & tends to fluctuate
  • Additional disturbance in cognition (e.g. memory, language)
  • Not better explained by preexisting dementia
  • Not in face of severely reduced level of arousal or coma
  • Evidence of an underlying organic etiology/etiologies
18
Q

What is the name of the tool used to diagnose delirium

A

The confusion assessment method

19
Q

The confusion assessment method assesses 4 features

A
  1. Acute onset & fluctuating course
  2. Inattention
  3. Disorganized thinking
  4. Altered level of consciousness
20
Q

How do we determine a diagnosis with the confusion assessment method

A

Requires presence of 1 and 2 and either 3 or 4

  1. Acute onset & fluctuating course
  2. Inattention
  3. Disorganized thinking
  4. Altered level of consciousness
21
Q

Question used to assess 1. Acute onset & fluctuating course

A

Is there evidence of an acute change in mental status from baseline? Does it wax & wane?
(+) = yes

22
Q

Question used to assess 2. Inattention

A

Does the pt. have difficulty focusing attention?

(+) = yes

23
Q

Question used to assess 3. Disorganized thinking

A

Was the patient’s thinking disorganized or incoherent?

(+) = yes

24
Q

Question used to assess 4. Altered level of consciousness

A

What is the patient’s level of consciousness?
- Alert, lethargic, stupor, coma
(+) = any answer other than alert

25
Q

Who is at risk for delirium?

A
  • Advanced age
  • Cognitive impairment
  • Depression
  • Frailty
  • Impaired vision & hearing
  • Dehydration
  • Severe illness
  • Polypharmacy/psychoactive medications
26
Q

Delirium - onset

A

Abrupt (hours-days), waxing & waning course

27
Q

Dementia - onset

A

Insidious (months-yrs), progressive

28
Q

Delirium - attention & orientation

A

Impaired

29
Q

Dementia - attention & orientation

A

Preserved

- Can be altered in late stages

30
Q

Delirium - level of consciousness

A

Fluctuating, seems reduced

31
Q

Dementia - level of consciousness

A

Normal

32
Q

Delirium - speech & language

A

Incoherent, disorganized

33
Q

Dementia - speech & language

A

Impairments in word retrieval, naming, fluency, and comprehension

34
Q

Delirium - memory for recent & past events

A

Variable, fluctuating

35
Q

Delirium - memory for recent & past events

A

Impaired for recent events

- Can be impaired for later in late stages

Geriatrics 1 (8 decks)

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