Cognitive Disorders

Question 1

Define Dementia

Answer 1

a decline in cognitive functioning with global deficits. Level of consciousness is stable.

Question 2

Age prevalence for dementia

Answer 2

> 85years of age

Question 3

Most common causes of dementia

Answer 3

Alzheimer’s disease (65%) & vascular dementia (20%)

Question 4

Causes of Dementia

Answer 4

DEMENTIASS
Degeneratice diseases (Parkinson & Huntington), Endocrine (thyroid, parathyroid, pituitary, adrenal), Metabolic (alcohol, electrolytes, B12 deficiency, glucose, hepatic, renal, Wilson dx), Exogenous (heavy metals, CO, drugs); Neoplasia; Trauma (subdural hematoma); Infection (meningitis, encephalitis, endocarditis, syphilis, HIV, prion dx, Lyme dx); Affective Disorders (pseudodementia); Stroke/Structure(vasc, ischemia, vasculitis, NPH)

Question 5

4 A’s of Dementia

Answer 5

Progression of cognitive impairment: Amnesia, Aphasia, Apraxia (inability to perform motor activities), Agnosia (inability to recognize previously known objects/places/people)

Question 6

Sundowning

Answer 6

In dementia patients, when patients become more confused late in the day and at night

Question 7

Steps for diagnosing dementia

Answer 7

H&P, Serial MMSE; r/o treatable causes (get CBC, RPR, CMP, TFT, HIV, B12/folate, ESR, UA and head CT/MRI)

Question 8

Treatment Plan for dementia

Answer 8

provide environmental cues and structure for pt’s daily life; Cholinesterase inhibitors; low-dose antipsychotics (agitation); education to patient and caregiver

Question 9

Risk of using low-dose antipsychotic in elderly dementia patients

Answer 9

CV risks

Question 10

Drug to avoid in dementia patients

Answer 10

Avoid Benzodiazepines

Question 11

Major causes of delirium

Answer 11

I WATCH DEATH
Infection; Withdrawal; Acute metabolic/substance Abuse; Trauma; CNS path; Hypoxia; Deficiencies; Endocrine; Acute vasc/MI; Toxins/drugs; Heavy metals

Question 12

Define delirium

Answer 12

Acute disturbance of consciousness with altered cognition that develops in hours-days

Question 13

Who are most susceptible to delirium?

Answer 13

Children, elderly, hospitalized patients (ICU psychosis)

Question 14

Common disease in elderly that can cause delirium

Answer 14

Occult UTI

Question 15

Treatment for delirium

Answer 15

Treat underlying causing, normalize fluids and electrolytes, optimize sensory environment, use low-dose anti-psychotics (haloperidol) for agitation, physical restraints if necessary

Question 16

Consciousness in delirium vs dementia

Answer 16

delirium has clouded consciousness, dementia has intact consciousness

Question 17

Onset of delirium vs dementia

Answer 17

delirium is acute onset, dementia is gradual onset

Question 18

Level of attention in delirium vs dementia

Answer 18

Delirium is impaired or fluctuating attn

Dementia patients are alert