Confusion in the elderly

Question 1

True or false: cognitive decline is probably the most common area that a geriatrician will be consulted about?

Answer 1

True

Question 2

What are the two types of confusion?

Answer 2

Acute and chronic

Question 3

What is dementia?

Answer 3

A syndrome characterized by an impairment in two or more intellectual or cognitive functions despite a state of clear consciouness

Question 4

How do you distinguish between dementia from delirium?

Answer 4

Dementia is persistent and stable

Question 5

True or false: any acute change in mental status is delirium until proven otherwise

Answer 5

True

Question 6

What is the first step in evaluating cognitive decline?

Answer 6

Comprehensive H&P

Question 7

What is the Folstein mini mental exam?

Answer 7

Rough test of mental ability

Question 8

What are the lab tests that are not obvious to get to evaluate for dementia? (3)

Answer 8

VDRL
B12
Homocysteine levels

Question 9

What is the DEMENTIAS mnemonic?

Answer 9

Drugs
Emotional disease
Metabolic disorders
Endocrine disease
Nutrition & degenerative neurologic disease
Trauma/tumor
Ischemia and infection
Anorexia/anemia/arrhythmia
Sjogren's, social, sensory deprivation

Question 10

What are the four daignoses that account for most cases of dementia in industrialized countries?

Answer 10

1. Alzheimers
2. Diffuse lewy body disease
3. Vascular dementia
4. Frontotemporal dementia

Question 11

What is agnoisa?

Answer 11

Difficulty recognizing things

Question 12

What is apraxia?

Answer 12

Inability to carry out motor functions

Question 13

What is aphasia?

Answer 13

Difficulty naming familiar items

Question 14

What is amnesia?

Answer 14

Initially short term memory

Question 15

What are the pathological hallmarks of alzheimer’s?

Answer 15

Fibrillary tangles

Question 16

What is Lewy body dementia?

Answer 16

Intraneuronal inclusions that contain alpha-synuclein, phosphorylated neurofilament proteins, and ubiquitin

Question 17

What are the two neurotransmitters that we attempt to upregulate?

Answer 17

Ach

Glutamate

Question 18

What are the four clinical features of Lewy body dementia?

Answer 18

1. Dementia
2. Fluctuating cognition
3. Recurrent visual hallucinations
4. Motor features of parkinsons

Question 19

Fluctuating cognition is characteristic of what disease?

Answer 19

Lewy body dementia

Question 20

What is the treatment of Lewy body dementia?

Answer 20

Ach esterase inhibitors

Question 21

What is vascular dementia?

Answer 21

Caused by decreased blood flow to the brain with significant enough brain damage to cause cognitive impariment

Question 22

What is the presentation of vascular dementia?

Answer 22

Stepwise deterioration

Question 23

What are frontotemporal disorders?

Answer 23

A heterogenous group of disorders that are less common than AD, DLBD, and vascular demnentia

Question 24

What are the findings of Pick’s disease, the most common frontotemporal disorder?

Answer 24

Focal atrophy of the frontal and temporal lobes, along with microscopic findings of argyrophilic inclusions and swollen, achromatic neurons

Question 25

Disinhibition in dementia = ?

Answer 25

Pick’s disease