Delirium and Dementia

Question 1

What are the differences between delirium and dementia?

Answer 1

Delirium is an acute disorder; reversible; toxic and metabolic causes are common; consciousness levels fluctuate.

Dementia is a chronic disorder; irreversible; level of consciousness is normal; toxic and metabolic causes are not common; aphasia is common.

Question 2

Delirium is more often characterized by ________-arousal, though the opposite can occur.

Answer 2

hypo

Question 3

Delirium is present in ________ percent of ICU patients.

Answer 3

60% - 80%

Question 4

Delirium predicts ________________.

Answer 4

mortality, a longer hospital stay, and increased likelihood of discharge to a nursing home

Question 5

The brain is exquisitely sensitive to __________ perturbations.

Answer 5

metabolic

Question 6

List some common causes for delirium – and the reasons.

Answer 6

Drugs and toxins (OTC, illicit, and prescription): side effects can precipitate acute brain dysfunction
Metabolic: the brain is “exquisitely sensitive” to metabolic disruptions
Infections and inflammatory states: inflammation agitates neuronal function
Lesions/masses: pressure on cerebrum induces dysfunction

Question 7

What things are useful in evaluating delirium?

Answer 7

Urine tox screen
BMP/CMP
CT/MRIs
History and physical
EEG

Question 8

What things should you consider in treatment of delirium?

Answer 8

First importance: Try to find and address its etiology.
Avoid daytime naps/sedation
Make the patient’s hospital room as human/familiar as possible (e.g., bring in pictures of family, a clock, a TV)

Question 9

Describe the defining criteria of dementia.

Answer 9

Dementia is an acquired and persistent impairment in function –that is of sufficient severity to impair social/occupational function – in at least three of the following areas: memory, visuospatial acumen, complex cognitive function, emotion, personality.

Question 10

What percent of dementia is caused by reversible etiologies?

Answer 10

10% - 20%

Question 11

Some of the causes of reversible dementia include _____________.

Answer 11

drugs and toxins; neoplasms; hydrocephalus; hypothyroidism; B12 deficiency; inflammatory disease; depression; and mTBIs

Question 12

What gene mutation has been correlated with late-onset Alzheimer’s?

Answer 12

Apolipoprotein E

Question 13

Frontotemporal dementia was formerly known as ____________.

Answer 13

Pick’s disease

Question 14

What cells are typically lost in Parkinson’s disease?

Answer 14

The dopaminergic cells of the substantia nigra

Question 15

Huntington’s disease often presents with ________________.

Answer 15

early personality changes, poor judgment, and antisocial behavior

Question 16

So far there has not been a case of human _________ disease (a condition of elk in Colorado).

Answer 16

wasting

Question 17

Impaired attention is characteristic of _____________.

Answer 17

delirium

Question 18

What is the best way to distinguish between psychoses and delirium?

Answer 18

Delirium presents with fluctuating states of consciousness, while psychoses do not.

Question 19

What is the accuracy of diagnosing Alzheimer’s based on clinical data?

Answer 19

90%

Question 20

Other than the cholinesterase inhibitors, what other drug is prescribed to those with Alzheimer’s?

Answer 20

Memantine –an NMDA antagonist

Question 21

The most salient feature of frontotemporal dementia is _____________.

Answer 21

change in personality

Question 22

Caudate atrophy presents in a disease with excessive repeats of which nucleotides?

Answer 22

CAG (this is Huntington’s)

Question 23

Incontinence, gait disruption, and personality changes may be a sign of ____________.

Answer 23

normal-pressure hydrocephalus –a reversible form of dementia

Question 24

Most cases of Creutzfeldt-Jakob disease are __________.

Answer 24

sporadic

Question 25

How many cases of Alzheimer’s are there in the U.S.?

Answer 25

5,000,000

Question 26

What are the four types of dementia?

Answer 26

Cortical (Alzheimer’s)
Sub-cortical (Parkinson’s)
White matter (Binswanger’s)
Mixed (multi-infarct)

Question 27

What is the prevalence of Alzheimer’s by age group?

Answer 27

65 - 85 = 5% - 10%

Older than 85 = 40%

Question 28

Describe the three stages of Alzheimer’s.

Answer 28

I: mild amnesia, apathy, anomia
II: marked amnesia, fluent aphasia, neuropsychiatric features, visuospatial problems
III: mutism, dementia, incontinence

Question 29

Which isoform of apolipoprotein E is protective? Which is detrimental?

Answer 29

2 = protective
4 = detrimental

Question 30

_________ percent of those with Parkinson’s develop dementia within 15 years.

Answer 30

Eighty

Question 31

Where is the substantia nigra?

Answer 31

The midbrain

Question 32

What is the pathology of Binswanger’s?

Answer 32

Vascular dementia that affects white matter (Blood White matter)

Question 33

What is the classic symptom of multi-infarct dementia?

Answer 33

Step-wise progression of dementia –indicating discrete strokes!

Question 34

CJD is characterized by ____________.

Answer 34

rapidly progressing dementia with myoclonus (rapid spasmodic jerks)