Dementia

Question 1

What’s included in the Mini-Cog?

Answer 1

1. remember 3 words, repeat to you
2. Draw clock and then add a time onto it (2 points)
3. Repeat 3 previous words (3 points)

Question 2

How to interpret Mini-cog scoring?

Answer 2

0-2 positive for dementia

3-5 negative

Question 3

If mini-cog is less or equal to 2, what’s the next step?

Answer 3

SLUMS, MOCA, MMSE

Question 4

What does SLUMS test for?

Answer 4

• Orientation, item recall, math, naming, clock, story comprehension

Question 5

How does SLUM score?

Answer 5

• HS graduates:

Question 6

When to refer patients to hospice

Answer 6

FAST score = 7, loss of speech, locomotion, and consciousness

Question 7

What’s classic features of AD?

Answer 7

Memory, language, visual-spatial disturbance, indifference, delusions, agitation

Question 8

What’s classic features of FTD?

Answer 8

Personality change, executive dysfunction, hyperorality, preservation (relative) of visual-spatial skills

Question 9

What’s classic features of LBD?

Answer 9

Visual hallucinations, delusions, EPS, fluctuating MS, sensitivity to antipsychotic meds

Question 10

What’s classic about vascular dementia?

Answer 10

Abrupt onset, stepwise deterioration, prominent aphasia, motor signs

Question 11

What’s included in the eval of dementia?

Answer 11

1. H & P
2. Functional Status
3. exclude Depression PHQ9
4. Eval MS: attention, immediate and delayed recall, remote memory, executive function

Question 12

Correct: Neuroimaging may detect 5% cases of clinical significant structural lesions would otherwise be missed

Answer 12

Correct

Question 13

FDG-PEC scan

Answer 13

if PFD is suspected, medicare covers

Question 14

Florbetapir F18 (amyvid)

Answer 14

FDA apporved for detection of amyloid plaque (scan), but medicare not cover

Question 15

What defines “mild cognitive impairment”?

Answer 15

• modest cognitive decline that does not interfere with “capacity for independence in everyday activities”
• MMSE 26-30; MOCA

Question 16

What defines “major” criteria?

Answer 16

Significant impairment is evident or reported and when it does interfere with a patient’s independence to the point that assistance is required

Question 17

What’s the prognosis with nursing home residents with advance dementia

Answer 17

70% die within 6 months of admission

Question 18

What are 4 non-cognitive symptoms of dementia?

Answer 18

1. Psychotic symptoms: 20%, delusion, hallucinations
2. Depressive: 40%, may precede onset of AD
3. Apathy
4. Agitation or Aggression: 80%

Question 19

Risk factors for Dementia - definitive

Answer 19

1. Age
2. APOE4 (whites)
3. AFib
4. Depression
5. Down syndrome
6. Fam Hx

Question 20

Possible risk factors for dementia

Answer 20

1. delirium
2. head trauma
3. heavy smoking
4. hypercholestrolemia
5. HTN
6. Lower education level
7. post menopausal HT

Question 21

Possible protectants

Answer 21

1. Antioxidants (vitamin E, beta carotene)
2. Mediterranean diet
3. Physical activites

Question 22

What are the common anticholinergic meds to avoid?

Answer 22

Benztropine, diphenhydramine, hydroxyzine, oxybutynin, TCAs, clozapine, and thioridazine

Question 23

What are 3 examples of cholinesterase inhibitor?

Answer 23

Galantamine, Rivastigmine, Donepezil

Question 24

How to treat mild to moderate AD pharmacologically?

Answer 24

Cholinesterase inhibitor/Donepezil++++ Vitamin E 2000IU/day

• only 10-25% show modest global impairment
• Less rapid cognitive decline
• Also benefit for LBD, Parkinson disease, and vascular dementia
• ADR: nvd, dyspepsia, anorexia, weight loss, leg cramps, bradycardia, syncope, insomnia, agitation

Question 25

How to treat moderate to severe AD pharmacologically?

Answer 25

Memantine alone or M + D

- ADR include: confusion, dizziness, constipation, and headache

Question 26

When to D/C cognitive enhancers?

Answer 26

FAST = 7 loss of speech, locomotion, and consciousness