Dementia and Delirium

Question 1

disorder that is characterized by a decline in cognition involving one or more cognitive domains

Answer 1

dementia

Question 2

most common form of dementia

Answer 2

alzheimer’s (60-80%)

Question 3

How many areas of cognition need to be impaired for diagnosis of Alzheimer’s?

Answer 3

two

Question 4

Earliest sign of Alzheimer’s

Answer 4

short-term memory loss

Question 5

MRI finding that suggests AD

Answer 5

bilateral hippocampal atrophy

Question 6

Scoring assessment of mini-mental status exam (MMSE)

Answer 6

20-26: mild functional dependence. 10-20: moderate dependence. Score < 10: severe, total dependence

Question 7

Neuropathological hallmarks of AD

Answer 7

Amyloid-rich senile plaques, Neurofibrillary tangles, Neuronal degeneration

Question 8

most common functioning deficit for patient’s at stage 4 of AD

Answer 8

decreased ability to manage instrumental (complex) activities of daily life.

Question 9

characteristic functional change of stage 5 of AD

Answer 9

deficits in basic activities of daily life and can’t recall major events

Question 10

characteristic function changes of stage 6 of AD

Answer 10

cannot perform basic activities without help and cannot live at home without assistance. lasts 2.5 yrs

Question 11

characteristic function changes of stage 7 of AD

Answer 11

inability to speak, walk, or sit up on their own. lasts 1 yr

Question 12

most frequent cause of death of AD

Answer 12

aspiration pneumonia

Question 13

MOA of cholinesterase inhibitors

Answer 13

curb the breakdown of acetylcholine

Question 14

What is the only tx approved by FDA for all stages of Alzheimer’s?

Answer 14

Donepezil (Aricept)

Question 15

Cholinesterase Inhibitors

Answer 15

Donepezil (Aricept), Rivastigmine (Exelon)‏, Galantamine (Reminyl)/Razadyne

Question 16

Cholinesterase inhibitor CI with severe renal or hepatic impairment

Answer 16

Galantamine (Reminyl)/Razadyne

Question 17

MOA of NMDA receptor antagonists

Answer 17

protective role in the brain by regulating the activity of a glutamate.

Question 18

NMDA receptor antagonists

Answer 18

Memantine (Namenda)‏

Question 19

Supplement that may be helpful with Alzheimers due to antioxidant properties

Answer 19

vitamin E

Question 20

SSRIs recommended for AD to treat depression or behavioral sx

Answer 20

sertraline (Zoloft), Paroxetine (Paxil), Citalopram (Celexa)

Question 21

Anxiolytics helpful for anxiety, restlessness, verbally disruptive behavior and resistance in AD

Answer 21

lorazepam (Ativan) and oxazepam (Serax)

Question 22

Pattern of deterioration associated with vascular dementia compared to AD

Answer 22

vascular is abrut, fluctuating or stepwise deterioration whereas AD is progressive

Question 23

Characterized by focal atrophy of the frontal and temporal lobes

Answer 23

frontotemporal dementia

Question 24

Characterized pathologically by the presence of Pick bodies in the neocortex and hippocampus.

Answer 24

Pick’s disease (subtype of FTD)

Question 25

Onset of FTD

Answer 25

35-75 yrs

Question 26

A condition of pathologically enlarged ventricular size with normal opening pressures on lumbar puncture

Answer 26

Normal-Pressure Hydrocephalus

Question 27

Triad of Normal-Pressure Hydrocephalus

Answer 27

dementia, gait disturbance, and urinary incontinence

Question 28

TX of normal-pressure hydrocephalus

Answer 28

placement of a ventriculoperitoneal shunt

Question 29

Miller Fisher Test used to assess for normal pressure hydrocephalus

Answer 29

objective gait assessment before and after removal of 30 cc CSF. Will improve after removal of CSF

Question 30

dementia accompanied by delirium, visual hallucinations, and parkinsonism

Answer 30

Dementia with Lewy Bodies

Question 31

cardinal motor features of parkinson’s

Answer 31

bradyakinesia, rigidity, resting tremor, postural instability

Question 32

How do you differentiate between parkinson’s dementia and DLB?

Answer 32

Dementia typically occurs in the last half of the clinical course of PD, whereas it is often one of the presenting features of DLB

Question 33

Restricted up-and-down eye movement (vertical gaze palsy) is a hallmark of this disease

Answer 33

Progressive supranuclear palsy (aka Steele Richardson Olszewski syndrome)

Question 34

How do you differentiate between progressive supranuclear palsy and Parkinson’s?

Answer 34

Patients with PSP stand straight or occasionally even tilt their heads backward, while those with Parkinson’s disease usually bend forward

Question 35

Etiology of Creutzfeldt-Jacob Disease (aka mad cow)

Answer 35

prion contracted by consuming mat’l from infected animals

Question 36

Infections that can cause dementia

Answer 36

syphilis and HIV

Question 37

medications associated with torsades de pointes and sudden death due to lengthened QT interval

Answer 37

haloperidol and inapsine

Question 38

Treatment of choice for delirium due to benzodiazepine or alcohol withdrawal

Answer 38

benzos

Question 39

Percent of patients with delirium who die within 6 months

Answer 39

25%

Question 40

Characteristics of delirium that differ from dementia

Answer 40

acute, reversible, attn impaired, range of LOC from lethargic to hyperalert, varied effect on memory