Dementia and Delirium - Goebel

Question 1

what is the most common type of dementia

Answer 1

Alzheimer’s disease

Question 2

what is the life expectancy of Alzheimer’s disease?

Answer 2

variable
older diagnosis = faster progression
10 years from diagnosis until death

Question 3

what is the average life expectancy once end-stage disease is reached

Answer 3

average 1 year or less

Question 4

what is the most likely diagnosis if a patient cannot cary our activities of daily living? and if they can?

Answer 4

Alzheimer’s disease

Mild cognitive impairment

Question 5

what type of memory gets impacted the most in Alzheimer’s

Answer 5

short term more than long term

Question 6

what protein is found in plaques

Answer 6

beta amyloid

Question 7

what protein is found in neurofibrillary tangles

Answer 7

tau hyperphosphorlyation

Question 8

when do plaques develop during the Alzheimers

Answer 8

long pre-clinical phase

Question 9

tangles, and synaptic loss, accelerate during what phase of Alzheimer’s

Answer 9

before symptomatic phase appears

Question 10

what is the progression for vascular type of neurocognitive disorder

Answer 10

step-wise

Question 11

Lewy body has symptoms of what? how is this different form Parkinson’s

Answer 11

both dementia and Parkinson’s disease

- symptoms present at the same time unlike Parkinson’s

Question 12

what is the hallmark clinical presentation of Lewy Body

Answer 12

Visual Hallucinations and falls

Question 13

what is the pathophysiology of Picks disease

Answer 13

too much or abnormal tau protein

tau bodies

Question 14

who usually gets Picks disease

Answer 14

younger onset

Question 15

what does Picks present clinically

Answer 15

behavior, emotional and language changes

Question 16

normal pressure hydrocephalus, what is the clinical feature

Answer 16

Wacky, wet, wobbly

memory loss, incontinence, unsteady gait

Question 17

what infections cause neurocognitive disorder

Answer 17

HIV
Syphilis
Creutzfel-Jakob-prion

Question 18

what deficiencies cause neurocognitive diorder

Answer 18

B12

hypothyroidism

Question 19

what substance abuse is found to lead to neurocognitive disorder

Answer 19

chronic alcohol use

Korsakoff’s syndrome-thiamine

Question 20

name 3 clinical memory tests

Answer 20

mini-cog
mini-mental status exam
montreal cognitive assessment (MOCA)

Question 21

what are the minimum lab studies that one needs to do for neurocognitive disorder

Answer 21

CBC
CCP
B12
TSH

Question 22

what imaging is done for neurocognitive disorders

Answer 22

CT without contrast

Question 23

what early onset genes can get mutated for Alzheimer’s ? what chromosomes are they located on

Answer 23

amyloid percursor protein (Chr21)
presenilin 1 (Chr14)
Presenilin 2 (Chr1)

Question 24

what is the late onset gene gets mutated for Alzheimers

Answer 24

APOE gene e4

Question 25

what is the biggest risk factor for Alzheimers

Answer 25

age

Question 26

what are 4 risk factors for Alzheimer's

Answer 26

hypertension Diabetes hypercholesterolemia smoking

Question 27

when do yo not give medications to an Alzheimer's patient

Answer 27

when they are bed bound

Question 28

what type of drug is Memantine

Answer 28

N methyl D aspartate receptor inhibitor | glutamate pathway

Question 29

what are 2 things that one can do to prevent Alzheimer's

Answer 29

no smoking | control blood pressure

Question 30

what neurocognitive disorder am I? | short term memory loss, gradual decline

Answer 30

Alzheimer's disease

Question 31

what neurocognitive disorder am I? | hallucinations/falls

Answer 31

lewy body

Question 32

what neurocognitive disorder am I? | stepwise decline

Answer 32

vascular

Question 33

what neurocognitive disorder am I? | behavior, speech, younger

Answer 33

picks

Question 34

what neurocognitive disorder am I? | wacky, wet, wobbly

Answer 34

normal pressure hydrocephalus

Question 35

What is the DSM-5 definition for Delirium

Answer 35

inattention | acute onset or fluctuating

Question 36

what is used to diagnose Delirium

Answer 36

CAM | confusion assessment method

Question 37

Diagnosis criteria using CAM ?

Answer 37

Both acute onset and fluctuating course and inattention needs to be present OR Both disorganized thinking or altered level of consciousness

Question 38

what is the mortality of Delirium

Answer 38

overall one year mortality - 35-40%

Question 39

What are patient risk factors for Delirium

Answer 39

male; functional impairment over 65; lack of physical activity dementia; alcohol abuse depression; vision problems terminal illness ; hearing loss polypharmacy; can't do ADLs

Question 40

what are etiologies of Delirium

Answer 40

``` Drugs, drugs, drugs! Electrolyte/endocrine disturbances lack of drugs ( ETOH withdrawal) infection reduced sensory input intracranial urinary, fecal major organ system issues ```

Question 41

what are surgeries can precipitate Delirium? When is it seen? what is the cause?

Answer 41

``` orthopedic surgery AAA repair thoracic surgery post op day 1 or 2 blood loss ```

Question 42

what are the basic evaluations that are done for Delirium

Answer 42

history: medication history, alcohol, illicit drug use physical exam: vital signs targeted labs: cbc, chem

Question 43

when do you give medication treatment for Delirium

Answer 43

severe agitation only

Question 44

what is the first line drug treatment for Delirium

Answer 44

haloperidol

Question 45

what is the alternate 1st line drug used to treat Delirium

Answer 45

atypical antipsychoitcs - Risperidone, olanzapine, quetiapine

Question 46

what is the second line treatment for Delirium? what type of patients take this drug and side effects?

Answer 46

Benzadiazepine- Iorazepam for ETOH and sedative withdrawal patients worsen other delirium syndromes

Question 47

what are 3 key features of delirium that differentiates it from dementia

Answer 47

acute onset impaired attention altered level of consciousness

Question 48

what protein is found in Lewy Body

Answer 48

Alpha Synuclein