Dementia & Delirium (4-16-14)

Question 1

Second MC cause of dementia after 65yo?

Answer 1

dementia w/ lewy bodies (DLB) = 15-20%

Question 2

MC cause dementia before 65?

Answer 2

frontotemporal dementia (FTD) = 5-9%
pick's disease is a type of FTD (behavioral subtype)

Question 3

MC cause of dementia after 65?

Answer 3

AD

Question 4

AD starts in the…

Answer 4

entorhinal cortex (medial temporal lobe) 
then proceeds to the hippocampus

Question 5

first sign of AD

Answer 5

memory loss

Question 6

abnormal aggregation of the presynaptic protein alpha-synuclein

Answer 6

dementia w/ lewy bodies (DLB)

Question 7

how do you distinguish between patient w/ DLB (dementia w/ lewy bodies) or PD (Parkinson’s disease)?

Answer 7

DLB = dementia w/i 1 yr of parkinsonium 
PD = no dementia in 1st year of parkinsonium

Question 8

Parkinson’s presents w/

Answer 8

movement disorders

Question 9

what presents w/ visual hallucinations?

Answer 9

DLB

Question 10

fluctuating cognition = lucid for period of time then go back to being demented

Answer 10

DLB

Question 11

DLB symptoms

Answer 11

sleep problems = act out dreams
visual hallucinations (affects posterior brain) 
delusions 
fluctuating cognition = switch btwb dementia and lucid
autonomic failure = syncope orthostatic hypotension

Question 12

frontotemporal dementia onset

Answer 12

happens at an early age

Question 13

temporal poles used for

Answer 13

naming things

semantic memory

Question 14

subcortical scans are useful for

Answer 14

PD, DLB

low DA binding in striatum

Question 15

Huntington’s age onset? dementia?

Answer 15

40s

dementia

Question 16

what is delirium

Answer 16

confusional state

state of consciousness between normal alertness and coma

Question 17

how many cases of delirium are misdiagnosed? what is is misdiagnosed as?

Answer 17

1/3 to 2/3 cases

misdiagnosed as depression

Question 18

failure to recognize symptoms of delirium results in:

Answer 18

poorer outcomes including increased mortality

Question 19

in one study, altered mental status noted in only ____% of elderly ED patients w/ delirium

Answer 19

16%

Question 20

patient experiencing a sudden deterioration in cognitive function should be assessed for:

Answer 20

delirium

Question 21

core symptoms of delirium

Answer 21

• attention deficits/memory impairment
• disorientation
• sleep/wake cycle disturbance
• thought process abnormalities
• language disturbances motor alterations

Question 22

associated or non-core symptoms of delerium

Answer 22

affective changes = anxiety, fear, depression rapid shifts

hyperactive delirium frequently mistaken for depression

Question 23

cause of deleirum

Answer 23

low ACh and/or excess DA

Question 24

treatment of delerium

Answer 24

fix underlying cause

-since you have too much DA –> give anti-psychotics

Question 25

Third MC cause of dementia after 65yo?

Answer 25

vascular dementia (5-10%)