Elderly Confusion

Question 1

Mr. Jones’s daughter states her dad seem confused? What are the DDX?

Answer 1

Delirium- acute, infx, drugs
Dementia- gradual
Depression- lack of interest, sad

Question 2

What is significant about elderly and schizophrenia?

Answer 2

NEW DX is RARE in older age
Delirium may seem like shchizo but it is NOT.
PROBLEM is WEST give antipsychotic to race, poor, cultures
BUT, many HCP give antipsychotics to not deal w/ it.
AVOID antipsychotics prn

Question 3

This confusion differential is caused w/in many disease:
Loss of recent memory
insidious onset-progressive decline
impaired judgement
Sleep and agression
Onset 40-90y

Answer 3

Dementia
Alzheimer -70%
Muli-infarct
Lewy Body
HIV
Parkinson
B12 deficiency
Thyroid and Liver

Question 4

What are the diagnoistic test for Alzheimers?

Answer 4

NONE
Clinically DX based on sx
MSE
Recognizing decline
Normal LOC- no syncope

TEST to R/o
FH
Nomral EEG, lumbar puncture, histology

Question 5

What is physicologically happening in the brain prior to clinical manifestations with Alzheimers?

Answer 5

1. amyloid plaques
2. neufibrillary tangles
3. Brain cell loss
   THEN
4. memory loss
5. fx decline
   Combo of later = Dementia

Question 6

Who are at risk for Alzheimer’s?

Answer 6

Genetic- down syndrome
Head trauma, HTN, DM, smoke, Depression
FH doubles risk
85y 50% risk

Question 7

Mr. Jones has diffuclty with finding keys, forgets to bathe, speaking slower, balance issues. What stage is AD?

Answer 7

Early
gradual memory loss
 N. LOC
Impaired ADLs
Subtle Language errors
DFx spatial perception

Question 8

Define late stages of AD?

Answer 8

Aphasia- no talking
Apraxia- no purposeful action
Agnosia- not recognizing
L and R confusion

**Specific to AD- word finding issues, apathy, delusion, disorientation

Question 9

Mr. Cog has tremor with resisted elbow flx, shuffled gait, falls often, intermittent cognitive fx, flat affect, dominant L arm tremor. He also states he saw his late wife in the kitchen. ? How would you DX this presentation?

Answer 9

PET scan + amyloid plaques

DX- Lew Body dementia

Question 10

Which dementia affects personality changes that involve impulsive and hypersexual thoughts/actions?

Answer 10

FRONTOTEMPORAL DEMENTIA

Question 11

Post TIA what can manifest cognitively?

Answer 11

VASCULAR DEMENTIA
Stuttering
stepwise deterioration 2/2 to TIA, CVA.
Don't miss bc reversible
N- LOC
CT MRI help DX

Question 12

This cognitive test strength include: standard, valid, quick, useful scoring
The limits include: no executive function, no capacity test, education and culturally not valid

Answer 12

Mini Mental State Exam

Question 13

This cognitive test name, memory, attn, langue, abstract, delayed recall, and orientation

Answer 13

MOCA

Montreal Cognitive Assess