Exam #1: Confusion in the Elderly

Question 1

What is dementia?

Answer 1

Syndrome characterized by an impairment in two or more intellectual or cognitive functions despite a clear sate of consciousness

Question 2

What is the difference between dementia & delirium?

Answer 2

Delirium= acute change in mental status 
Dementia= chronic 

**The main difference is time; need to look for reversible cause if acute

Question 3

Outline the evaluation of the demented patient.

Answer 3

1) Comprehensive history & physical w/ emphasis on the timeline
2) Folstein mini-mental exam
3) Labs
4) Neuroimaging (CT w/out or MRI)

**Note that the Folstein mini-mental is NOT definitive; highly functioning individuals can pass & still be demented

Question 4

What labs should be ordered when evaluating a demented patient?

Answer 4

• Electrolytes
• BUN
• Mg++
• Ca++
• Glucose
• TSH
• Creatinine
• CBC
• B12
• Folate
• VDRL

Question 5

What is the DEMENTIAS mnemonic?

Answer 5

D= drugs
E= emotional disease
M= metabolic disorders
E= endocrine disease
N= nutritional & degenerative neurologic disease 
T= trauma or tumor
I= ischemia & infection
A= anoxia, anemia, arrhythmia 
S= Sjogren's Syndrome, social, sensory, & spiritual deprivation

Question 6

What are the four diagnoses that account for dementia in industrial countries?

Answer 6

1) Alzheimer’s Disease
2) Diffuse Lewy Body Dementia
3) Vascular Dementia
4) Frontotemporal Dementia

Question 7

What are the characteristics of Alzheimer’s Disease?

Answer 7

Gradual decline that is steady w/

• Amneisa
• Agnosia= difficulty remembering things
• Apraxia= inability to carry out motor functions
• Aphasia= difficulty naming familiar items

Question 8

What are the pathologic hallmarks of Alzheimer’s Disease?

Answer 8

Neuritic plaques & neurofibrillary tangles

Question 9

How is Alzhemier’s Disease treated?

Answer 9

Drugs that increase:

1) ACh
2) Glutamate

Question 10

What is diffiuse lewy body dementia?

Answer 10

This is a “cousin” to PD

- Alpha-synuclein–>Lewy body OUTSIDE OF THE SN

Question 11

What are the characteristics of Diffuse Lewy Body Dementia?

Answer 11

1) Dementia
2) Fluctuating cognition
3) Reuccrent visual hallucincations
4) Motor features of Parkinsonism

Question 12

How is Diffuse Lewy Body Dementia treated?

Answer 12

Increase ACh

Also, glutamate stabilization

Question 13

What is vascular dementia?

Answer 13

Decreased cerebral bloodflow leading to cognitive decline

**Significant overlap with Alzhemimer’s Disease–>treated the same

Question 14

What is Frontotemporal Dementia?

Answer 14

Frontal atrophy of the frontal & temporal lobes along with microscopic findings

• Bizarre behavioral changes
• Dis-inhibition