Geriatric Psych

Question 1

Depression vs dementia

Answer 1

subacute onset that is faster than dementia dementia has a slow, insidious and progressive cognitive decline over period of years

change in sleep, appetite and energy, which should be normal in dementia

prominent feeling of worthlessness, guilt and suicidal ideation

cognitive loss often inconsistent and patchy (e.g. memory loss of some things but remembers other things), whereas dementia have more consistent and universal cognitive loss

gives up easily and admit cognitive deficits, whereas dementia tries to hide deficits

personal or family history of affective disorder

improvement with treatment of antidepressants

no aphasia, apraxia and agnosia in depression, which can be present in dementia

Question 2

Depression vs delirium

Answer 2

subacute onset that is slower than delirium

constant level of cognitive loss that is less severe than fluctuating confusion in delirium

depression usually have no acute biological cause, whereas delirium almost always caused by biological trigger (DIMS)

depression has prominent feeling of worthlessness, guilt, suicide, low mood and loss of interest, which are less prominent in delirium

Question 3

What does the dementia quick screen consist of

Answer 3

mini-cog test including

1) 3-item recall (normal 2+ recalled)
2) clock drawing of 10 minutes after 11:00 (most important component)
3) animal naming (naming as many animals as possible in 1 minute) normal >12

Question 4

Why is the MoCA a better test than the MMSE

Answer 4

more sensitive

includes cognitive domains (e.g. visual spatial, executive function) that are better for other types of dementia (e.g. Lewy Body dementia, Parkinson’s dementia, frontotemporal dementia)

Question 5

Mild cognitive impairment presentation

Answer 5

mild cognitive impairment do not meet all of the diagnostic criteria for dementia

usually, mild cognitive impairment presents with slightly lower than normal cognitive score (usually borderline low) and preserved daily psychosocial function (preserved IADL and ADL)

Question 6

MMSE scoring

Answer 6

score total = 30

score >25 is normal score

20-24 is mild cognitive impairment score

10-19 is moderate cognitive impairment score

0-9 is severe cognitive impairment

Question 7

Alzheimer’s disease progression through the brain

Answer 7

1) temporal lobe
2) parietal lobe
3) frontal lobe

Question 8

Interpretation of moca scoring

Answer 8

score total = 30

score 26-30 = normal

score 20-25 = mild cognitive impairment

score 15-20 = mild dementia

score 10-15 = moderate dementia

score 0-9 = severe dementia

Question 9

Out of MMSE and moca which adjusts score for education level

Answer 9

moca