[IEMR36]Delerium Dementia and Depression Flashcards
What is the third most common type of dementia? What is the prevalence in percentage form?
Lewy Body Disease. 15%
What are the types of cardiovascular problems that cause delirium?
Arrhythmias, heart failure, myocardial infarctions
What is the most common type of dementia in the United States?
Alzheimer’s disease
Depression isn’t common in what type of dementia?
Frontotemporal
What diagnostic criteria is required for a patient who possibly has depression?(DSM-V)
The patient must have five of the listed symptoms and have a representative change in previous function
What is the percentage of dementia cases you can contribute to Alzheimer’s type?(range)
60-80%
What is a good differential diagnosis: self-reported memory probelms?
depression
What are the signs and symptoms of Alzheimer’s disease in the middle stage years 5-8?(4*-12 points)
disoriented to time and place, memory loss, poor insight and apraxia
Localized atrophy & hypoperfusion is a neurological feature in what type of dementia?
frontotemporal dementia
Hippocampal atrophy, enlarged lateral ventricles is associatd with what form of dementia?
Alzheimer’s
What age range is the usual onset for dementia?(1984 criteria)
40-65 YO
A late occurence of psychosis with an incidence of 20% occurs in what type of dementia?
AD
What are symptoms of patients with vitamin B12 deficiency that could also present in dementia presents?
Parathesia, memory loss and gait disturbance
What are more extensive items than MMSE used in cognitive screening?(1-2 points)
clock drawing and trails
What is done during the MIN-COG?(time, tasks2-3 points)
2-4 minutes, 3 item immediate verbal recall task, clock drawing and 3 item delayed recall
What is a good differential diagnosis: acute onset, disturbance in consciousness, fluctuating presentation?
delirium
What age range is it considered to be an early onset of dementia?(1984 criteria)
younger than 65 YO is early onset
What type of screening tool: 10-item observational scale rating onset, perceptual disturbance, hallucinations, delusions, psychomotor behavior, cognitive status, physical disorder, sleep-wake cycle and symptom variability?
Delirium rating scale
What is the most widely used cognitive screener?
MMSE
Mild,fluctuating memory impairment is a characteristic feature in what type of dementia?
Lewy Body
For a person to be diagnosed with dementia, there must be a deficit in how many areas of cognition?(1984 criteria)
There must be a deficit in at least one area of cognition, interfering with daily life
What are the other causes of delirium?(2-5 points)
medications, fecal impaction, postoperative state, sleep deprivation and fluid retention
Sever loss in executive function is a characteristic feature in what type of dementia?
Frontotemporal
What are examples of metabolic disorders that cause delirium?(2-4 points)
dehydration, hypoglycemia, hyperglyemia and electrolyte imbalance
Generalized atrophy is a characteristic neurological feature in what type of dementia?
Lewy Body
Personality and langue changes is a characteristic feature in what type of dementia?
Frontotemporal
Mid-Late Stage loss of executive function is a characteristic feature of what type of dementia?
Alzheimer’s Dementia
What time during the evaluation of delirium can the physician evaluate dementia?
There isn’t an opportune time to do so during the delirium evaluation
What is usually done during the delirium evaluation?(2-4 points)
consider the context of multiple comorbidities like frailty and fatigue; review of prescription and over the counter drugs; exclude infections and other medical causes; conduct test
What range range is the usual onset for dementia?(2011 criteria)
any age
Depression is common in what type of dementia?(2 points)
Vascular and Lewy Body
Mild memory impairment is a characteristic feature in what type of dementia?(2 points)
Vascular and Frontotemporal dementia
What type of patients are at increased risk for dementia: age and disease?
older patients with dementia
What are the signs and symptoms of the advanced stages of dementia, year 8-12?(4*-10 points)
nearly intelligible verbal output, memory loss, remote memory gone and dependent for ADLs/IADLs, executive dysfunction, apathy, loss of insight, aphasia, psychosis and disruptive agitation
What are the distinguishing clinical features of dementia in Alzheimer’s, vascular, Lewy body and frontotemporal when considering: progression?(4 points)
insidious decline; slow, stepwise, rapid decline, graudual decline
Progressive loss of intellectual abilities sufficient enough to affect daily life?
Dementia
What is the fourth most common type of dementia?(2 points) What is the percentage?
Parkinson’s Disease with dementia and Frontotemporal dementia. 5%
Neuroimaging being used in the diagnostic workup for dementia is used for what type of patients?(3-4)
Young patients, sudden onset, suspected reversible causes and abnormal neurological exam
Early and severe memory impairment is a characteristic feature in what type of dementia?
Alzheimer’s Dementia
Early & severe loss of executive dysfunction is a characteristic feature in what type of dementia?
Vascular
Deficits of dementia include a decline in what type of function?
A decline in higher level of functioning
Acute disturbance of cognitive impairment?
delirium
For a person to be diagnosed with dementia, there must be a deficit in how many areas of cognition?(2011 criteria)
There must be a deficit in at least two areas of cognition affecting daly life
Psychosis is rare in what type of dementia?(2 points)
Vascular and frontotemporal
What are good differential diagnoses to consider for a patient suffering from dementia?(3*-7 points)
Vitamin B-12 deficiency, hypothyroidism, depression, normal pressure hydrocephalus, drug reaction , brain tumors and delirium
What is a good differential diagnosis: gradual onset, progressive decline, informant-reported memory complains?
dementia
Vascular lesions is associated with what form of dementia?
Vascular Dementia
What type of lab test should you order to eliminate potentially reversible causes of cognitive dysfunction?(4-6 points)
thyroid stimulating hormone test, vitamin B 12, glucose, electrolyte, complete blood count and calcium
What type of delirium is often unrecognized by clinicians?
Hypoactive delirium
Visual hallucinations occur in what type of dementia?
Lewy Body
Generally speaking, how is neuroimaging used as a part of a diagnostic workup?
It isn’t necessary
What are the different types of evaluation that should be conducted to evaluate for dementia?(4-8 points)
Clinical history, physical exam, neurological exam, lab testing, cognitive testing, interview with informant, depression screening and neuroimaging
What symptoms do you see in the early stage (years 1-4) of Alzheimer’s disease?(3*-8 points)
memory loss, executive dysfunction, apathy, disoriened to date, depression(variable), decreased insight, aphasia and anomia
What type of dementia evaluation: assess presence, severity and fluctuation of 9 delirium features, and it takes 5 minutes?
Confusion Assessment Method
What is the second most common type of dementia? What is the prevalance in percentage form?
Vascular dementia is the second most common type of dementia. It accounts for approximately 25% of the dementia cases
What type of impairments are associated with dementia?(3-5 points)
learning, memory, abstract thinking, judgement and/or language
What are the types of neurological problems that cause dementia?(6 points)
tumors, CNS infections, head trauma, seizures, strokes and TIA
What is a rare differential diagnosis for dementia?
Neurosyphillis
What type of trail-making screening test is used to evaluate a person’s driving ability?
Trail-making B
What are the two types of delirium?
hypoactive and hyperactive
Hallucinations is seen in what type of delirium?
hyperactive delirium
Early, fluctuating loss in executive function is a characteristic feature in what type of dementia?
Lew Body
What are the general causes of delirium?(5 points)
infections, other, metabolic disorders, cardiovascular conditions and neurological conditions
How does depression in the elderly usually present itself?(2-5 points)
self-reported memory complaints, poor memory and concentration, sleep and appetite changes,
What are the distinguishing clinical features of dementia in Alzheimer’s, vascular, Lewy body and frontotemporal when considering: onset?(4 points)
Gradual, abrupt/gradual; early onset; and early onset
What is conducted during the depression evaluation?(3 points)
Obtain a clinical history, ask the patient to complete a screening tool and rule out other conditins that mimic depressive symptomatology
Depression is found in 40% of this particular type of dementia. What is it?
AD
What are common cognitive screens used for delirium evaluation?
Confusion Assessment Method (CAM), Global Attentiveness Rating (GAR) and Delirium Rating Scale (DRS).
What cognitive screener is more sensitive to subtle cognitive change?
Montreal Cognitive Assessment
What are the symptoms of depression?(3*-9 points)
Depressed mood, loss of pleasure in activities, significant change in weight or apetite, sleep disturbance, psychomotor disturbance, fatigue, feelings of worthlessness or guilt, cognitive impairment, recurrent thoughts of death, suicidal ideation
What type of dementia - evaluation: physician rated, based on a minimum of 2 minutes of general conversation with patient, high rating - easy engagement, low rating = difficult engagement due to agitation or low arousal
Global Attentiveness Rating(GRS)
