neuro case

Question 1

mental status diagnostic tools

Answer 1

• Mini Mental Exam

- also mini-cog & Folstein (sp?)

Question 2

differential diagnosis for cognitive problems

Answer 2

 Psychiatric disease such as depression
 Medications: anti-cholinergics and antihistamines
 Sleep disturbances
 Metabolic Disturbances: B12 and hypothyroidism
 Normal Aging
 Structural Brain Disease: very uncommon
 Delirium

Question 3

definition of dementia

Answer 3

• Evidence from the history and mental status examination that indicates major impairment in learning and memory as well as at least one of the following:
• Impairment in handling complex tasks
• Impairment in reasoning ability
• Impaired spatial ability and orientation
• Impaired language

Question 4

risk factors for dementia

Answer 4

• Age is the strongest RF
• Family Hx, Genetic Factors, MCI, Lifestyle: social, mental, and physical activity, Education and Cognitive Reserve
• Atherosclerotic Risk Factors: Hypercholesterolemia, DM, HTN, Smoking

Question 5

interventions to prevent dementia

Answer 5

• Treating uncontrolled BP is the big thing to prevent dementia
• Vitamin supplementation, diet, active lifestyle, socialization, some alcohol, anti-HTN

Question 6

dementia

Answer 6

Gradual in onset, Short Term memory loss, Functional impairment in executive function and activities of daily living

Question 7

mild cognitive impairment

Answer 7

Memory difficulty, Objective memory impairment, Still able to maintain and care for oneself, preserved ability to fxn in daily life, Increased Risk of Dementia

Question 8

derlirium

Answer 8

Acute onset, Clouded sensorium, Difficulty w/ attention, maybe hypersomnolent
Short term, acute, and temporary. Typically due to a metabolic problem. Fluxtuates with the time of day.

Question 9

prevalence of AD

Answer 9

• 4 million people in the US (Axelrod)
• most common cause of dementia in US
• risk doubles every 5 years after age 65

Question 10

risk of AD by age 85

Answer 10

-20-40% (Axelrod)

Question 11

prognosis in dementia

Answer 11

• Not good, prognosis for incident dementia is 4.5 years

- Progressive loss of autonomy & independence, 70% end up in long term facility

Question 12

how did the authors determine if the patients had dementia?

Answer 12

• the 856 HRS respondents had a 3-4 hour in-home clinical assessment for dementia.
• Clinical assessment part of the Aging, Demographics, and Memory Study (ADAMS).

Question 13

who is more likely to have dementia

Answer 13

• Nonwhite race or ethnic status
• Female sex
• Single status
• Older age
• Lower educational level
• Lower household income

Question 14

what are the costs involved in treating a patient with dementia

Answer 14

• Out-of-Pocket Spending: nursing home stays, hospital stays, medical visits, outpatient surgery, home health care, special services, prescription drugs, and dental services.
• Spending by Medicare
• Net Nursing Home Spending
• Formal Home Care
• Informal Health care