Term
| What are the four categories of delirium? |
|
Definition
1. Due to GMC (general medical condition)
2. Substance-induced
3. Multiple causes
4. Delirium NOS |
|
|
Term
| What are the six subcategories of dementia? |
|
Definition
1. Alzheimer's type
2. Vascular
3. Other medical conditions
4. Substance induced
5. Multiple etiologies
6. NOS |
|
|
Term
| What are the three subcategories of amnestic disorder? |
|
Definition
1. Due to medical condition
2. Substance induced
3. NOS |
|
|
Term
| What is the point prevalence of dementia? |
|
Definition
0.4% among >18y
1.1% among >55y |
|
|
Term
| How does the prevalence of dementia change among different hospital wards? |
|
Definition
General medical inpatients - 10-30%
Surgical or cardiac ICU - 30%
Orthopedic surgery patients - 33%
|
|
|
Term
| What subset of patients have the highest recorded prevalence of delirium? |
|
Definition
| Post-cardiotomy patients - >90% |
|
|
Term
| How does the prevalence of dementia differ among patient subgroups? |
|
Definition
Patients recovering from hip fractures - 40-50%
Institutionalized elderly - 44%
AIDS patients - 30-40%
Terminally ill patients - 80% |
|
|
Term
| Does delirium show a gender bias? |
|
Definition
| Male gender is an independent risk factor for delirium according to DSM-IV-TR |
|
|
Term
| What are the common DSM-IV-TR diagnostic criteria for Delirium, regardless of etiology? |
|
Definition
A. Disturbance of conciousness with reduced ability to focus, sustain, or shift attention
B. A change in cognition or the development of a perceptual disturbance not better acounted for by dementia
C. The disturbance develops over a short period of time and tends to fluctuate |
|
|
Term
| What does the EEG of delirium pateints show? |
|
Definition
Diffuse slowing of background activity
(Patients with delirium d/t hypnotic-sedative or alcohol withdrawal have low-voltage fast activity) |
|
|
Term
| What neurotransmitter is hypothesized to be involved in delirium? |
|
Definition
| Acetylcholine - low levels |
|
|
Term
| What neuroanatomical area and which major pathway are hypothesized to be involved in delirium? |
|
Definition
| The reticular formation and the dorsal tegmental pathway (from the mesencephalic reticular formation to the tectum and thalamus) |
|
|
Term
| What three conditions causing delirium are associated with bradycardia? |
|
Definition
Hypothyroidism
Stokes-Adams syndrome
Increased ICP |
|
|
Term
| Which two conditions are known to cause the snout response in a delirious patient? |
|
Definition
Frontal mass
Bilateral posterior cerebral artery occlusion |
|
|
Term
| What are the ten standard studies to be performed in a patient with delirium? |
|
Definition
Blood chemistries
CBC
Thyroid function
Serology for syphillis
HIV Ab test
Urinalysis
EKG
EEG
CXR
Blood and urine drug screens |
|
|
Term
| What is the difference between dementia and delirium in regards to speech? |
|
Definition
Dementia - word-finding difficulty
Delirium - incoherent (slow or rapid) speech |
|
|
Term
| What is the difference between dementia and delirium in regards to memory? |
|
Definition
Dementia - impaired remote memory
Delirium - impaired recent and immediate memory |
|
|
Term
| How are awareness and vigilance different in dementia and delirium patients? |
|
Definition
Dementia patients are usually normally aware and alert
Patients with delirium exhibit reduced awareness and altered (hypervigilant or reduced) alertness |
|
|
Term
| What is the term for delirium occuring in a dementia patient? |
|
Definition
|
|
Term
| What are two major features allowing differentiating delirium from psychosis? |
|
Definition
Hallucinations and delusions are usually more constant and better organised in psychosis
Patients with schizophrenia usually experience no change in their level of consiousness or in orientation |
|
|
Term
| Has delirium been shown to progress to dementia? |
|
Definition
|
|
Term
| How long does it take for patients to recover from delirium after the causative agent has been removed? |
|
Definition
| Usually 3-7 days, but may be as long as 2 weeks |
|
|
Term
| What is the pharmacological treatment of patients with delirium due to anticholinergic toxicity? |
|
Definition
| Physostigmine salicylate 1-2mg IV or IM, repeated doses in 15-30 minutes |
|
|
Term
| What is the preferred pharmacological treatment of psychosis in delirium patients? |
|
Definition
Haloperidol - initially 2-6mg IM. Once patient is calm: 5-40mg PO bid (2/3 at bedtime).
Alternatives: Droperidol (monitor EKG closely) or 2nd generation anti-psychotics |
|
|
Term
| What is the preferred treatment of insomnia in delirium patients? |
|
Definition
| Benzodiazepines with short of intermediate half-lives (e.g. lorazepam 1-2mg) |
|
|
Term
| Are patients with Parkinson's disease more suspect to delerium? |
|
Definition
Antiparkinsonian agents are frequently implicated in causing delerium
Parkinson's disease with co-existing dementia recieving antiparkinsonian medication are twice as likely to develop delirium as PD patients without dementia |
|
|
Term
| What is the treatment for a patient with Parkinson disease and delirium in whom antiparkinsonian agents cannot be reduced, or in whom delirium persists despite reducting antiparkinsonian drugs? |
|
Definition
|
|
Term
| What are the ICD-10 diagnostic criteria for delirium? |
|
Definition
A) Clouding of conciousness
B) Disturbance of cognition: impairment of immediate recall and recent memory with intact remote memory and disorientation in time, place or person
C) At least one psychomotor disturbance: increased reaction time, rapid or slow speech, enhanced startle reaction, rapid shifts from hypo- to hyper-activity
D) Sleep-wake cycle disturbed: insomnia, reversal of sleep-wake cycle, sundowning, or disturbing dreams and nightmares.
E) Rapid onset and fluctuations |
|
|
Term
| What percentage of dementia patients have reversible illnesses if treatement is initiated in time? |
|
Definition
|
|
Term
| What is the prevalence of dementia? |
|
Definition
5% in >65y
20-40% in >85y |
|
|
Term
| What are the two most common forms of dementia? |
|
Definition
Alzheimer's disease - 50-60%
Vascular dementia - 15-30%
Approximately 10-15% have both types |
|
|
Term
| What are the six forms of degenerative dementia? |
|
Definition
Alzheimer's
Frontotemporal (e.g. Pick's disease)
Parkinson's disease
Lewy body dementia
Idiopathic cerebral ferrocalcinosis (Fahr's disease)
Progressive supranuclear palsy (PSP) |
|
|
Term
| What are three infectious causes of dementia? |
|
Definition
Syphillis
HIV
Prion diseases |
|
|
Term
| What percentage of patients with Alzheimer's disease have a family history of the disease? |
|
Definition
|
|
Term
| What are neurofibrillary tangles made of? |
|
Definition
| Cytoskeletal elements, mostly phosphorylated Tau protein |
|
|
Term
| What is the differential diagnosis of neurofibrillary tangles? (6 diseases) |
|
Definition
Alzheimer's disease
Down's syndrome
Dementia pugilistica
Parkinson-dementia complex of Guam
Hallervorden-Spatz disease
Normal aging |
|
|
Term
| Where are neurofibrillary tangles usually found? 4 locations |
|
Definition
Cortex
Hippocampus
Sunstantia nigra
Locus cereleus |
|
|
Term
| Does the number or density of senile plaques correlate with disease severity in Alzheimer's disease? |
|
Definition
|
|
Term
| Which four neurotransmitters are hypothesized to be hypoactive in Alzheimer's disease? |
|
Definition
Acetylcholine
Norepinephrine
Somatostatin
Corticotropin |
|
|
Term
| What is Binswanger's disease? |
|
Definition
| Subcortical arteriosclerotic encephalopathy - many small infarctions of the white matter that spare cortical regions. |
|
|
Term
| What lobes of the brain are predominantly affected in Alzheimer's disease? |
|
Definition
|
|
Term
| What two lobes are primarily affected in Pick's disease? |
|
Definition
|
|
Term
| What are two risk factors for Pick's disease? |
|
Definition
Men
First-degree relative with the disease |
|
|
Term
| What are the diagnostic criteria of dementia with Lewy bodies? |
|
Definition
All patients must have cognitive decline.
3 core features:
Fluctuating levels of attention and alertness
Recurrent visual hallucinations
Parkinsonian features
Possible disease - 1 core feature
Probable disease - ≥2 core features |
|
|
Term
| What percentage of patients with Parkinson's disease have dementia? |
|
Definition
| 20-30%, with an additional 30-40% having measurable impairment of cognitive abilities |
|
|
Term
| What percentage of patients with dementia have hallucinations and delusions? |
|
Definition
20-30% have hallucinations
30-40% have delusions |
|
|
Term
| What are the DSM-IV-TR diagnostic criteria for Dementia of the Alzheimer's type? |
|
Definition
A. Development of both:
A1) memory impairment
A2) one of: aphasia, apraxia, agnosia or disturbance in executive functioning
B. Cause significant impairment
C. Gradual onset and continuing decline
D. Not due to neurologic disease, GMC or substance
E. Not exclusively in delirium |
|
|
Term
| What is the cutoff for diagnosing early-onset Alzheimer's disease? |
|
Definition
|
|
Term
| What percentage of dementia patients have mood disorders or anxiety? |
|
Definition
Depression and anxiety are major symptoms in 40-50% of patients.
Only 10-20% present the full syndrome of depressive disorder. |
|
|
Term
| What percentage of dementia patients have seizures? |
|
Definition
| 10% of Alzheimer's disease patients, 20% of vascular dementia patients |
|
|
Term
| What percentage of dementia patients have myoclonic jerks? |
|
Definition
|
|
Term
| In dementia, which is lost first: memory for time and place, or memory for person? |
|
Definition
| Time and place lost first |
|
|
Term
| In dementia, which is lost first: recent memory or remote memory? |
|
Definition
|
|
Term
| Which antihypertensives should be avoided in patients with dementia? |
|
Definition
|
|
Term
| Which two groups or drugs have been shown to improve dementia? |
|
Definition
Cholinesterase inhibitors (e.g. donezepil, rivastigmine, galantamine, tacrine)
Memantine |
|
|
Term
| What is the cutoff for transient or chronic amnestic syndrome? |
|
Definition
|
|
Term
| What are the two most common causes of amnestic syndrome? |
|
Definition
| Alcohol abuse (decreasing prevalnce) and head injury (increasing prevalence) |
|
|
Term
| What is the most common perscription drug group associated with amnesia? |
|
Definition
|
|
Term
| What are the DSM-IV-TR diagnostic criteria for amnestic disorder? |
|
Definition
A. Memory impairment
B. Significant impairment
C. Not exclusive to dementia or delirium
D. Etiology: GMC, substance, NOS |
|
|
Term
| Temporally, which memories are affected in amnestic syndrome? Remote past memories, recent memories, or immediate memory? |
|
Definition
Remote past and immediate memories are intact
Recent memory is impaired |
|
|
Term
| How often does Korsakoff's syndrome follow Wernicke's encephalopathy? |
|
Definition
|
|
Term
| What is the prognosis of Korsakoff's syndrome? |
|
Definition
| With treatment, 1/4-1/3 of patients recover fully, 1/4 show no improvement of symptoms |
|
|
Term
| Name 10 drug classes known to cause secondary mood disorders |
|
Definition
Alcohol
Sedative-hypnotics
Antidepressants
Metoclopraminde, H2-receptor blockers
Antihypertensives (esp. those with CNS activity, e.g. methyldopa, clonidine, reserpine)
Sex steroids
Glucocorticoids
Levodopa
Bromocriptine |
|
|
Term
| In the evaluation of psychosis, what is the indication for MRI? |
|
Definition
| Any new-onset psychosis, regardless of age |
|
|
Term
| In regards to psychosis due to GMC, what brain area is associated with first-rank symptoms (e.g. thoughts spoken aloud, voices commenting, made actions or feelings)? |
|
Definition
| The dominant temporal lobe |
|
|
Term
| In regards to psychosis due to GMC, what brain area is associated with complex delusions? |
|
Definition
|
|
Term
| In regards to psychosis due to GMC, what brain area is associated with misidentification synmdrome (e.g. Capgras syndrome, Fregoli syndrome)? |
|
Definition
| The nondominant (or bilateral injury to ) parietal, temporal or frontal lobe |
|
|
Term
| Stimulant induced psychosis is associated with? |
|
Definition
| Formication, i.e. the sensation of bugs crawling under the skin |
|
|
Term
| Temporal lobe epilepsy is often associated with which two psychoses? |
|
Definition
| Olfactory hallucinations and religious delusions |
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