CMS 200 Dementia

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Questions and Answers

What is a key characteristic of Mild Cognitive Impairment (MCI) regarding daily activities?

Total dependence on others for daily activities

Exclusively resulting from delirium

Ability to perform complex instrumental activities with preserved capacity (correct)

Significant interference with social functioning

Which condition must be ruled out to diagnose Mild Cognitive Impairment?

Delirium

Major Depressive Disorder (correct)

Schizophrenia

Bipolar Disorder

In assessing cognitive decline, which assessment method is preferred for diagnosing MCI?

Standardized neuropsychological testing or other quantified assessment (correct)

Observation of daily behavior over time

Neurological examinations without standardized testing

Informal discussions with family

Which of the following is NOT a criterion for MCI diagnosis?

Cognitive deficits occurring exclusively in the context of a delirium Signup and view all the answers

What cognitive aspect remains preserved in individuals with MCI despite some impairment?

Complex decision-making skills Signup and view all the answers

What is the primary distinction between mild cognitive impairment (MCI) and dementia?

MCI allows for maintenance of daily functioning Signup and view all the answers

Which subtype of MCI has a greater likelihood of progressing to Alzheimer's disease?

Amnestic MCI Signup and view all the answers

How often should persons with suspected MCI be reassessed for potential progression to dementia?

Every 12 months Signup and view all the answers

What percentage of older adults may exhibit symptoms of mild cognitive impairment?

Up to 15% to 20% Signup and view all the answers

What is a characteristic of the timing and clinical course of mild cognitive impairment?

Progressive and gradual onset Signup and view all the answers

Which domain is NOT typically used to subclassify mild neurocognitive disorder?

Social interaction skills Signup and view all the answers

Which statement best describes the cognitive decline experienced in normal aging compared to MCI?

Normal aging has a decline but remains within normal cognitive range Signup and view all the answers

What other forms of dementia might older individuals with non-amnestic MCI progress to?

Frontotemporal dementia and vascular dementia Signup and view all the answers

What distinguishes delirium from dementia in terms of onset and reversibility?

Delirium has a fluctuating course over hours to days, while dementia has a gradual decline. Signup and view all the answers

Which of the following characteristics is NOT associated with delirium?

Gradual cognitive decline over years Signup and view all the answers

According to sensitivity and specificity metrics, how effective is the Mini Mental State Exam (MMSE) in detecting cognitive impairment?

Sensitivity of 89% and specificity of 81% Signup and view all the answers

When can a diagnosis of dementia be made regarding the presence of delirium?

Once the delirium symptoms have resolved. Signup and view all the answers

What is a common risk factor for developing delirium?

History of prior delirium episodes Signup and view all the answers

Which of the following options describes the clinical course of delirium?

Symptoms can wax and wane throughout a 24-hour period. Signup and view all the answers

What is the likelihood ratio for a negative Mini Mental State Exam (MMSE)?

0.19 Signup and view all the answers

In what way are delirium and dementia similar?

Both can present with altered mental status. Signup and view all the answers

What condition is characterized by cognitive deficits that do not significantly interfere with independence in daily activities?

Mild Cognitive Impairment (MCI) Signup and view all the answers

Which characteristic distinguishes Mild Cognitive Impairment from dementia?

Compensatory strategies may be required Signup and view all the answers

In diagnosing Mild Cognitive Impairment, which criterion must be met regarding other mental disorders?

The cognitive deficits should not occur alongside delirium Signup and view all the answers

Which of the following options describes the relationship between Mild Cognitive Impairment (MCI) and Alzheimer's disease?

MCI can be a risk factor for progressing to Alzheimer's disease Signup and view all the answers

Which of the following statements is true regarding cognitive testing in Mild Cognitive Impairment?

Quantified clinical assessments can supplement neuropsychological testing Signup and view all the answers

What is the typical progression rate of individuals with mild cognitive impairment (MCI) to Alzheimer's disease annually?

12% to 15% Signup and view all the answers

Which cognitive aspect is most likely to be affected in someone diagnosed with amnestic MCI compared to non-amnestic MCI?

Memory function Signup and view all the answers

What differentiates mild cognitive impairment (MCI) from normal aging?

Compensatory methods to adapt Signup and view all the answers

Which of the following is a characteristic of the clinical course in mild cognitive impairment?

Insidious and gradual progression Signup and view all the answers

In the context of dementia progression from MCI, older individuals with which type of MCI are more likely to progress to frontotemporal dementia or vascular dementia?

Non-amnestic MCI Signup and view all the answers

What key feature distinguishes mild neurocognitive disorder from more severe forms of cognitive impairment, such as dementia?

Maintenance of independence in everyday activities Signup and view all the answers

Which of the following statements is true regarding the DSM-V's classification of mild neurocognitive disorder?

It is a framework for diagnosing mild cognitive impairment. Signup and view all the answers

Which of the following laboratory evaluations is least likely to be included in the assessment for mild cognitive impairment?

Genetic testing for Alzheimer's Signup and view all the answers

Which characteristic is most indicative of delirium compared to dementia?

Reversible cognitive impairment Signup and view all the answers

What is a primary reason the diagnosis of dementia cannot be made until after delirium resolves?

Both conditions present with altered mental status Signup and view all the answers

What is the significance of lucid intervals in patients with delirium?

They represent periods of stable mental status Signup and view all the answers

Which of the following is a common feature shared by both delirium and dementia?

Both involve disturbances in attention and awareness Signup and view all the answers

What role does the Mini Mental State Exam (MMSE) play in evaluating cognitive impairment?

It helps in screening for cognitive impairment Signup and view all the answers

How does the threshold for a positive Mini Mental State Exam (MMSE) result vary?

It varies widely based on patient demographics Signup and view all the answers

What type of attention difficulty is associated with delirium?

Reduced ability to direct and shift attention Signup and view all the answers

What is a potential impact of dementia on the development of delirium?

Dementia serves as a major risk factor for delirium Signup and view all the answers

Study Notes

Dementia Overview

Dementia is a broad term encompassing a spectrum of disorders affecting multiple cognitive functions.
It's characterized by a decline in cognitive function, memory loss, and difficulties with daily living.
Risk factors for dementia encompass age, family history, cardiovascular conditions, and modifiable risk factors like hearing loss, smoking, and diabetes.
Types of dementia include Alzheimer's disease, vascular dementia, Lewy body dementia, and frontotemporal dementia, each with unique characteristics and diagnostic criteria.
Important to distinguish dementia from delirium, other psychiatric conditions, and normal age-related cognitive changes.
Diagnosis involves a thorough history, physical exam, cognitive assessment, functional evaluation, and potentially lab tests, neuroimaging, and neuropsychological assessments to rule out underlying conditions, determine subtypes and assess the severity of cognitive decline.
Early detection is critical for timely intervention and support for patients and caregivers.
Screening tools like the Mini-Cog, GPCOG, and AD8 are useful for initial evaluation, with varying sensitivities and specificities.

Learning Objectives

Evaluate the definition, characteristics, prevalence, and risk factors of various dementia subtypes, including associated modifiable and non-modifiable risk factors.
Differentiate between dementia, delirium, mild cognitive impairment, neurological & psychiatric diseases, and memory loss.
Synthesize patient information from history, physical exam, functional assessments, cognitive evaluations, and collateral history, incorporating risk factors in the analysis.
Apply evidence-based principles, interpret lab tests, neuroimaging, and neuropsychological assessments, considering medication effects, interactions and environmental factors when diagnosing cognitive impairment.
Appraise the effectiveness of methods for early detection and diagnosis of dementia, assessing the importance of screening in older adults. Considering the potential impact of factors like education, occupation, social circles, and cultural background on the presentation of cognitive symptoms.
Assess the impact of dementia on patients and caregivers, considering ethical considerations, cultural factors, societal expectations, and the importance of support, education, and effective management.
Formulate strategies for ongoing monitoring, follow-up, and interprofessional collaboration, addressing BPSD (behavioral and psychological symptoms of dementia) and complications.
Analyze the role of modifiable risk factors, like hypertension, diabetes, smoking, and hyperlipidemia, in preventing dementia and improving patient outcomes. Analyzing the prevalence and incidence of each dementia type to understand its impact on different demographics.

Cognitive Domains

Perceptual-motor function (visual perception, visuoconstructional reasoning, perceptual-motor coordination).
Language (object naming, word finding, fluency, grammar, syntax, receptive language).
Executive function (planning, decision-making, working memory, responding to feedback, inhibition, flexibility).
Learning & Memory (free recall, cued recall, recognition memory, semantic and autobiographical long-term memory, and implicit learning).
Social Cognition (recognition of emotions, theory of mind, insight).
Complex attention (sustained attention, divided attention, selective attention, processing speed).
Specific cognitive functions can be impaired, depending on the type of dementia, and the specific area of the brain affected.

Dementia Specifics:

Memory Impairment: Common symptom, but some dementia types don't primarily present with memory loss; some present with prominent language or behavioral issues initially.
DSM-5: Replaced the term 'dementia' with 'major neurocognitive disorder', emphasizing cognitive decline in multiple domains, excluding delirium.
Prevalence: Dementia affects millions globally and is projected to rise substantially in the future, with incidence and prevalence increasing with age.
Epidemiology: Factors of Dementia's risk include age, gender, family history, modifiable risk factors (like hearing loss, smoking, diabetes, and vascular conditions), and potentially ethnicity and socioeconomic factors.

Differential Diagnosis

Delirium
Psychiatric disorders (pseudodementia)
Mild cognitive impairment
Normal aging

Delirium Overview

Acute confusional state often triggered by medical conditions, medications, or substance use.
Characterized by fluctuating cognitive dysfunction, impaired attention, and awareness, often with a rapid onset.
Crucial to distinguish delirium from other cognitive disorders, especially dementia, via history taking.
The etiology of delirium is often multifactorial, stemming from a combination of medical problems, and substance use/withdrawal, infections, and side effects of medications.
Includes physical symptoms that may involve other medical conditions; often requires a holistic evaluation to determine the cause
It can be treatable and potentially reversible if the underlying cause is identified and addressed promptly.

MCI (Mild Cognitive Impairment)

Transition phase between normal aging and dementia, characterized by subtle memory or cognitive deficits.
Individuals with MCI may experience difficulty with day-to-day activities.
Some cases of MCI progressively develop into dementia, others remain stable or improve.
Critical to distinguish from normal age-related cognitive decline and other conditions via detailed examinations; often progresses slowly to a more significant decline if not treated
Early diagnosis is key for potential intervention.

Alzheimer's Disease

Most common type of dementia, associated with diffuse functional and structural brain abnormalities (pathological hallmarks: amyloid plaques & neurofibrillary tangles) affecting aspects of cognition, including memory and language.
Risk factors include aging, genetics (APOE ε4 allele), vascular risk factors, and potentially some lifestyle factors
Characterized by insidious onset and gradual progression of cognitive decline, with memory loss, difficulty with daily activities, language problems, and potential personality changes in later stages.

Vascular Dementia

Second most common type of dementia, caused by cerebrovascular disease (strokes).
Risk factors including hyperlipidemia, hypertension, diabetes mellitus, smoking.
Symptoms fluctuate, depending on the location and extent of the affected brain areas, and may involve abrupt changes or progressive decline.

Lewy Body Dementia

Dementia type characterized by the presence of Lewy bodies (abnormal protein deposits) in the brain.
Often accompanied by symptoms that mimic Parkinson's disease (e.g., motor problems) and recurrent visual hallucinations; prominent fluctuations in cognitive function.
Diagnosis includes clinical evaluation, potentially neuroimaging and other tests, often challenging due to its broad symptom presentation.
Treatment focuses on symptom management.

Frontotemporal Dementia

Dementia spectrum involving the frontal and anterior temporal lobes of the brain.
Characterized by changes in personality, behavior, and language, compared to memory loss being a frequent presentation in Alzheimer's.
A variety of phenotypes (behavioral variant, semantic variant, and non-fluent variant) presents with unique symptom sets.
Common to have initial presentations of behavioral problems, language challenges, or personality changes.
Diagnosis, often supported by neuroimaging and biomarker analysis, may be challenging due to the variability of presentations.

Behavioral & Psychological Symptoms of Dementia (BPSD)

A wide range of neuropsychiatric disturbances (agitation, aggression, depression, apathy, etc) commonly encountered in dementia patients.
Often impacts quality of life for both patient and caregiver, creating psychosocial and emotional stressors
Associated with changes in the brain but also influenced by other factors like psychological and social stressors.

Further Testing (Across types)

Specific testing criteria exists for each type of dementia to aid in diagnosis, often involving a combination of approaches
A variety of neuroimaging, blood work, and biomarker analyses are used to aid in diagnosis and differentiate between different types of dementia.

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