D ementia and Delirium
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Which of the following is a key diagnostic feature of dementia? A) Loss of memory only B) Loss of memory and at least one other cognitive domain C) Decline in physical ability without cognitive impairment D) Sudden onset of memory loss

  • Loss of memory only
  • Loss of memory and at least one other cognitive domain (correct)
  • Decline in physical ability without cognitive impairment
  • Sudden onset of memory loss

    • Dementia is defined as:

  • A temporary decline in cognitive function due to reversible causes.
  • A progressive neurodegenerative condition causing a decline in cognition and functional independence. (correct)
  • A neuropsychiatric condition associated with hallucinations.
  • A developmental disorder present since childhood.

    • What is the prevalence of dementia in individuals over 90 years of age?

  • 4%
  • 20%
  • 50% (correct)
  • 80%

    • Which of the following cognitive domains can be affected in dementia in addition to memory?

    <p>All of the above</p> Signup and view all the answers

    Dementia is most commonly:

    <p>Age-related and often unrecognized in earlier stages.</p> Signup and view all the answers

    What percentage of dementia cases are caused by Alzheimer’s disease?

    <p>50%–75%</p> Signup and view all the answers

    Which of the following types of dementia is most commonly associated with vascular changes?

    <p>Vascular dementia</p> Signup and view all the answers

    Lewy body dementia accounts for approximately:

    <p>10%-25% of cases</p> Signup and view all the answers

    Which of the following is NOT considered a primary type of dementia?

    <p>Huntington’s disease</p> Signup and view all the answers

    Which type of dementia is associated with abnormal tau proteins and TDP-43 protein inclusions?

    <p>Frontotemporal dementia</p> Signup and view all the answers

    Mixed dementia refers to: A) The co-occurrence of Alzheimer’s and Parkinson’s disease. B) Dementia with features of multiple etiologies, such as Alzheimer’s and vascular dementia. C) A combination of cognitive and motor impairments. D) Cognitive impairment caused by multiple traumatic brain injuries.

    <p>Dementia with features of multiple etiologies, such as Alzheimer’s and vascular dementia.</p> Signup and view all the answers

    Which of the following is a rare prion disease that causes rapidly progressive dementia?

    <p>Creutzfeldt-Jakob disease</p> Signup and view all the answers

    Which type of dementia is most closely associated with alpha-synuclein protein deposition?

    <p>Lewy body dementia</p> Signup and view all the answers

    Which type of dementia is associated with stepwise deterioration due to small infarcts?

    <p>Vascular dementia</p> Signup and view all the answers

    What is the average life expectancy after the diagnosis of Alzheimer’s disease?

    <p>10 years</p> Signup and view all the answers

    Which pathological features are hallmarks of Alzheimer’s disease?

    <p>Amyloid plaques and neurofibrillary tangles</p> Signup and view all the answers

    What is a defining feature of Lewy body dementia?

    <p>Triad of visual hallucinations, fluctuating cognition, and Parkinsonism</p> Signup and view all the answers

    Frontotemporal dementia primarily affects which cognitive domains early in the disease?

    <p>Behavioral control, emotion, and language</p> Signup and view all the answers

    What risk factors are commonly associated with vascular dementia?

    <p>Smoking, obesity, hypertension, and atrial fibrillation</p> Signup and view all the answers

    Which genetic factor is implicated in Alzheimer's disease and accounts for approximately 7% of the risk?

    <p>APOE4 gene</p> Signup and view all the answers

    Which of the following is characteristic of frontotemporal dementia's behavioral variant? A) Stepwise cognitive decline B) Disinhibition and inappropriate social behavior C) Visual hallucinations D) Rapidly progressive memory loss

    <p>Disinhibition and inappropriate social behavior</p> Signup and view all the answers

    What is a common downside of traditional Alzheimer’s diagnostic models?

    <p>Sensitivity and specificity are lower than postmortem validation.</p> Signup and view all the answers

    Which form of dementia has a strong association with Parkinsonism?

    <p>Lewy body dementia</p> Signup and view all the answers

    What type of brain changes are typically seen in Alzheimer's disease?

    <p>Ventricular enlargement and macroscopic hippocampal atrophy</p> Signup and view all the answers

    Which variant of frontotemporal dementia is characterized by early language disturbance with preservation of other cognitive domains?

    <p>Primary progressive aphasia</p> Signup and view all the answers

    Which of the following is a hallmark memory-related symptom of dementia?

    <p>Forgetfulness and inability to follow movies or read books</p> Signup and view all the answers

    Which of the following describes apraxia? A) Difficulty remembering familiar faces B) Inability to complete motor tasks despite previous proficiency C) Disturbance in executive function D) Difficulty finding the right words

    <p>Inability to complete motor tasks despite previous proficiency</p> Signup and view all the answers

    Which of the following diagnostic tools is commonly used to screen for cognitive impairment in dementia?

    <p>4AT and MMSE</p> Signup and view all the answers

    Which symptom is specifically more common in Lewy body dementia compared to Alzheimer’s disease?

    <p>Resting tremor</p> Signup and view all the answers

    Which DSM-IV criterion is required for diagnosing Alzheimer’s disease?

    <p>Memory impairment and one or more cognitive deficits such as aphasia, apraxia, or agnosia</p> Signup and view all the answers

    What is an example of emotional lability in dementia patients?

    <p>Sudden and unpredictable changes in mood or emotions</p> Signup and view all the answers

    Which of the following is a general inspection finding that may be observed in dementia patients?

    <p>Disorientation in time and place</p> Signup and view all the answers

    What is a key feature of aphasia in dementia?

    <p>Word-finding difficulties or problems with speech</p> Signup and view all the answers

    Which of the following behavioral changes might be observed in a dementia patient?

    <p>Repetitive physical behaviors</p> Signup and view all the answers

    Which cranial nerve deficits are commonly associated with swallowing difficulty in severe dementia?

    <p>CN V, IX, X</p> Signup and view all the answers

    Visual field deficits in dementia are most likely to occur due to:

    <p>Infarction in vascular dementia</p> Signup and view all the answers

    Slurred speech in dementia is often associated with:

    <p>Cerebellar involvement</p> Signup and view all the answers

    What type of gait is most commonly observed in Lewy body dementia?

    <p>Slow, shuffling, stooped gait</p> Signup and view all the answers

    Hemiparesis or spasticity is most commonly associated with which type of dementia?

    <p>Vascular dementia</p> Signup and view all the answers

    Which clinical finding is commonly associated with changes in sensation in vascular dementia?

    <p>Hemisensory changes</p> Signup and view all the answers

    Paucity of speech in dementia is indicative of: A) Word-finding difficulty or aphasia B) Tremors and Parkinsonism C) Visual hallucinations D) Impaired balance

    <p>Word-finding difficulty or aphasia</p> Signup and view all the answers

    Unilateral weakness and asymmetrical deep tendon reflexes in dementia are suggestive of: A) Alzheimer's disease B) Vascular dementia C) Lewy body dementia D) Frontotemporal dementia

    <p>Vascular dementia</p> Signup and view all the answers

    Which finding differentiates vascular dementia from other types?

    <p>Asymmetrical deep tendon reflexes and hemiparesis</p> Signup and view all the answers

    Which of the following is a prognostic marker for dementia?

    <p>Functional loss/personal care dependence</p> Signup and view all the answers

    What is the primary cause of Alzheimer’s disease?

    <p>Cholinergic neuron loss and amyloid plaques</p> Signup and view all the answers

    Which of the following is NOT a differential diagnosis for dementia?

    <p>Parkinson's disease</p> Signup and view all the answers

    Which of the following symptoms is most indicative of Frontotemporal dementia?

    <p>Behavioral changes and disinhibition</p> Signup and view all the answers

    A resting tremor is commonly seen in which type of dementia?

    <p>Lewy body dementia</p> Signup and view all the answers

    Which of the following is NOT a common cause of dementia? A. Creutzfeldt-Jakob disease B. Thiamine deficiency C. Normal pressure hydrocephalus D. Hyperthyroidism

    <p>Hyperthyroidism</p> Signup and view all the answers

    The diagnostic test commonly used to assess cognitive impairment in patients suspected of dementia is:

    <p>Mini-Mental State Examination (MMSE)</p> Signup and view all the answers

    Which of the following is a possible infectious cause of cognitive impairment?

    <p>Creutzfeldt-Jakob disease</p> Signup and view all the answers

    Which of the following medications is commonly associated with cognitive impairment in elderly patients?

    <p>Antidepressants</p> Signup and view all the answers

    Which of the following is a possible diagnosis for a patient presenting with cognitive decline, gait disturbance, and urinary incontinence?

    <p>Normal pressure hydrocephalus</p> Signup and view all the answers

    A deficiency in which of the following vitamins can contribute to cognitive impairment?

    <p>Vitamin B12</p> Signup and view all the answers

    What is a common finding in patients with limbic encephalitis?

    <p>Memory loss and personality changes</p> Signup and view all the answers

    Delirium is characterized by:

    <p>A fluctuating change in mental status with altered consciousness</p> Signup and view all the answers

    Which of the following is NOT a type of delirium?

    <p>Chronic</p> Signup and view all the answers

    A person presenting with heightened arousal, restlessness, and agitation is likely experiencing which type of delirium?

    <p>Hyperactive delirium</p> Signup and view all the answers

    Which of the following is a key feature of hypoactive delirium?

    <p>Lethargy and reduced motor activity</p> Signup and view all the answers

    Mixed delirium involves: A. Only hyperactive symptoms B. Only hypoactive symptoms C. A combination of both hyperactive and hypoactive symptoms D. Chronic symptoms that worsen over time

    <p>A combination of both hyperactive and hypoactive symptoms</p> Signup and view all the answers

    Which of the following is a common drug that may cause or worsen delirium?

    <p>Opioids</p> Signup and view all the answers

    Which of the following causes of delirium is related to metabolic abnormalities?

    <p>Glucose or thyroid imbalances</p> Signup and view all the answers

    What is a risk factor for delirium?

    <p>Physical frailty</p> Signup and view all the answers

    Which of the following is considered a reversible cause of delirium?

    <p>Infection</p> Signup and view all the answers

    The 'DEMENTIA' acronym for delirium causes includes which of the following? A. Drugs, Dehydration, Detox (withdrawal), Discomfort B. Dementia, Environment, Electrolytes C. Depression, Electrolytes, Environment D. Dysphoria, Euphoria, Electrolytes

    <p>Drugs, Dehydration, Detox (withdrawal), Discomfort</p> Signup and view all the answers

    Which of the following conditions increases the risk of delirium due to impaired oxygen delivery?

    <p>Hypoxia</p> Signup and view all the answers

    Which of the following drugs can contribute to delirium by causing sedation or confusion?

    <p>Antihistamines</p> Signup and view all the answers

    Which of the following is a potential cause of delirium related to the environment?

    <p>Being in an unfamiliar environment</p> Signup and view all the answers

    Which of the following is a common symptom of delirium?

    <p>Disorientation in time and place</p> Signup and view all the answers

    Delirium is most commonly characterized by: A. A stable course of symptoms B. Fluctuating symptoms C. A gradual decline over months D. No change in mental status

    <p>Fluctuating symptoms</p> Signup and view all the answers

    What would you most likely observe in a general inspection of a patient with delirium?

    <p>Sloppily dressed and apathetic appearance</p> Signup and view all the answers

    Which of the following speech findings is associated with delirium? A. Slurred speech B. Rapid and clear speech C. Loud speech D. No speech

    <p>Slurred speech</p> Signup and view all the answers

    Which of the following is a symptom of delirium related to a patient's behavior?

    <p>Behavioral disturbances and agitation</p> Signup and view all the answers

    A patient with delirium may show which of the following signs during a clinical exam?

    <p>Repetitive physical behaviors</p> Signup and view all the answers

    What is a common finding in the speech exam of a delirium patient?

    <p>Slow speech and paucity of speech</p> Signup and view all the answers

    A common feature of delirium is:

    <p>Decreased speed of activity</p> Signup and view all the answers

    Which of the following is a key aspect of the history-taking process during the first assessment of a dementia patient?

    <p>Collateral or informant history</p> Signup and view all the answers

    Which of the following is commonly asked during the first assessment of a patient suspected of dementia?

    <p>Whether the patient has any cognitive impairments in instrumental activities (e.g., appointments, finances)</p> Signup and view all the answers

    Which of the following cognitive assessment tools is commonly used in the diagnosis of dementia?

    <p>RUDAS</p> Signup and view all the answers

    During the first assessment of a patient with suspected dementia, which of the following would be a key historical question?

    <p>Whether the patient is experiencing weight loss or reduced dietary intake</p> Signup and view all the answers

    Which of the following is a common historical sign suggesting dementia that should be addressed during the initial assessment?

    <p>Withdrawal from social activity</p> Signup and view all the answers

    Which cognitive assessment tool is specifically designed to assess dementia in patients from diverse linguistic and cultural backgrounds?

    <p>RUDAS</p> Signup and view all the answers

    What is an important consideration when assessing cognition in a patient suspected of dementia?

    <p>Using cognitive assessments like MMSE or MOCA</p> Signup and view all the answers

    Which of the following neuro-imaging techniques is commonly used to assess brain atrophy in dementia?

    <p>CT and MRI Brain</p> Signup and view all the answers

    Which of the following blood tests is commonly ordered in the initial work-up for dementia diagnosis?

    <p>B12/folate, TFTs, routine blood tests</p> Signup and view all the answers

    When is a lumbar puncture useful in the diagnosis of dementia? A. It is routine in all dementia patients B. It is useful in younger patients with suspected dementia C. It is primarily used to rule out infection D. It is mainly used to diagnose Alzheimer’s disease

    <p>It is useful in younger patients with suspected dementia</p> Signup and view all the answers

    Which of the following is a newer diagnostic tool being used in dementia research?

    <p>PET Tau scanning</p> Signup and view all the answers

    Which of the following measures can help delay or prevent dementia? (Select one)

    <p>Strengthening the brain through education and maintaining a cognitively enriching environment</p> Signup and view all the answers

    Which of the following interventions can help reduce the risk of vascular dementia?

    <p>Active treatment of blood pressure in middle age and older people</p> Signup and view all the answers

    What is the primary role of PET 18 FDG & PET amyloid scanning in dementia diagnosis?

    <p>They are used when the dementia diagnosis is unclear</p> Signup and view all the answers

    Which of the following can help prevent damage to the brain and reduce the risk of dementia?

    <p>Increasing social engagement and managing depression</p> Signup and view all the answers

    Which of the following is a key aspect of non-pharmacological management of dementia?

    <p>Driving assessment</p> Signup and view all the answers

    When should enduring power of attorney and advanced care directives be discussed in dementia management?

    <p>Early in the disease process, before significant cognitive decline</p> Signup and view all the answers

    Which of the following pharmacological treatments is commonly used to manage symptoms of dementia?

    <p>Cholinesterase inhibitors (Donepezil, Rivastigmine, Galantamine)</p> Signup and view all the answers

    What is the role of NMDA receptor antagonist in the pharmacological management of dementia?

    <p>To minimize cognitive impairment in dementia patients</p> Signup and view all the answers

    What is an important aspect of managing carer stress in dementia?

    <p>Monitoring carer stress and providing support</p> Signup and view all the answers

    Which of the following medications should be removed or minimized in dementia patients to avoid impairing cognition?

    <p>Anti-cholinergic medications</p> Signup and view all the answers

    Which of the following statements is true about new disease-modifying treatments for Alzheimer's disease?

    <p>Aducanemab and Lecanemab are monoclonal antibodies that target soluble and insoluble oligomers of A-beta amyloid in plaques.</p> Signup and view all the answers

    In delirium management, which of the following should be avoided if possible?

    <p>Sedation</p> Signup and view all the answers

    What is the main difference between delirium and dementia regarding onset?

    <p>Delirium has an acute onset, while dementia has an insidious onset.</p> Signup and view all the answers

    Which of the following is a major complication of delirium in older patients?

    <p>Increased risk of falls and fractures</p> Signup and view all the answers

    Which of the following is true about the prognosis of delirium?

    <p>Delirium can last for weeks or months, even after the underlying cause is treated.</p> Signup and view all the answers

    What is an important distinction between delirium and dementia regarding attention?

    <p>Delirium has impaired attention, while dementia usually has normal attention unless severe.</p> Signup and view all the answers

    Which of the following cognitive assessments is used for evaluating delirium across domains of alertness, awareness, attention, and change in behavior?

    <p>4AT</p> Signup and view all the answers

    Which of the following investigations is essential to determine the underlying cause of delirium? A. Electroencephalogram (EEG) B. Chest X-ray (CXR) and urine dip C. MRI brain D. Skin biopsy

    <p>Chest X-ray (CXR) and urine dip</p> Signup and view all the answers

    What is the primary aim of delirium management?

    <p>To treat the underlying cause of delirium</p> Signup and view all the answers

    In delirium management, which of the following should be avoided, especially in older adults?

    <p>Pharmacological sedation</p> Signup and view all the answers

    Which of the following antipsychotic medications is used for delirium management but should be avoided in Parkinson's disease?

    <p>Risperidone</p> Signup and view all the answers

    What is the preferred approach to pharmacological management in delirium?

    <p>Start low, go slow</p> Signup and view all the answers

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