Senile Dementia Quiz

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Questions and Answers

Which symptom is typically not associated with senile dementia?

Shuffling gait

Sudden onset of confusion (correct)

Loss of appetite

Disorientation to time, place and person

What is a psychological feature of senile dementia?

Increased attention span

Improved memory recall

Regression to childlike behavior (correct)

Euphoria

Which physical feature is commonly observed in individuals with senile dementia?

Fragile bones (correct)

Increased muscle strength

Decreased weight loss

Clear vision

How does the course of dementia differ from that of delirium?

Dementia is stable over the course of the day. Signup and view all the answers

Which of the following is an incorrect statement about senile dementia?

It primarily affects individuals under the age of 65. Signup and view all the answers

Which type of dementia is characterized by memory loss followed by confusion and poor judgment?

Dementia of the Alzheimer’s type Signup and view all the answers

Which of the following is a known cause of dementia?

Vitamin B12 deficiency Signup and view all the answers

What symptom is commonly associated with dementia, relating to emotional state?

Lability of mood Signup and view all the answers

Which type of dementia is often caused by chronic conditions such as tuberculosis or fungal infections?

Chronic granulomatous meningitis dementia Signup and view all the answers

Which indicator is NOT typically considered a clinical feature of dementia?

Normal speech patterns Signup and view all the answers

Which of the following conditions is associated with dementia caused by head trauma?

Normal-pressure hydrocephalus Signup and view all the answers

Which of the following is NOT a type of dementia listed?

Anxiety-related Dementia Signup and view all the answers

Amnestic syndrome is characterized by what type of memory impairment?

Impairment of both short-term and long-term memory Signup and view all the answers

What is a common characteristic of senile dementia regarding age onset?

Onset 65 years and above Signup and view all the answers

What distinguishes mental retardation from senile dementia in terms of brain structure?

No degeneration in mental retardation Signup and view all the answers

How does attention typically manifest in someone with delirium?

Lacks direction and sensitivity Signup and view all the answers

What is the typical appetite pattern in individuals with mental retardation?

Good appetite Signup and view all the answers

Which statement is true regarding awareness in a person experiencing delirium?

Awareness is reduced Signup and view all the answers

What differentiates appetites in senile dementia from those in mental retardation?

Appetite is poor in senile dementia and good in mental retardation Signup and view all the answers

Who is more likely to be affected by senile dementia according to sex?

More common in females than males Signup and view all the answers

Which of the following best describes drug use as defined in the context provided?

Any mind-altering agents affecting integrity Signup and view all the answers

What is a common characteristic of dementia?

Insidious development of cognitive deficits Signup and view all the answers

Which of the following drugs is not typically associated with the management of puerperium-related issues?

Antidepressants Signup and view all the answers

A common psychotic symptom seen in delirium may include which of the following?

Hallucinations Signup and view all the answers

Which investigative procedure is typically not included for diagnosing delirium?

X-ray of chest Signup and view all the answers

In contrast to delirium, how is the level of awareness in dementia patients usually described?

Intact and stable Signup and view all the answers

What kind of behavioral symptom may be observed in patients experiencing delirium?

Emotional lability Signup and view all the answers

Which of the following metals is known to cause toxic effects that may be relevant in puerperium investigations?

Lead Signup and view all the answers

What is a key feature of the sleep cycle associated with patients who have delirium?

Fragmented sleep/work cycle Signup and view all the answers

Which of the following characteristics describes psychological dependency?

Perceiving drug use as necessary for wellbeing Signup and view all the answers

What term describes the set of signs and symptoms that occur after sudden cessation of drug intake?

Withdrawal syndrome Signup and view all the answers

Which factor is NOT commonly associated with drug abuse and dependency?

Physical fitness Signup and view all the answers

What is termed as the irresistible urge to obtain and use a psychoactive drug?

Craving Signup and view all the answers

Which of the following is a common withdrawal symptom associated with alcohol cessation?

Tremors of hands Signup and view all the answers

Which drug commonly leads to the characteristic symptom of severe craving during withdrawal?

Cocaine Signup and view all the answers

What is the main characteristic of chemical dependency?

Development of tolerance to the drug Signup and view all the answers

Which of the following drugs is NOT typically associated with withdrawal symptoms?

LSD Signup and view all the answers

What is one of the physical effects of drug/alcohol dependence?

Cirrhosis of the liver Signup and view all the answers

Which therapy is associated with the treatment of alcohol dependence?

Aversion therapy Signup and view all the answers

What is a recommended method to prevent drug/alcohol dependence among youth?

Education programs Signup and view all the answers

What role does psychotherapy play in the treatment of drug/alcohol dependence?

It addresses psychological issues. Signup and view all the answers

Which of the following is a psychological effect of drug/alcohol dependence?

Delirium Signup and view all the answers

What does the Dangerous Drug Act (D.D.A.) regulate?

Prescribing and distribution of drugs Signup and view all the answers

Which of the following is NOT a recommendation for preventing drug dependence?

Encouraging drug use in schools Signup and view all the answers

How should drugs be stored as per the regulations?

Under a lock Signup and view all the answers

Study Notes

Neurocognitive Disorders

Neurocognitive disorders is a new global term encompassing both delirium and dementia diagnoses (DSM-5, 2013). Previously, these were called organic mental syndrome and disorder.

Causes

Cognitive psychotic conditions have diverse causes (etiologies).
A mnemonic "MEND A MIND" helps remember causes of cognitive impairment:
- M - Metabolic disorder
- E - Electrical disorder
- N - Neoplastic disease
- D - Degeneration
- A - Arterial disease
- M - Mechanical disease
- I - Infectious disease
- N - Nutritional disease
- D - Drug toxicity

Delirium

Definition: An acute organic mental syndrome characterized by a clouding of consciousness, accompanied by disorientation, memory problems, and reduced concentration. It is reversible.
Prevalence: Up to 15% of patients over 65 are delirious upon hospital admission.
Risk factors: Increasing age, underlying dementia, and physical illness.
Outcome: Full recovery is usual but there is significant associated morbidity and mortality.
Onset: Sudden and tends to resolve rapidly with cause identified and appropriate treatment. Common in children and those aged 60 and above.
Types:
- Delirium due to a general medical condition
- Substance-induced delirium
  - Substance intoxication delirium
  - Substance withdrawal delirium
- Delirium due to multiple etiologies/delirium not otherwise specified
Causes (categorized):
- A. Infections: Systematic infections (e.g., malaria, typhoid fever, pneumonia), etc.
- B. Drug intoxication/withdrawal: Alcohol, anxiolytics, opioids, CNS stimulants, cocaine, crack, amphetamines, marijuana, etc.
- C. Neurological disorders: Seizures, head trauma
- D. Postoperative state; puerperium (post-partum); hypertensive encephalopathy
- 1. Drugs: Antibiotics, antiparkinsonian, anticholinergics (and anti-tuberculosis), anticonvulsants, analgesics, anti-inflammatory
- 1. Metals and gases: Mercury, Lead, Arsenic, Carbon Monoxide

Clinical Features of Delirium

Altered state of alertness, awareness, and consciousness (may fluctuate between hyperalert and obtunded; lucid intervals may occur).
Onset may be dramatic/sudden but can be difficult to detect and may evolve over days/weeks.
Disorientation and confusion. Decreased attention, concentration, and memory.
Psychotic symptoms: Paranoia, hallucinations (often visual).
Behavioral disinhibition; emotional liability; irritability.
Psychomotor retardation or agitation (may vary in a 24-hour period)
Fragmented sleep/wake cycle; increased agitation at night.
Usually reversible with correction of the underlying etiology.

Investigations

Aim for minimal but thorough investigations: Blood HB, Blood Urea, Electrolytes, urinary sugar and protein, Bender Gestalt Test, Memory Test, Fundus Examination, X-ray of skull, EEG, CSF Routine, Brain Scan, Brain Biopsy

Dementia

Definition: Characterized by a (usually) insidious but sometimes acute development of generalized brain dysfunction with multiple cognitive deficits resulting in impairment of social and/or occupational functioning and decline from previous levels.
Consciousness: In contrast to delirium, awareness and mental alertness are intact and stable in the early phases of dementia.
Memory impairment: The hallmark of dementia—loss of recent and past memories, as well as difficulty learning new information.

Types of Dementia

Alzheimer's type
Vascular Dementia
Due to HIV
Due to head trauma
Due to Parkinson's Disease
Due to Huntington's Disease
Due to Pick's disease
Due to Creutzfeldt-Jakob's disease
Due to other General Medical Conditions
Substance-induced persisting dementia
Due to multiple etiology
Not otherwise specified

Causes of Dementia (Partial List)

Alcohol-related dementia
Alzheimer’s disease
Amyotrophic lateral sclerosis
Bromide poisoning
Chronic granulomatous meningitis (tuberculosis, fungal)
Folic acid deficiency
Head trauma
Human immunodeficiency virus (HIV)
Huntington’s chorea
Hypothyroidism
Multi-infarct Dementia
Multiple sclerosis
Neoplasms
Normal-pressure hydrocephalus
Parkinson’s disease
Postanoxic state
Progressive Supranuclear Palsy
Transmissible virus dementia (e.g., Jacob-Creutzfeldt)
Vitamin B12 deficiency

Clinical Features of Dementia, cont'd

Personality changes, loss of interest in surroundings, irritability
Dullness, apathy, fatigue
Delusions of persecution
Disorientation; regression to childishness
Euphoria (in some cases)
Severely demented, emaciated, bedridden, helpless in advanced stages
Memory impairment/amnesia (anterograde and retrograde)
Lack of concentration to time, place and person
Episodes of confusion
Poor judgment, inappropriate decisions inconsistent with history

Senile Dementia

A chronic organic mental condition due to degenerative brain changes typically arising in the 65+ age group.
Characterized by permanent impairment of cognitive functioning and behavioral changes
Psychological features:
- Feeling rejected
- Regression (childish behaviour)
- Memory loss (anterograde and retrograde amnesia)
- Overtalkativeness
Physical features:
- Repetition of words (verbigeration)
- Confabulation
- Disorientation to time, place, and person
- Mood swings
- Restlessness & aimless wandering
- Hallucinations & delusions
- Incontinence of urine & feces,
- General bodily weakness,
- Loss of appetite,
- Shuffling gait
- Blurred/incoherent speech
- Weight loss,
- Loss of vision & hearing,
- Deafness,
- Wrinkled/ inelastic skin,
- Loss of teeth,
- Fragile bones,
- Neglect of personal hygiene
- Epileptic fits

General Paralysis of the Insane (GPI)

A mental disorder resulting from untreated syphilis.
Syphilis is a venereal disease causing progressive brain infection.
Symptoms can appear 5-75 years after infection with a slow onset.
Symptoms include both neurological and psychological issues, with gradual onset.
- Loss of memory
- Impairment of judgment
- Disorientation
- Lack of initiative & concentration
- Grand/nihilistic delusions
- Mood swings
Neurological features that appear with increasing severity:
- Small, unequal & irregular pupils which do not react to light (e.g. Argyll Robertson pupils)
- Tremors of lips, tongue, and facial muscles -> slurred speech and indistinct words (dysarthria)
- Tremors of hands, incoordination of all movements,
- Epileptic attacks,
- increased appetite

Parkinson's Disease

A common disease affecting 1 in 1000 and occasionally 1% of people over 70 years old. Peak incidence is in the sixth decade.
Also known as paralysis agitans.
Symptoms and signs include: Akinesia, rigidity, pill-rolling tremor, postural abnormality, shuffling gait, and difficulty in handwriting or walking.
Other neurological conditions associated with Parkinsonism appearance (clinical syndrome).

Epilepsy

A disorder of excessive and recurring neural discharge in the brain characterized by episodes of motor, sensory or psychic dysfunction; sometimes with and sometimes without unconsciousness and convulsive movements.
Causes include:
- Constitutional factors
- Predisposing factors: Intracranial infections, degenerative diseases, brain tumors, head injuries, metabolic disorders, emotional stress, etc
- Precipitants such as drugs, boredom, sensory stimulus, or fatigue.
- Other possible causes: Sexual activity, excitement, strong emotions, fever
Types/Classifications include:
- Generalized epilepsy (with loss of consciousness), with subtypes like grand mal (major epilepsy) or petit mal (minor epilepsy). Features of grand-mal include aura, tonic, clonic, and coma stages.

Mental Retardation/Intellectual Disability

A condition characterized by a sub-average level of intelligence and impairments in adaptive behavior, usually apparent before the age of 18.
Types of impairments include: learning disability, subnormality, oligophrenia, and mentally defective.
Other possible names: intellectually or mentally handicapped, mentally challenged, mentally disabled, amentia, moron/mongolism, imbecile, idiot, feeblemindedness
Causes include
- Hereditary (genetic abnormalities)
- Environmental (prenatal infections like Rubella; various maternal factors such as malnutrition, frequent radiation exposure, chemicals during pregnancy. During birth, premature separation of placenta (Placenta praevia). Post-natal factors such as childhood malnutrition traumatic brain injury and infection of central nervous system (such as meningitis). Thyroid disorders during pregnancy-creatinism
Classification of levels: mild, moderate, severe, and profound.
IQ scores are used to categorize the severity of retardation.
Physical features can indicate syndromes:
- The cranium (large/small head; delayed closure of fontanelles)
- The mouth (shape of jaw & teeth; high arched palate)
- The ears (abnormal shape)
- The nose (e.g., depressed bridge)
- The eyes (slanted; extra skin folds; corneal opacity; involuntary rapid eye movement - nystagmus)
- The trunk (long trunk)
- The hands & feet (shorter digits; webbed digits; clumsiness; loss of motor coordination)
Diagnosis requires assessment of physical outlook, mental development, and school/occupational performance; IQ testing (IQ formula MA/CA*100%).

Substance Abuse

Excessive intake of any mind-altering substance (drugs or alcohol), impacting biological, physiological, and socio-cultural well-being.
Drug: Any substance, other than food, intended to diagnose, treat, cure, alleviate, or mitigate disease (or prevent diseases).
Drug Dependence (addiction): A state of periodic or chronic intoxication harmful to the individual and society, resulting from repeated drug use. The drug may be natural or synthetic.
Characteristics of dependence include compulsive use, use despite harm, withdrawal symptoms, increased need for the substance to get the same effect, psychological and physical dependency.
Examples of drugs include marijuana, cocaine, heroin, mescaline, LSD, amphetamines, barbiturates, morphine
Causes of substance/drug abuse and dependence include hereditary factors; familial factors, anxiety, peer group influence, psychological/physical problems, particular occupations, and unusual curiosity.
Withdrawal syndromes (with specific symptoms related to drug substances) may occur upon cessation of taking the drug, or when blood level falls suddenly: e.g. Alcohol, amphetamines, cocaine, marijuana, opioids
Treatment strategies for withdrawal and dependence.

Alcoholism

Excessive and prolonged alcohol intake, leading to physical and mental illness, impacting socio-economic functions and relationships.
Causes: Stress, peer influence, poor upbringing, anxiety, hereditary factors, low self-esteem, occupations (e.g. breweries, bartenders, mortuary workers) and curiosity
Effects on CNS: Depression (impairing memory, reasoning). Large doses lead to e.g.: muscular in-coordination, poor judgment, nausea, vomiting, diplopia, ataxia, amnesia, cold, clammy skin. May led to coma and death.
Possible alcohol-related psychoses: pathological intoxication (state of acute excitement with violence and loss of self-control). Dipsia mania (periodic excessive drinking bouts, followed by abstinence periods; causes neglect of work and personal hygiene)
Symptoms of Delirium Tremens (alcohol withdrawal delirium).
Causes of Delirium Tremens (e.g., sudden withdrawal, reduction in alcohol consumption, pre-existing physical issues).
Management of alcoholism including hospitalization, close observation, complete bedrest, administration of anxiolytics or sedatives; nutritional support (vitamins and fluids) and personal hygiene attention.

Other Cognitive Impairments

Briefly describe some other impairments (e.g., Amnestic syndrome; Organic Delusional Syndrome; Organic Hallucinations; Organic Mood Syndrome; and Organic Anxiety Syndrome & Organic Personality Syndrome) as separate disorders with related psychological/behavioral effects and treatment strategies.

Prevention of Drug/Alcohol Dependence

Education on the harmful effects of drug/alcohol abuse targeting particularly youth and other educational initiatives/programs.
Legal interventions include banning certain drugs and requiring prescription, as well as proper distribution and sale strategies.

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Description

Test your knowledge on senile dementia with this quiz that covers symptoms, psychological features, and different types of dementia. Understand the differences between dementia and delirium, as well as common characteristics and causes of dementia. Challenge yourself and learn more about this critical topic in mental health.