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67 Cards in this Set

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Dementia is:
a) a progressive illness noted by plaques & tangles; b) often accompanied with cogwheel rigidity; c) a set of symptoms which may be associated with many disorders; d) synonymous with declines in intellect.
C) A set of symptoms which may be associated with many disorders.
What is the essential feature of dementia?
Short and long-term memory, associated with impairment in abstract thinking, impaired judgment, other disturbances of higher cortical functioning, or personality change.
True or false - Dementia always has an underlying organic cause.
True
Estimates of the prevalence of dementia among the elderly have ranged from ____% to ___% of persons over 65 for severe demential, and ___% to ___% for those with milder dementia.
Estimates of the prevalence of dementia among the elderly have ranged from 1.3% to 6.2% of persons over 65 for severe dementia, and 2.6% to 15.4% for those with milder dementia.
Which type of dementia affects at least half of the dementia cases?
Alzheimer's Disease (affecting 5-6% of people above 65).
Can a 4-year-old develop dementia?
Yes. "If a 4 year old developed a chronic neurologic disorder that interfered with previously acquired functions so as to significantly lower IQ or adaptive fxning, he would be considered to have both dementia and retardation."
Dementias due to _____________, _____________, & _____________ may have a gradual onset.
Dementias due to BRAIN TUMORS, SUBDURAL HEMATOMAS, & METABOLIC FACTORS may have a gradual onset.
Primary progressive dementia of the Alzheimer's type usually involves a ____ deterioration.
Primary progressive dementia of the Alzheimer's type usually involves a SLOW deterioration.
The first phase of DAT is _________ (noticed by the individual & sometimes those close to person) & accompanying _________ caused by forgetfulness.
The first phase of DAT is THE FORGETFUL PHASE (noticed by the individual & sometimes those close to person) & accompanying ANXIETY caused by forgetfulness.
The _____phase leads to "severe deficits in memory for recent event, difficulty in _______ & _____, and ___________________ (e.g., word finding difficulty) despite generally intact vocabulary and syntax."
The CONFUSION phase leads to "severe deficits in memory for recent event, difficulty in ORIENTATION & CONCENTRATION, and SUBTLE LANGUAGE DEFICITS (e.g., word finding difficulty) despite generally intact vocabulary and syntax."
What does the dementia phase entail?
Severe disorientation, abnormalities of language, perception and praxis, and behavioral problems including motor restlessness, wandering, & psychotic symptoms (paranoia).
Cerebral hypoxia or encephalitis can possibly lead to dementia. Are the symptoms acute or insidious?
ACUTE, but then remain stationary for a long time.
In _____________, the deficits are believed to be the result of the accumulation of abrupt vascular episodes ("strokes").
In MULTI-INFARCT DEMENTIA, the deficits are believed to be the result of the accumulation of abrupt vascular episodes ("strokes").
With multi-infarct dementia are the signs and symptoms most likely to be focal or diffuse?
Focal.
Mild dementia memory problems are notable for ______________.
Mild dementia memory problems are notable for MODERATE MEMORY LOSS WHICH IS MORE MARKED FOR RECENT EVENTS (e.g., names, telephone #s, conversations, etc.)
In severe dementia, only _____________ is retained, and new information is rapidly forgotten.
In severe dementia, only HIGHLY LEARNED MATERIAL is retained, and new information is rapidly forgotten.
___________________ may be associated with dementia, typically altering or accentuating premorbid traits.
PERSONALITY CHANGES may be associated with dementia, typically altering or accentuating premorbid traits.
What is the essential feature of depression?
Depressed mood or loss of interest or pleasure inall, or almost all, activities (may also result in diminished capacity to think or concentrate.
What is the distinguishing feature of depression when compared to dementia?
It is not initiated or maintained by "organic" factors.
Untreated, the depression can usually last _______ months or more, although the chronic type can go for ___________ years.
Untreated, the depression can usually last 6 months or more, although the chronic type can go for 2 years.
What is the prevalence of depression in elderly citizens who live within the community: a) 20-25%
b) 35%
c) 13%
13 %
While memory and learning are affected, deficits are seen in ____________ requiring effort. This interferes with initial________.
While memory and learning are affected, deficits are seen in SUSTAINED ATTENTION requiring effort. This interferes with initial PROCESSING.
True or False: Depressed patients appear to retain information once it is learned.
TRUE. It is often retrieval deficits that are found (perhaps in part because of effort).
Some would say that in the depressed patient, deficits in memory functions is not the issue, rather, they have problems with ____, ______, & ______.
Some would say that in the depressed patient, deficits in memory functions is not the issue, rather, they have problems with MOTIVATION, DRIVE, & ATTENTION.
TRUE OR FALSE: In a major depressive episode, the distinction between depression and dementia is clear because of global attention and effort problems.
FALSE: The symptoms may be severe enough to mistaken depression for dementia (poor mental status exam and neuropsychological testing.
What is the most common psychiatric condition that is associated with pseudodementia?
DEPRESSION
___________________ is a label given to psychiatric diorders which involve dementia-type symptoms and which persist if untreated.
PSEUDODEMENTIA
There is disagreement over whether dementia should be based on its "organicity" vs. _________.
There is disagreement over whether dementia should be based on its "organicity" vs. IT'S PROGRESSIVE NATURE.
What are some difficulties with differentiating between early stage dementia and normal aging?
In normal aging, normal decline of IQ can be mistaken for dementia, in addition to memory changes associated with normal aging.
What is the main complaint of elderly depressed patients?
MEMORY PROBLEMS. If the depression is treated, the short-term memory problems may remit.
Depression is frequently accompanied by cognitive problems, esp. in older folks; sometimes severe enough to be labeled _______________.
Depression is frequently accompanied by cognitive problems, esp. in older folks; sometimes severe enough to be labeled PSEUDODEMENTIA.
What are some of the signs & symptoms that overlap btwn. depression & dementia?
1 - Both interfere with social & occupational functioning.

2- Both result in withdrawal from activities.
With depression, what may lead to withdrawal from activities?
Loss of interest.
With dementia, what may lead to withdrawal from activities?
It may be due to anxiety & attempts to hide deteriorating facultiesas well as loss of interest from depression.
TRUE OR FALSE: Depression rarely occurs as a complication od dementia, thus making it easier to differentiate btwn the two.
FALSE.
What aspects of the clinical presentation of both early dementing process and dementia are most likely to contribute to misdiagnosis?
Depressed mood & agitated state; hx of psychiatric disturbance; psychomotor retardation; impaired immediate memory & learning; loss of interest of one's surroundings (or self care).
Based on research (Ron & colleages, 1979), based on the orinigal diagnosis of the pts. under age 65, what was the % of cases that were confirmed?
a) 50% b) 75% c) 69%
C) 69% (8 had affective illness, 1 paranoid psychosis, 1 schizophrenic, 3 PD, 2 nonprogressive brain damage of unknown etiology, 1 "transient acute organic reaction w/marked affective symptoms)
When uncertain, the ________ diagnosis should be given, & the appropriate tx prescribed.
When uncertain, the LEAST SERIOUS diagnosis should be given, & the appropriate tx prescribed.
What type of scans are useful in evaluating dementia? Is it good in differentiating DAT and MID from normal aging depression?
CT SCANS - sensitivity to focal lesions; it's use as a diagnostic tool to differentiate dementias remains in doubt.
Identify one good geriatric mental status interview that is comprehensive, has valid discrimination btwn dementia & functional psychiatric disorders?
The Geriatric Mental Status Interview (GMS), developed by Gurland, 1976.
What are the disadvantages of the GMS and it's accompanying CARE evaluation?
1 - very lengthy to administer
2 - need specific training
Identify an example of a rating scale developed specifically to evaluate various stages throughout the course of dementia.
Global Deterioration Scale of Primary Degenerative Dementia (GDS) - it defines 7 stages in the course of dementia.
Mini mental status exams lack sufficient __________to separate various disorders presenting as dementia.
Mini mental status exams lack sufficient SPECIFICITY to separate various disorders presenting as dementia.
Why assess intelligence when assessing possible dementia?
Because impairment in intellectual functioning is one of the defining features of dementia.
One aspect of verbal impairment that appears early in the course of DAT is __________________.
loss of spontaneity so that conversation always has to be initiated by someone else, also known as DYSFLUENCY.
TRUE OR FALSE: Perceptual deficits in dementia are frequently seen early in the course.
FALSE - more frequent & apparent as the severity of the dementia increases over time.
In the differential diagnosis, what is one of the 1st questions to ask?
Does the condition have an organic basis?
If the signs & symptoms are "organic" then the next question is what?
Is it progressive or non-progressive, and will treatment help.
If the deterioration is not severe enough to significantly interfere with work, usual social activities, or relationships, does it meet DMS criteria for dementia?
NO.
TRUE OR FALSE: A vocabulary subtest score that is at least twice as large as block design is highly likely indicator of dementia & rarely occurs among depressed patients.
TRUE
Cooledge et al found that with AD, the highest scores are on tests of ________________ presented in a familiar format & of ______________.
Cooledge et al found that with AD, the highest scores are on tests of OVERLEARNED BEHAVIORS presented in a familiar format & of IMMEDIATE MEMORY RECALL.
The bottom rank scores for individuals with AD include:
Block Design, Digit Symbol, & Digits Backwards.
If treatment of the depression does not improve symptoms (particularly cognitive problems), then what would the diagnosis be?
Dementia with depression
Cognitive impairments accompanying depressive reactions are more likely to evolve over a _________ period of time, with the exception of __________.
Cognitive impairments accompanying depressive reactions are more likely to evolve over a SHORTER period of time, with the exception of MID, which has a suddent onset & is associated with a vascular event.
In _________________, onset can frequently be dated with some precision because of its association with some precipitating event (s).
In DEPRESSIVE PSEUDODEMENTIA onset can frequently be dated with some precision because of its association with some precipitating event (s).
Dementia patients are much more likely to suffer from ______________________ of depression (such as ___________, ___________, & _________.
Dementia patients are much more likely to suffer from VEGETATIVE SYMPTOMS of depression (such as LOSS OF APPETITE, DISTURBED SLEEP & CONSTIPATION.
What is one distinguishing factor, in terms of speech & language, btwn DAT & depression?
The structure & content of speech remains essentially intact in depression.
In depressed pseudodementia patients, what type of learning/memory pattern do they tend to show?
They can learn - showing this on delayed recall & recognition, despite immediate recall possibly being impaired.
Neurologic signs clearly discrminate btwn dementia & depression (pseudodementia). These include:
aphasias, apraxias, agnosias
What are the distinguishing features in drawing/construction btwn depression & dementia?
Dementia - no or fragmented response with perseverations despite obvious good effort.
Depression - careless mistakes, shabby or incomplete due to apathy, low energy, or poor performance.
How does "disorientation" differ btwn depression & dementia?
Depression - inconsistent & may be due to attentional motivational deficit.
Dementia - more consistent/predictable.
Who is more likely to complain of memory problems, a person with dementia or depression?
Depression - complaints may even exceed true difficulties. In dementia they may report improvement as they decline.
In the differential diagnosis of pseudodementia & depression, what group is more likely to have their family aware of the dysfunction & its severity?
Pseudodementia.
Which group is more likely to have date of onset within broad limits?
Dementia
Which group usually has symptoms of long duration before medical help is sought?
Dementia
Which group has rapid progression of symptoms after onset?
Psuedodementia
In which group is previous psychiatric dysfunction common?
Pseudodementia.