______ is defined as a syndrome characterized by a decline in cognitive function sufficiency to cause impairment in social and occupational performance
Dementia
Another term for dementia
Major neurocognitive disorder
DSM-IV criteria for dementia
A1. Memory impairment
A2. At least one of the following: aphasia, apraxia, agnosia, disturbance in executive functioning
B. Above deficits cause significant impairment in social or occupational functioning & a significant decline from previous functioning
C. The cognitive effects do not occur exclusively during periods of delirium
DSM-V criteria for major neurocognitive disorder
A. Evidence of decline from previous level in the following:
- Learning & memory
- Language
- Executive function
- Complex attention
- Perceptual-motor
- Social cognition
B. The above interferes w/ ADLs
C. Deficits do not only occur in the context of delirium
D. Deficits not better explained by another mental disorder (e.g. MDD)
Will we always be able to tell between dementia & delirium?
No
Complaint of memory loss is likely associated with
Depression
What is an informant interview?
A brief eight-item questionnaire for informants (family)
- Appears to be sensitive for detecting dementia & cognitive impairment
8 components of the informant interview
- Problems w/ judgement
- Reduced interest in activities
- Repeated questions, stories
- Trouble learning how to use a tool or appliance
- Forget correct month or year
- Difficulty handling financial affairs
- Difficulty remembering appts
- Consistent problems with thinking or memory
Is the Informant interview more sensitive or specific
Sensitive
Diagnostic evaluation of dementia
- CBC, glucose, urea nitrogen, electrolyte, Ca+, PO4, LFTs, TSH, serologic test for syphilis, HIV
- CT of head
- Neuropsych testing
Causes of REVERSIBLE dementia
- Drugs
- Neoplasm
- Metabolic disorder
- Depression
- Trauma
- Toxin
- Alcoholism
- Infection (HIV)
Causes of IRREVERSIBLE dementia
- Alzheimer dz
- Lewy body dementia
- PD
- Huntington
- Vascular dementia
- Infection
What causes 65% of dementia?
Alzheimer’s (AD)
At age ___, 53% of people have AD
95+
Is AD projected to increase or decrease
Increase (double by 2050)
What increases risk of delirium? (one thing)
Elective surgery
DSM-V definition of delirium
- Disturbance in attention & awareness
- Develops acutely & tends to fluctuate
- Additional disturbance in cognition (e.g. memory, language)
- Not better explained by preexisting dementia
- Not in face of severely reduced level of arousal or coma
- Evidence of an underlying organic etiology/etiologies
What is the name of the tool used to diagnose delirium
The confusion assessment method
The confusion assessment method assesses 4 features
- Acute onset & fluctuating course
- Inattention
- Disorganized thinking
- Altered level of consciousness
How do we determine a diagnosis with the confusion assessment method
Requires presence of 1 and 2 and either 3 or 4
- Acute onset & fluctuating course
- Inattention
- Disorganized thinking
- Altered level of consciousness
Question used to assess 1. Acute onset & fluctuating course
Is there evidence of an acute change in mental status from baseline? Does it wax & wane?
(+) = yes
Question used to assess 2. Inattention
Does the pt. have difficulty focusing attention?
(+) = yes
Question used to assess 3. Disorganized thinking
Was the patient’s thinking disorganized or incoherent?
(+) = yes
Question used to assess 4. Altered level of consciousness
What is the patient’s level of consciousness?
- Alert, lethargic, stupor, coma
(+) = any answer other than alert
