Review Session: Cognitive and Behavioral Disorders Domain Kevin Overbeck, DO Assistant Professor UMDNJ–SOM NJISA

Review Session: Cognitive and Behavioral Disorders

Domain

Kevin Overbeck, DOAssistant ProfessorUMDNJ–SOM NJISA

Review Session: Cognitive and Behavioral Disorders Domain

This medical student presentation is offered by the New Jersey Institute for

Successful Aging.

This lecture series is supported by an educational grant from the

Donald W. Reynolds Foundation Aging and Quality of Life program.

“Buzz Words/Phrases”

A panel of “experts” (geriatric psychiatry and geriatric medicine physicians) rated each item from a 0-3 in how well it applied to:

• Dementia• Delirium• Depression

Paniagua M, van Zuilen M, Pua R, Mintzer M and Silver I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805


Caused by diazepam(a)Dementia

(b)Delirium

(c) Depression


Caused by diazepam(a)Dementia [0.00]

(b)Delirium [2.8]

(c) Depression [0.33]

Paniagua M, van Zuilen M, Pua R, Mintzer M and Silver I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805.


Acute(a)Dementia

(b)Delirium

(c) Depression


Acute(a)Dementia [0.13]

(b)Delirium [3.0]


Paniagua M, van Zuilen M, Pua R, Mintzer M and Silver, I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805


Anhedonia(a)Dementia

(b)Delirium

(c) Depression


Anhedonia(a)Dementia [1.38]

(b)Delirium [0.5]




Brought in by caregivers soon after onset of symptoms

(a)Dementia

(b)Delirium

(c) Depression


Brought in by caregivers soon after onset of symptoms

(a)Dementia [0.43]

(b)Delirium [2.9]




Brought in by caregivers with symptoms present for a while

(a)Dementia

(b)Delirium

(c) Depression


Brought in by caregivers with symptoms present for a while

(a)Dementia [2.86]

(b)Delirium [0.4]




Can make decisions(a) Dementia (b) Delirium (c) Depression


Can make decisions(a) Dementia [1.38](b) Delirium [0.6](c) Depression [2.63]



Result of Polypharmacy(a) Dementia (b) Delirium (c) Depression


Result of Polypharmacy(a) Dementia [0.86](b) Delirium [2.6](c) Depression [1.43]

Paniagua, M, van Zuilen, M, Pua, R, Mintzer, M and Silver, I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805


“I Don’t Know” answers are common(a) Dementia(b) Delirium(c) Depression


“I Don’t Know” answers are common(a) Dementia [1.71](b) Delirium [0.5](c) Depression [2.5]



Potentially reversible (a) Dementia (b) Delirium (c) Depression


Potentially reversible(a) Dementia [1.0](b) Delirium [3.0](c) Depression [2.5]



Family History(a) Dementia (b) Delirium (c) Depression


Family history

(a) Dementia [2.43]

(b) Delirium [0.1](c) Depression [2.13]



Hoarding

(a) Dementia

(b) Delirium(c) Depression


Hoarding

(a) Dementia [2.43]




Sleep wake cycle fluctuates hour by hour

(a) Dementia

(b) Delirium (c) Depression


Sleep wake cycle fluctuates hour by hour

(a) Dementia [0.5]




Sleep wake cycle with day night reversal

(a) Dementia

(b) Delirium (c) Depression


Sleep wake cycle with day night reversal

(a) Dementia [2.5]




Tries hard but gives incorrect answers

(a) Dementia

(b) Delirium(c) Depression


Tries hard but gives incorrect answers

(a) Dementia [2.86]



Sample Case VignettesMemory Loss Problem

Solving

Memory Loss Problem Solving

A Case: Mr. Raymond

A Case: Mr. Raymond

• HPI: Mr. Raymond is a 62 year old male reluctantly brought in for an evaluation by his distressed wife at the request of his psychiatrist after he had reviewed a recent MRI. He has been exhibiting behavior out of character from his previous personality profile.

• PMHx: Dyslipidemia• Social Hx: Retired accountant

x 4 years; denied drugs, EtOH, tobacco

GDS 1/15

MMSE 29/30 deficit Pentagon

Source: Microsoft Office Images #MP900443187 by iStockphoto (http://office.microsoft.com/en-us/images/)

A Case: Mr. Raymond

The clinical presentation of the case is most consistent with which of the following conditions?

(a) Delirium(b) Depression(c) Vascular dementia(d) Frontotemporal lobe dementia(e) Lewy body dementia


A Case: Mrs. Tindell


Mrs. Tindell is an 87 year old female who carries a diagnosis of dementia. She is admitted to an Assisted Living facility following the death of her caregiver.

Image copyright © 1997 PhotoDisc, Inc. (http://www.hallogram.com/photodisc/lisence1.html)

http://www.hallogram.com/photodisc/lisence1.html

http://www.hallogram.com/photodisc/lisence1.html


During the course of the next 9 months, she continues to decline in functional status (i.e., requiring assistance with all ADLs except for self feeding), despite evaluations and treatments by physical therapy and occupational therapy.

The family is seeking your opinion regarding this 9 month deterioration in function.


Physical Exam• (+) gait dysfunction with short, shuffling steps

and decreased arm swing with ambulation

MMSE: 20/30• 3/5 deficit in time orientation• 3/5 deficit in location orientation• 2/3 deficit in short term recall• 1/5 deficit in serial sevens• 0/1 deficit with pentagon

GDS: 2/15


Which of the following clinical syndromes is most compatible with Mrs. Tindell’s constellation of signs and symptoms?

(a)Parkinson’s disease(b)Frontotemporal lobe dementia(c) Brain tumor(d)Dementia with Lewy bodies(e)Creutzfeldt-Jakob disease


A Case: Mr. Gulch

A Case: Mr. Gulch

Mr. Gulch is an 83 year old man who is brought to the physician by his daughter because she is concerned about his memory loss over the past year. Yesterday, he could not remember his 18 month old granddaughter’s name. Although he denies that there is any problem, she says he has been forgetful and becomes easily confused. There is no history of alcohol abuse.

Source: Microsoft Office Images #MP900407473 (http://office.microsoft.com/en-us/images/)

A Case: Mr. Gulch

On mental status examination, his mood is normal. He is oriented to person and place, but initially gives the wrong month, which he is able to correct. He does not know the county and has made an error on the season. He reports that it is winter, but, in fact, it has just turned into spring.

He recalls memories from his youth in great detail, but only recalls one of three words after 5 minutes. He has difficulty recalling the name of the current US president.

A Case: Mr. Gulch

His temperature is 37°C (98.6°F), pulse is 77/min, respirations are 12/min, and blood pressure is 118/84 mm Hg.

Physical examination, laboratory studies, and thyroid function tests show no abnormalities.

A Case: Mr. Gulch

Which of the following clinical syndromes is most compatible with Mr. Gulch’s constellation of signs and symptoms?

(a)Alzheimer’s disease(b)Frontotemporal lobe dementia(c)Age-associated memory loss(d)Dementia with Lewy bodies(e)Delirium

Documents

Review Session: Cognitive and Behavioral Disorders Domain Kevin Overbeck, DO Assistant Professor UMDNJ–SOM NJISA