Mia Yang, MD Please grab a clicker 3D Day Knowledge Quiz Mia Yang, MD Please grab a clicker

Q1. Ms. T is a 80yoF with COPD, DM, CAD, presenting to her primary care clinic with memory loss such as misplacing her keys and can’t remember people’s names. She lives alone and does her own cooking, shopping, and finances. Her primary care doctor speaks with her daughter who confirmed that Her MMSE in clinic is 24/30. Does she have dementia? A. Yes, because her MMSE is 24 B. No, because she is still functioning well with her IADLs (cooking, shopping, finances) C. Not sure

Q1. Ms. T is a 80yoF with COPD, DM, CAD, presenting to her primary care clinic with memory loss such as misplacing her keys and can’t remember people’s names. She lives alone and does her own cooking, shopping, and finances. Her primary care doctor speaks with her daughter who confirmed that Her MMSE in clinic is 24/30. Does she have dementia? A. Yes, because her MMSE is 24 B. No, because she is still functioning well with her IADLs (cooking, shopping, finances) C. Not sure

Dementia Dementia is a disorder characterized by problems with cognition + functional impairment Cognition components: learning/recall, reasoning, language, spatial ability/orientation, and executive function/handling complex tasks Functional impairments: Activities of Daily Living (ADLs): eating, dressing, toileting, etc Instrumental Activities of Daily Living (IADLs): grocery shopping, cooking, finances, medications, driving, etc.

A. Parkinson’s dementia B. Alzheimer’s disease C. Lewy body dementia Q2. Mr. W is a 67yoM with HTN who comes to clinic with his wife. His wife says that he has been more forgetful over the 6 months, initially making mistakes balancing the checkbook, but now forgetting how to drive to the bank. She is most worried that over the past week he started seeing and hearing children playing in the house, but she is adamant that there were no children. His MMSE in clinic is 22/30. You notice that he has a shuffling gait, which wife says is also new. What is the most likely diagnosis? A. Parkinson’s dementia B. Alzheimer’s disease C. Lewy body dementia D. Fronto-temporal dementia E. Cruetzfeldt-Jakob disease

A. Parkinson’s dementia B. Alzheimer’s disease C. Lewy body dementia Q2. Mr. W is a 67yoM with HTN who comes to clinic with his wife. His wife says that he has been more forgetful over the 6 months, initially making mistakes balancing the checkbook, but now forgetting how to drive to the bank. She is most worried that over the past week he started seeing and hearing children playing in the house, but she is adamant that there were no children. His MMSE in clinic is 22/30. You notice that he has a shuffling gait, which wife says is also new. What is the most likely diagnosis? A. Parkinson’s dementia B. Alzheimer’s disease C. Lewy body dementia D. Fronto-temporal dementia E. Cruetzfeldt-Jakob disease

Dementia subtypes Lewy Body dementia: prevalence around 15% cognitive impairment, hallucinations, & Parkinson-like symptoms such as shuffling gait, falls, rigidity & tremors Cognitive & hallucinations may occur before or at the same time as Parkinson-like symptoms. Parkinson’s dementia - must have motor symptoms before cognitive impairment by 1 year Fronto-temporal dementia: usually younger patients, with executive and language dysfunction and often behavioral changes such as disinhibition & impulsivity. Memory impairment less prominent. 5/2/2019

Q3. You test a patient in the hospital with mini-cognitive (Mini-Cog) screen. He drew the clock below when you asked him to put the hands at “ten past eleven.” He had 1/3 word recall. How do you interpret the result? Positive for cognitive impairment Negative for cognitive impairment Inconclusive

Q3. You test a patient in the hospital with mini-cognitive (Mini-Cog) screen. He drew the clock below when you asked him to put the hands at “ten past eleven.” He had 1/3 word recall. How do you interpret the result? Positive for cognitive impairment Negative for cognitive impairment Inconclusive

Mini-Cog- dementia screen Ask patient to repeat three words: banana, sunrise, chair Ask patient to draw face of a clock, then draw hands to read “ten past eleven” Ask the patient to recall the three words http://www.alz.org/documents_custom/minicog.pdf

Q4. Which of the following is required in order to screen positive for delirium? Memory impairment Inattention Presence of acute onset & fluctuating course All of the above Both B & C

Q4. Which of the following is required to screen positive for delirium? Memory impairment Inattention Presence of acute onset & fluctuating course All of the above Both B & C

Delirium Screening Screen is positive if the person has 1 & 2 plus either 3 or 4 of the following: (1) Presence of acute onset and fluctuating course. (2) Inattention (3) Disorganized thinking (such as orientation questions, date of birth) (4) Altered level of consciousness (ie somnolent or agitated) 5/2/2019

Q5. Ms. T is a 80yoF with COPD, DM, CAD, cognitive impairment, who fell and admitted to the hospital. She was found to have a L femur fracture. On POD 2, she was hard to arouse, cannot say the days of the week forward nor backwards, and did not know where she was. Which of the following could be the cause of her hypoactive delirium? Constipation Received lorazepam for anxiety prior to surgery Uncontrolled pain Hospital-acquired pneumonia All of the above

Q5. Ms. T is a 80yoF with COPD, DM, CAD, cognitive impairment, who fell and admitted to the hospital. She was found to have a L femur fracture. On POD 2, she was hard to arouse, cannot say the days of the week forward nor backwards, and did not know where she was. Which of the following could be the cause of her hypoactive delirium? Constipation Received lorazepam for anxiety prior to surgery Uncontrolled pain Hospital-acquired pneumonia All of the above

Q6. Older depressed patients are LESS likely to complain of this compared to younger patients? Somatic complaints such as pain, fatigue Sadness Difficulty concentrating Trouble performing daily tasks None of the above, depression in older adults is the same presentation as in younger adults.

Q6. Older depressed patients are LESS likely to complain of this compared to younger patients? Somatic complaints such as pain, fatigue Sadness Difficulty concentrating Trouble performing daily tasks None of the above, depression in older adults is the same presentation as in younger adults.