Question 1

A patient with dementia experiences agitation and visual hallucinations and is given haloperidol with a subsequent worsening of symptoms. Based on this response, what is the likely cause of this patient's symptoms?

A) Alzheimer's disease
B) Lewy body dementia
C) Pseudodementia
D) Vascular neurocognitive disorder

B

Accepted Answer

The worsening of symptoms after the administration of haloperidol suggests that the patient may have Lewy body dementia, which can be worsened by antipsychotic medication. This is because Lewy bodies are sensitive to dopamine-blocking medication, which can exacerbate symptoms such as agitation and hallucinations. Alzheimer's disease and vascular neurocognitive disorder may also present with similar symptoms, but the worsening of symptoms after haloperidol is more suggestive of Lewy body dementia. Pseudodementia, on the other hand, refers to cognitive symptoms that occur as a result of depression or other psychiatric conditions, rather than neurological damage or degeneration.

Question 2

An elderly patient has symptoms of depression and the patient's daughter asks about possible Alzheimer's disease (AD) since there is a family history of this disease. A screening evaluation shows no memory loss. What is the initial step in managing this patient?

A) Order brain imaging studies such as CT or MRI.
B) Perform genetic testing to identify true risk.
C) Prescribe a trial of an antidepressant medication.
D) Recommend a trial of a cholinesterase inhibitor drug.

C

Accepted Answer

Since there is no memory loss, there is no indication for brain imaging studies or a trial of a cholinesterase inhibitor drug. Genetic testing is also not necessary since there is no definitive genetic test for AD. The initial step in managing this patient is to prescribe a trial of an antidepressant medication for the symptoms of depression. AD should continue to be monitored for in the future, especially with the family history.

Question 3

What are initial approaches when managing delirium in a hospitalized patient who is agitated and confused? (Select all that apply.)&#10;A) Administer medications for sleep.&#10;B) Apply physical restraints.&#10;C) Attend to hydration and toileting needs.&#10;D) Decrease stimulation.&#10;E) Discontinue any non-essential medications.

Accepted Answer

The best initial approaches when managing delirium in a hospitalized patient who is agitated and confused are attending to hydration and toileting needs, decreasing stimulation, and discontinuing any non-essential medications. Administering medications for sleep or applying physical restraints should not be the first choice as they can worsen the patient's confusion and agitation, and can lead to complications. Physical restraints should only be considered as a last resort when all other options have been exhausted and there is an imminent risk of harm to the patient or others.

Question 4

A patient with Alzheimer's disease (AD) is taking donepezil to treat cognitive symptoms. The patient's son reports noting increased social withdrawal and sleep impairment. What is the initial step to manage these symptoms?

A) Encourage activity and exercise.
B) Prescribe a selective serotonin reuptake inhibitor (SSRI).
C) Recommend risperidone.
D) Referral to a neurologist for evaluation.

Accepted Answer

Encouraging activity and exercise can be a non-pharmacological intervention to manage social withdrawal and sleep impairment in patients with AD. It has also been shown to improve cognitive function, mood, and quality of life in these patients. Additionally, given the potential risks associated with medications such as SSRIs and risperidone, non-pharmacological interventions should be considered first. Referral to a neurologist should be considered if there is a need for further evaluation of cognitive symptoms or if behavioral interventions are not effective.

Question 5

A previously lucid patient with early-stage Alzheimer's disease is hospitalized after a surgical procedure and exhibits distractibility and perceptual disturbances that occur only in the late afternoon. The patient has difficulty sleeping at night and instead sleeps much of the morning. What is the likely cause of these symptoms?

A) Hyperactive delirium
B) Hypoactive delirium
C) Sundowner syndrome
D) Worsening dementia

Accepted Answer

The symptoms described in the scenario, including distractibility and perceptual disturbances in the late afternoon, difficulty sleeping at night, and sleeping in the morning, are consistent with Sundowner syndrome. Sundowner syndrome, also known as sundowning, is common among individuals with dementia and Alzheimer's disease, and is characterized by a worsening of symptoms in the late afternoon and evening, including confusion, anxiety, and agitation. These symptoms often improve in the morning. Hyperactive and hypoactive delirium are unlikely causes as the symptoms do not match the presentation of either type of delirium, and worsening dementia would not explain the specific timing of the symptoms.

Question 6

An 80-year-old patient becomes apathetic, with decreased alertness and a slowing of speech several days after hip replacement surgery alternating with long periods of lucidity. What is the most likely cause of these symptoms?

A) Anesthesia effects
B) Delirium
C) Pain medications
D) Stroke

Accepted Answer

The patient's symptoms suggest delirium, which is a common complication following surgery in older adults. Delirium is characterized by a fluctuating level of consciousness, changes in attention and cognition, and alterations in perception, activity level, and sleep-wake cycle. It is often caused by a combination of factors, including underlying medical conditions, medications, anesthesia, and surgical stress. The patient's age and hip replacement surgery increase their risk of delirium. Apathy, decreased alertness, and slowing of speech may also be seen in other conditions, including anesthesia effects or stroke, but delirium is the most likely cause in this case based on the timing of symptoms and the patient's history. Pain medications may also contribute to delirium, but would not be the primary cause.

Deck 174: Dementia