Dementia vs. Depression
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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.
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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?
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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).
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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?
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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?
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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?
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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.