gc06-1 - EVALUATION OF THE PATIENT WITH DEMENTIA Jonathan...

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EVALUATION OF THE PATIENT WITH DEMENTIA Jonathan T. Stewart, MD Professor in Psychiatry University of South Florida College of Medicine Chief, Geropsychiatry Section Bay Pines VA Medical Center
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DEMENTIA A syndrome characterized by acquired , progressive cognitive impairment Affects 10% of individuals over 65 Caused by at least 80 different diseases, many reversible Unfortunately, the most common diseases (85 – 90%) are irreversible Diagnosis will have prognostic and treatment implications All demented patients need a work-up …and it’s mostly a good history
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PRIMARY SYMPTOMS ATTENTION MEMORY POSTROLANDIC (“COGNITION”) EXECUTIVE (FRONTAL/SUBCORTICAL) INSIGHT
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PRIMARY SYMPTOMS ATTENTION: clouded sensorium, delirium MEMORY: forgetfulness POSTROLANDIC: aphasia, apraxia, getting lost EXECUTIVE: poor judgment, disinhibition, abulia, urge incontinence INSIGHT: anosognosia, catastrophic reactions
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TWO TYPES OF DEMENTIA Postrolandic Frontal/subcortical
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POSTROLANDIC Memory deficits Aphasia Apraxia Agnosia Personality more or less preserved MMSE valid FRONTAL/SUBCORTICA L Memory deficits Loss of behavioral plasticity and adaptability, judgment Personality changes Disinhibition Abulia Urge incontinence MMSE useless
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THE REST OF THE HISTORY Time course Depressive symptoms Past medical history Medical and psychiatric conditions Family Hx EtOH Medications (including OTC, OPM)
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THE REST OF THE EXAM Physical exam Neurologic exam Mental status exam
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THE FOLSTEIN MMSE Most studied and used of the
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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gc06-1 - EVALUATION OF THE PATIENT WITH DEMENTIA Jonathan...

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