Review Session: Cognitive and
Behavioral Disorders Domain
Kevin Overbeck, DO
Assistant Professor
UMDNJ–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
“Buzz Words/Phrases”
Caused by diazepam
(a) Dementia
(b) Delirium
(c) Depression
“Buzz Words/Phrases”
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.
“Buzz Words/Phrases”
Acute
(a) Dementia
(b) Delirium
(c) Depression
“Buzz Words/Phrases”
Acute
(a) Dementia [0.13]
(b) Delirium [3.0]
(c) Depression [1.3]
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
“Buzz Words/Phrases”
Anhedonia
(a) Dementia
(b) Delirium
(c) Depression
“Buzz Words/Phrases”
Anhedonia
(a) Dementia [1.38]
(b) Delirium [0.5]
(c) Depression [2.75]
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
“Buzz Words/Phrases”
Brought in by caregivers soon after onset of symptoms
(a) Dementia
(b) Delirium
(c) Depression
“Buzz Words/Phrases”
Brought in by caregivers soon after onset of symptoms
(a) Dementia [0.43]
(b) Delirium [2.9]
(c) Depression [0.75]
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
“Buzz Words/Phrases”
Brought in by caregivers with symptoms present for a
while
(a) Dementia
(b) Delirium
(c) Depression
“Buzz Words/Phrases”
Brought in by caregivers with symptoms present for a
while
(a) Dementia [2.86]
(b) Delirium [0.4]
(c) Depression [2.5]
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
“Buzz Words/Phrases”
Can make decisions
(a) Dementia
(b) Delirium
(c) Depression
“Buzz Words/Phrases”
Can make decisions
(a) Dementia [1.38]
(b) Delirium [0.6]
(c) Depression [2.63]
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
“Buzz Words/Phrases”
Result of Polypharmacy
(a) Dementia
(b) Delirium
(c) Depression
“Buzz Words/Phrases”
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
“Buzz Words/Phrases”
“I Don’t Know” answers are common
(a) Dementia
(b) Delirium
(c) Depression
“Buzz Words/Phrases”
“I Don’t Know” answers are common
(a) Dementia [1.71]
(b) Delirium [0.5]
(c) Depression [2.5]
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
“Buzz Words/Phrases”
Potentially reversible
(a) Dementia
(b) Delirium
(c) Depression
“Buzz Words/Phrases”
Potentially reversible
(a) Dementia [1.0]
(b) Delirium [3.0]
(c) Depression [2.5]
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
“Buzz Words/Phrases”
Family History
(a) Dementia
(b) Delirium
(c) Depression
“Buzz Words/Phrases”
Family history
(a) Dementia [2.43]
(b) Delirium [0.1]
(c) Depression [2.13]
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
“Buzz Words/Phrases”
Hoarding
(a) Dementia
(b) Delirium
(c) Depression
“Buzz Words/Phrases”
Hoarding
(a) Dementia [2.43]
(b) Delirium [0.3]
(c) Depression [0.43]
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
“Buzz Words/Phrases”
Sleep wake cycle fluctuates hour by hour
(a) Dementia
(b) Delirium
(c) Depression
“Buzz Words/Phrases”
Sleep wake cycle fluctuates hour by hour
(a) Dementia [0.5]
(b) Delirium [2.4]
(c) Depression [1.0]
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
“Buzz Words/Phrases”
Sleep wake cycle with day night reversal
(a) Dementia
(b) Delirium
(c) Depression
“Buzz Words/Phrases”
Sleep wake cycle with day night reversal
(a) Dementia [2.5]
(b) Delirium [1.3]
(c) Depression [0.75]
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
“Buzz Words/Phrases”
Tries hard but gives incorrect answers
(a) Dementia
(b) Delirium
(c) Depression
“Buzz Words/Phrases”
Tries hard but gives incorrect answers
(a) Dementia [2.86]
(b) Delirium [1.0]
(c) Depression [0.38]
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
Sample Case Vignettes
Memory 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
Source: Microsoft Office Images #MP900443187 by
iStockphoto (http://office.microsoft.com/en-us/images/)
GDS 1/15
MMSE 29/30
deficit Pentagon
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
Memory Loss Problem Solving
A Case: Mrs. Tindell
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)
A Case: Mrs. Tindell
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.
A Case: Mrs. Tindell
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
A Case: Mrs. Tindell
Which of the following clinical syndromes is most
compatible with Mrs. Tindell’s constellation of signs and
symptoms?
(a)
(b)
(c)
(d)
(e)
Parkinson’s disease
Frontotemporal lobe dementia
Brain tumor
Dementia with Lewy bodies
Creutzfeldt-Jakob disease
Memory Loss Problem Solving
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)
(b)
(c)
(d)
(e)
Alzheimer’s disease
Frontotemporal lobe dementia
Age-associated memory loss
Dementia with Lewy bodies
Delirium