Cognitive disorders (dementia)

Cognitive disorders (dementia) US Medical PG Question 1: A group of neurologists develop a new blood test for Alzheimer's. They are optimistic about the test, as they have found that for any given patient, the test repeatedly produces very similar results. However, they find that the new test results are not necessarily consistent with the gold standard of diagnosis. How would this new test most accurately be described?

• A. Valid and reliable
• B. Reliable (Correct Answer)
• C. Valid
• D. Biased
• E. Neither valid nor reliable

Cognitive disorders (dementia) Explanation: ***Reliable*** - The test produces **similar results repeatedly** upon repeated measures, indicating high **reliability** or **precision**. - Reliability refers to the **consistency** of a measure, even if it is not accurate. *Valid and reliable* - While the test is **reliable**, it is explicitly stated that the results are **not consistent with the gold standard**, meaning it lacks **validity**. - A test must be both **consistent** (reliable) and **accurate** (valid) to be described as valid and reliable. *Valid* - **Validity** refers to the **accuracy** of a test, or how well it measures what it is supposed to measure. - The test is explicitly stated to **not be consistent with the gold standard**, indicating a lack of agreement with the true measure of Alzheimer's. *Biased* - **Bias** refers to a **systematic error** in measurement that can lead to consistently high or low results compared to the true value. - While the test might be biased due to its lack of consistency with the gold standard, "biased" is not the most accurate single descriptor of its measurement properties given the information provided. *Neither valid nor reliable* - The test is described as producing **very similar results repeatedly**, which directly indicates it has **high reliability**. - Therefore, stating it is neither valid nor reliable is incorrect, as it possesses reliability.

Cognitive disorders (dementia) US Medical PG Question 2: A 15-year-old female presents to her family physician for an annual school physical exam and check-up. She is accompanied by her mother to the visit and is present in the exam room. The patient has no complaints, and she does not have any past medical problems. She takes no medications. The patient reports that she remains active, exercising 5 times a week, and eats a healthy and varied diet. Which of the following would be the best way for the physician to obtain a more in-depth social history, including sexual history and use of alcohol, tobacco, or recreational drugs?

• A. Disallow the mother to be present in the examination room throughout the entirety of the visit
• B. Give the patient a social history questionnaire to fill out in the exam room
• C. Ask the mother to step outside into the hall for a portion of the visit (Correct Answer)
• D. Ask the patient the questions directly, with her mother still in the exam room
• E. Speak softly to the patient so that the mother does not hear and the patient is not embarrassed

Cognitive disorders (dementia) Explanation: ***Ask the mother to step outside into the hall for a portion of the visit*** - This approach allows the physician to speak with the adolescent **privately and confidentially**, which is crucial for obtaining sensitive information such as sexual history, drug use, and mental health concerns. - Adolescents are more likely to disclose personal information when their parents are not present, fostering trust and ensuring **comprehensive history-taking** vital for their well-being. *Disallow the mother to be present in the examination room throughout the entirety of the visit* - This is an **overly restrictive** approach that might create tension or distrust between the physician, patient, and parent, especially at the start of the visit. - While privacy is essential for sensitive topics, parental presence can be valuable for discussing general health, family history, and **treatment plans**, especially for younger adolescents. *Give the patient a social history questionnaire to fill out in the exam room* - While questionnaires can be useful for gathering basic information, they often **lack the nuance** of a direct conversation and may not prompt the patient to elaborate on sensitive issues. - Furthermore, having the mother present while the patient fills out a questionnaire on sensitive topics still **compromises confidentiality** and may lead to incomplete or dishonest answers. *Ask the patient the questions directly, with her mother still in the exam room* - Asking sensitive questions with a parent present is **unlikely to yield truthful and complete answers**, as adolescents may feel embarrassed, judged, or fear parental disapproval. - This approach compromises the **confidentiality** that is fundamental to building trust with adolescent patients. *Speak softly to the patient so that the mother does not hear and the patient is not embarrassed* - Speaking softly is **unprofessional** and still does not guarantee privacy, as the mother might still overhear parts of the conversation. - This method also **fails to establish true confidentiality**, which is central to building rapport and encouraging open communication with adolescent patients about sensitive topics.

Cognitive disorders (dementia) US Medical PG Question 3: A 66-year-old man is brought into the emergency department by his daughter for a change in behavior. Yesterday the patient seemed more confused than usual and was asking the same questions repetitively. His symptoms have not improved over the past 24 hours, thus the decision to bring him in today. Last year, the patient was almost completely independent but he then suffered a "series of falls," after which his ability to care for himself declined. After this episode he was no longer able to cook for himself or pay his bills but otherwise had been fine up until this episode. The patient has a past medical history of myocardial infarction, hypertension, depression, diabetes mellitus type II, constipation, diverticulitis, and peripheral neuropathy. His current medications include metformin, insulin, lisinopril, hydrochlorothiazide, sodium docusate, atorvastatin, metoprolol, fluoxetine, and gabapentin. On exam you note a confused man who is poorly kept. He has bruises over his legs and his gait seems unstable. He is alert to person and place, and answers some questions inappropriately. The patient's pulse is 90/minute and his blood pressure is 170/100 mmHg. Which of the following is the most likely diagnosis?

• A. Normal aging
• B. Lewy body dementia
• C. Vascular dementia (Correct Answer)
• D. Pseudodementia (depression-related cognitive impairment)
• E. Alzheimer's dementia

Cognitive disorders (dementia) Explanation: ***Vascular dementia*** - This diagnosis is strongly supported by the patient's **stepwise decline** in cognitive function following a "series of falls" (likely small strokes or transient ischemic attacks) and his extensive history of **vascular risk factors** including hypertension, diabetes, and previous myocardial infarction. - The acute worsening of confusion over 24 hours, coupled with pre-existing impaired executive function (inability to cook or pay bills), is characteristic of **vascular dementia's fluctuating course** and presentation often linked to new cerebrovascular events. *Incorrect: Normal aging* - **Normal aging** involves a very gradual and mild decline in cognitive functions, primarily affecting processing speed and memory recall, without significant impairment in daily activities. - This patient's rapid, stepwise decline and inability to perform instrumental activities of daily living (IADLs) such as cooking and managing finances go beyond what is considered normal cognitive changes with aging. *Incorrect: Lewy body dementia* - **Lewy body dementia** is characterized by prominent **fluctuations in attention and alertness**, recurrent visual hallucinations, and spontaneous parkinsonism, none of which are explicitly mentioned as primary features in this patient's presentation. - While fluctuations in confusion are present, the history of a clear stepwise decline post-falls and significant vascular risk factors points away from Lewy body dementia as the most likely primary cause. *Incorrect: Pseudodementia (depression-related cognitive impairment)* - **Pseudodementia** refers to cognitive impairment that occurs in the context of **major depression**, where patients may exhibit poor concentration, memory difficulties, and psychomotor slowing that mimics dementia. - While this patient is on fluoxetine for depression, the **stepwise decline** after clear vascular events (falls), multiple vascular risk factors, and impaired executive function point to a true neurodegenerative process rather than depression-induced cognitive changes, which typically improve with treatment of the underlying mood disorder. *Incorrect: Alzheimer's dementia* - **Alzheimer's dementia** typically presents with a **gradual and progressive decline** in memory, particularly episodic memory, followed by other cognitive domains over several years. - The patient's history of a clear **stepwise decline** in function after acute events (falls) and the strong presence of **vascular risk factors** make vascular dementia a more fitting diagnosis than Alzheimer's, which is not typically associated with such a sudden, step-like progression.

Cognitive disorders (dementia) US Medical PG Question 4: A geriatric investigator is evaluating the consistency of Alzheimer dementia diagnoses based on clinical symptoms. Patients with known chart diagnoses of Alzheimer dementia were evaluated by multiple physicians during a fixed time interval. Each evaluator was blinded to the others' assessments. The extent to which the diagnosis by one physician was replicated by another clinician examining the same patient is best described by which of the following terms?

• A. Validity
• B. Specificity
• C. Predictive value
• D. Sensitivity
• E. Precision (Correct Answer)

Cognitive disorders (dementia) Explanation: ***Precision*** - **Precision** refers to the consistency or reproducibility of a measurement or diagnosis. When multiple physicians reach the same diagnosis for the same patient, it indicates high precision. - In this context, it specifically assesses **inter-rater reliability**, which is the extent to which different observers agree on the same assessment. *Validity* - **Validity** refers to the extent to which a test or measure accurately assesses what it is intended to measure. It is about the "truthfulness" of the diagnosis. - While important for diagnosis, validity is about accuracy against a gold standard, not consistency among different observers. *Specificity* - **Specificity** is the ability of a test to correctly identify individuals who do *not* have the disease (true negatives). - It measures the proportion of healthy individuals who are correctly identified as healthy by the test, which is not what is being evaluated here. *Predictive value* - **Predictive value** assesses the probability that a person *actually has* (positive predictive value) or *does not have* (negative predictive value) a disease given their test result. - This concept relates to the diagnostic utility of a test in a population, not the consistency of different clinician diagnoses. *Sensitivity* - **Sensitivity** is the ability of a test to correctly identify individuals who *do* have the disease (true positives). - It measures the proportion of diseased individuals who are correctly identified as diseased by the test, which is distinct from inter-rater agreement.

Cognitive disorders (dementia) US Medical PG Question 5: A 77-year-old woman is brought to the physician for gradually increasing confusion and difficulty walking for the past 4 months. Her daughter is concerned because she has been forgetful and seems to be walking more slowly. She has been distracted during her weekly bridge games and her usual television shows. She has also had increasingly frequent episodes of urinary incontinence and now wears an adult diaper daily. She has hyperlipidemia and hypertension. Current medications include lisinopril and atorvastatin. Her temperature is 36.8°C (98.2°F), pulse is 84/min, respirations are 15/min, and blood pressure is 139/83 mmHg. She is confused and oriented only to person and place. She recalls 2 out of 3 words immediately and 1 out of 3 after five minutes. She has a broad-based gait and takes short steps. Sensation is intact and muscle strength is 5/5 throughout. Laboratory studies are within normal limits. Which of the following is the most likely diagnosis in this patient?

• A. Pseudodementia
• B. Normal pressure hydrocephalus (Correct Answer)
• C. Creutzfeldt-Jakob disease
• D. Frontotemporal dementia
• E. Dementia with Lewy-bodies

Cognitive disorders (dementia) Explanation: ***Normal pressure hydrocephalus*** - The constellation of **gradually increasing confusion**, an **ataxic gait** (broad-based, short steps), and **urinary incontinence** in an elderly patient is the classic triad of **normal pressure hydrocephalus (NPH)**. - Lumbar puncture with temporary symptom improvement or **neuroimaging** showing ventriculomegaly without significant sulcal atrophy would further support this diagnosis. *Pseudodementia* - **Pseudodementia** is a cognitive impairment primarily caused by **depression**, characterized by rapid onset of symptoms and often a history of mood disturbances. - The patient's progressive decline over 4 months and lack of overt depressive symptoms make this less likely. *Creutzfeldt-Jakob disease* - **Creutzfeldt-Jakob disease (CJD)** is a rapidly progressive and fatal neurodegenerative disorder characterized by a very fast decline in cognitive function, typically over months, along with **myoclonus**, ataxia, and other neurological signs. - The slower, more subtle progression of symptoms and absence of myoclonus make CJD less likely. *Frontotemporal dementia* - **Frontotemporal dementia (FTD)** usually presents with prominent early changes in **personality, behavior**, or **language (aphasia)**, rather than the classic NPH triad. - While confusion can occur, gait disturbance and incontinence are not typically primary or early features. *Dementia with Lewy-bodies* - **Dementia with Lewy bodies (DLB)** is characterized by **fluctuating cognition**, **recurrent visual hallucinations**, and **spontaneous parkinsonism**. - While gait disturbance can occur (parkinsonism), the absence of hallucinations and significant cognitive fluctuations makes NPH a more fitting diagnosis for the specific triad presented.

Cognitive disorders (dementia) US Medical PG Question 6: A 76-year-old man is brought to his geriatrician by his daughter, who reports that he has been "losing his memory." While the patient previously performed all household duties by himself, he has recently had several bills that were unpaid. He also called his daughter on several occasions after getting lost while driving and having "accidents" before getting to the toilet. On exam, the patient is conversant and alert to person, place, and time, though his gait is wide-based and slow. Which of the following diagnostic procedures would be most appropriate to confirm the suspected diagnosis in this patient?

• A. Warfarin
• B. Donepezil
• C. Carbidopa/Levodopa
• D. Memantine
• E. Lumbar puncture (Correct Answer)

Cognitive disorders (dementia) Explanation: ***Lumbar puncture*** - The patient's symptoms of **cognitive decline**, **gait disturbance**, and **urinary incontinence** (losing control before reaching the toilet) represent the classic triad of **Normal Pressure Hydrocephalus (NPH)**. - **Lumbar puncture** with removal of CSF (30-50 mL) serves as both a **diagnostic and therapeutic test** (tap test); transient improvement in symptoms, especially gait, strongly supports the diagnosis of NPH. - This is the only **diagnostic procedure** among the options; the others are medications/treatments. *Warfarin* - This is an **anticoagulant medication** (not a diagnostic procedure) used to prevent blood clots in atrial fibrillation or venous thromboembolism. - Has no role in diagnosing or treating NPH, which involves CSF dynamics, not coagulation. *Donepezil* - **Donepezil** is an **acetylcholinesterase inhibitor medication** (not a diagnostic procedure) used to treat Alzheimer's disease symptoms. - While the patient has cognitive decline, the classic NPH triad (cognitive, gait, incontinence) distinguishes this from typical Alzheimer's dementia. - This is a treatment option, not a diagnostic test. *Carbidopa/Levodopa* - This **medication combination** (not a diagnostic procedure) is the primary treatment for **Parkinson's disease**, replacing dopamine. - While Parkinson's causes gait issues, it doesn't typically present with this specific triad, and parkinsonian gait differs from NPH's magnetic/apraxic gait. - This is a treatment, not a diagnostic procedure. *Memantine* - **Memantine** is an **NMDA receptor antagonist medication** (not a diagnostic procedure) used in moderate to severe Alzheimer's disease. - Like donepezil, this treats dementia symptoms but is not a diagnostic test for NPH.

Cognitive disorders (dementia) US Medical PG Question 7: A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

• A. "Does the diarrhea typically precede the constipation, or vice-versa?"
• B. "Is the diarrhea foul-smelling?"
• C. "Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"
• D. "Are the symptoms worse in the morning or at night?"
• E. "Can you tell me more about the symptoms you have been experiencing?" (Correct Answer)

Cognitive disorders (dementia) Explanation: ***Can you tell me more about the symptoms you have been experiencing?*** - This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis. - In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions. *Does the diarrhea typically precede the constipation, or vice-versa?* - While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience. - It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture. *Is the diarrhea foul-smelling?* - Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions. - However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed. *Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life* - Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time. - However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially. *Are the symptoms worse in the morning or at night?* - Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related. - This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.

Cognitive disorders (dementia) US Medical PG Question 8: A 72-year-old woman is brought to the physician by her son for an evaluation of cognitive decline. Her son reports that she has had increased difficulty finding her way back home for the last several months, despite having lived in the same city for 40 years. He also reports that his mother has been unable to recall the names of her relatives and been increasingly forgetting important family gatherings such as her grandchildren's birthdays over the last few years. The patient has hypertension and type 2 diabetes mellitus. She does not smoke or drink alcohol. Her current medications include enalapril and metformin. Her temperature is 37°C (98.6°F), pulse is 70/min, and blood pressure is 140/80 mm Hg. She is confused and oriented only to person and place. She recalls 2 out of 3 words immediately and 1 out of 3 after 5 minutes. Her gait and muscle strength are normal. Deep tendon reflexes are 2+ bilaterally. The remainder of the examination shows no abnormalities. Further evaluation is most likely to reveal which of the following findings?

• A. Generalized cerebral atrophy (Correct Answer)
• B. Myoclonic movements
• C. Hallucinations
• D. Urinary incontinence
• E. Resting tremor

Cognitive disorders (dementia) Explanation: ***Generalized cerebral atrophy*** - The patient's symptoms of progressive **cognitive decline**, including difficulty with navigation and memory, are classic signs of **Alzheimer's disease**. - **Generalized cerebral atrophy**, particularly of the **hippocampus** and **temporal lobes**, is a hallmark pathological finding in Alzheimer's disease due to neuronal loss and synaptic dysfunction. *Myoclonic movements* - **Myoclonic movements** are sudden, brief, involuntary muscle jerks, most commonly associated with **Creutzfeldt-Jakob disease** or certain types of dementia with Lewy bodies, which are not suggested by the patient's presentation. - While some rare forms of early-onset Alzheimer's can have atypical features, myoclonus is not a typical or early finding in the more common late-onset presentation described. *Hallucinations* - **Hallucinations**, particularly visual hallucinations, are frequently seen in **dementia with Lewy bodies** and **Parkinson's disease dementia**, often preceding or co-occurring with cognitive decline. - While hallucinations can occur in late-stage Alzheimer's, they are not a prominent or early feature differentiating it from other dementias. *Urinary incontinence* - **Urinary incontinence** can be a symptom of various conditions, including **normal pressure hydrocephalus (NPH)**, which presents with a triad of gait instability, dementia, and urinary incontinence. - In Alzheimer's disease, incontinence typically appears in the **later stages**, after significant cognitive impairment and functional decline have occurred. *Resting tremor* - A **resting tremor** is a characteristic symptom of **Parkinson's disease** and is often seen in **Parkinson's disease dementia** or **dementia with Lewy bodies**. - The patient's neurological examination, including normal gait and muscle strength, does not suggest Parkinsonian features.

Cognitive disorders (dementia) US Medical PG Question 9: A 78-year-old man is brought to the physician by his daughter for a follow-up examination. The daughter noticed that he has gradually become more forgetful and withdrawn over the last year. He frequently misplaces his car keys and forgets the names of his neighbors, whom he has known for 30 years. He has difficulty recalling his address and telephone number. He recently had an episode of urinary and fecal incontinence. Last week, his neighbor found him wandering the parking lot of the grocery store. He has hypertension and hyperlipidemia. He had smoked one pack of cigarettes daily for 40 years but quit 18 years ago. His current medications include hydrochlorothiazide and atorvastatin. He appears healthy; BMI is 23 kg/m2. His temperature is 37.2°C (99.0°F), pulse is 86/min, respirations are 14/min, and blood pressure is 136/84 mm Hg. Mini-mental state examination score is 19/30. He is not bothered by his forgetfulness. Cranial nerves II–XII are intact. He has 5/5 strength and full sensation to light touch in all extremities. His patellar, Achilles, and biceps reflexes are 2+ bilaterally. His gait is steady. MRI scan of the brain shows ventriculomegaly and prominent cerebral sulci. Which of the following is the most appropriate pharmacotherapy?

• A. Acetazolamide
• B. Sertraline
• C. Memantine
• D. Thiamine
• E. Donepezil (Correct Answer)

Cognitive disorders (dementia) Explanation: ***Donepezil*** - The patient exhibits features consistent with **Alzheimer's disease**, including gradual memory loss, difficulty with daily tasks, episodes of incontinence, and a Mini-Mental State Examination (MMSE) score of 19/30. Donepezil, a **cholinesterase inhibitor**, is a first-line treatment for mild to moderate Alzheimer's to slow cognitive decline. - The MRI findings of **ventriculomegaly and prominent cerebral sulci** are consistent with general cerebral atrophy often seen in Alzheimer's disease, not hydrocephalus requiring shunting or other specific brain pathologies (normal pressure hydrocephalus would have gait disturbance as a prominent feature, which is absent here). *Acetazolamide* - **Acetazolamide** is a **carbonic anhydrase inhibitor** used to treat conditions like glaucoma, altitude sickness, and idiopathic intracranial hypertension. - There is no indication of elevated intracranial pressure or hydrocephalus that would warrant the use of acetazolamide in this patient. *Sertraline* - **Sertraline** is a **selective serotonin reuptake inhibitor (SSRI)** primarily used to treat depression, anxiety disorders, and obsessive-compulsive disorder. - While depression can coexist with dementia, the primary cognitive symptoms described here are not primarily depressive; therefore, an antidepressant is not the most appropriate initial pharmacotherapy for cognitive decline. *Memantine* - **Memantine** is an **NMDA receptor antagonist** used in moderate to severe Alzheimer's disease, often in combination with cholinesterase inhibitors or when cholinesterase inhibitors are not tolerated. - While appropriate for moderate to severe Alzheimer's, **cholinesterase inhibitors** are typically the initial treatment for mild to moderate stages, and the patient's MMSE score of 19/30 often falls into the mild-moderate category where donepezil is usually favored first. *Thiamine* - **Thiamine** (vitamin B1) supplementation is primarily used to treat **Wernicke-Korsakoff syndrome**, which is associated with chronic alcohol abuse and presents with ataxia, ophthalmoplegia, and confusion, none of which are the primary presenting symptoms here. - There is no evidence of **nutritional deficiency** or alcohol abuse in this patient to suggest thiamine deficiency as the cause of his cognitive decline.

Cognitive disorders (dementia) US Medical PG Question 10: A 65-year-old woman comes to the physician for the evaluation of several episodes of urinary incontinence over the past several months. She reports that she was not able to get to the bathroom in time. During the past 6 months, her husband has noticed that she is starting to forget important appointments and family meetings. She has type 2 diabetes mellitus treated with metformin. The patient had smoked a pack of cigarettes daily for 45 years. Her vital signs are within normal limits. On mental status examination, she is confused and has short-term memory deficits. She walks slowly taking short, wide steps. Muscle strength is normal. Deep tendon reflexes are 2+ bilaterally. Which of the following is the most likely underlying cause of this patient's urinary incontinence?

• A. Bacterial infection of the urinary tract
• B. Normal pressure hydrocephalus (Correct Answer)
• C. Detrusor-sphincter dyssynergia
• D. Impaired detrusor contractility
• E. Loss of sphincter function

Cognitive disorders (dementia) Explanation: ***Normal pressure hydrocephalus*** - The patient's presentation with **urinary incontinence**, **memory deficits/dementia**, and an **ataxic gait** (slow, short, wide steps) represents the classic triad of **Normal Pressure Hydrocephalus (NPH)**. - While the incontinence itself is urge-type (not getting to the bathroom in time), the constellation of symptoms points to NPH as the underlying neurological cause. *Bacterial infection of the urinary tract* - Although urinary tract infections can cause **acute urinary incontinence**, especially in the elderly, they do not explain the accompanying **memory loss** and **gait disturbance**. - There are no symptoms typical of infection such as **dysuria**, **frequency**, or **fever** mentioned in the vignette. *Detrusor-sphincter dyssynergia* - This condition involves involuntary contraction of the urethral sphincter during detrusor contraction, typically seen in **spinal cord injury** patients, and is characterized by **incomplete bladder emptying**, not primarily urge incontinence alone. - It does not account for the **cognitive decline** or **gait abnormalities** presented. *Impaired detrusor contractility* - **Impaired detrusor contractility** (underactive bladder) typically leads to **overflow incontinence** with incomplete emptying, characterized by a constant dribble and difficulty initiating urination, which contrasts with the presented urge incontinence. - This condition does not explain the patient's **dementia** or **gait disturbance**. *Loss of sphincter function* - **Loss of sphincter function** (stress incontinence) typically causes urine leakage with increased intra-abdominal pressure (e.g., coughing, sneezing, lifting), which is different from the patient's report of not making it to the bathroom in time which points towards urge incontinence. - This condition also does not explain the neurological symptoms of **dementia** and **gait ataxia**.

Cognitive disorders (dementia) Flashcard 1 of 10

Question: Which psychiatric disorder, delirium or dementia, is characterized by memory deficits, apraxia, aphasia, agnosia, behavioral/personality changes, and impaired judgment? _____

Answer: Dementia

Cognitive disorders (dementia) Flashcard 2 of 10

Question: Which psychiatric disorder, delirium or dementia, is characterized by disorganized thinking, visual hallucinations, disturbances in sleep wake cycle, cognitive dysfunction, and agitation? _____

Answer: Delirium

Cognitive disorders (dementia) Flashcard 3 of 10

Question: When diagnosing neurodegenerative disorders, you must first rule out _____ as a cause of the presenting dementia

Answer: depression (psych disorder)

Cognitive disorders (dementia) Flashcard 4 of 10

Question: Non-pharmacological treatment for Tourette syndrome includes _____ and behavioral therapy

Answer: psychoeducation

Cognitive disorders (dementia) Flashcard 5 of 10

Question: Early-onset dementia with Parkinsonian features is suggestive of _____ dementia

Answer: Lewy body

Cognitive disorders (dementia) Flashcard 6 of 10

Question: mammillary bodies

Answer: confusion, ophthalmoplegia, ataxia, confabulation, personality change, permanent anterograde and retrograde amnesia

Cognitive disorders (dementia) Flashcard 7 of 10

Question: frontal lobe

Answer: disinhibition; deficits in concentration, orientation, judgment; reemergence of primitive reflexes

Cognitive disorders (dementia) Flashcard 8 of 10

Question: conduction aphasia

Answer: damage to arcuate fasciculus of dominant hemisphere

Extra Information: fluent speech, intact comprehension, impaired repetition

Cognitive disorders (dementia) Flashcard 9 of 10

Question: aphasia

Answer: speech deficit due to high-order processing problem

Cognitive disorders (dementia) Flashcard 10 of 10

Question: long-term memory

Answer: limbic system