Clinical Neuroscience of Dementia Exam
Questions And Answers
Define delirium + a potential useful/sensitive bedside marker? -
correct answer ✅the failure of cognition due to the stress of an
illness on the brain
- reverse digit span measure of WM and attention
What is the DSM-IV criteria for delirium? -
correct answer ✅- disturbance of consciousness
- change in cognition in 2+ domains, or perceptual change
- acute, usually over hours or days
- physiological precipitant
describe hyperactive delirium -
correct answer ✅- hyper-consciousness; aggression, agitation,
hyper-alert
- 20% delirium
- easily recognised
describe hypoactive delirium -
correct answer ✅- hypo-consciousness; inattentive, bewildered,
sleepy
- 80% delirium
,Clinical Neuroscience of Dementia Exam
Questions And Answers
- highest mortality
- usually unrecognised
why is delirium important? (6) -
correct answer ✅- 15% hospitals
-50% under-recognised
- 20% increased mortality
- 60% underlying dementia
- £13k/patient
-majority of causes are reversible
how are delirium and dementia different from one another
clinically? -
correct answer ✅- dementia progressive decline in cognition,
delirium acute and can fluctuate
- dementia alertness preserved, delirium altered
- dementia orientation initially preserved, delirium lost early
-dementia hallucination less prominent, delirium often prominent
- dementia aphasic features, delirium incoherent language
altogether
,Clinical Neuroscience of Dementia Exam
Questions And Answers
- dementia generally engages, delirium restless or inertia
- dementia usually not reversible, delirium usually reversible
cognition: link between delirium and dementia? -
correct answer ✅- memory clinic ps - faster cognitive decline if get
delirium
- cohort older ps - MMSE + delirium history = worse MMSE
trajectory, especially if also have dementia-related pathology @
post-mortem
what are the pathophysiological differences between delirium and
dementia? -
correct answer ✅dementia = progressive degeneration
delirium = acute injury/infection
what is the steroid explanation of delirium? -
correct answer ✅- limbic cortex, hypothalamus, pituitary, adrenal,
cortisol feedback regulation (LHPA)
- limbic system atrophy normal ageing = lower threshold stress ->
elevated cortisol -> too much = cytotoxic
- cortisol in CSF delirium elevated
, Clinical Neuroscience of Dementia Exam
Questions And Answers
what is the inflammatory explanation of delirium? -
correct answer ✅- mouse microglia only release inflammatory IL1-
beta when coupled with degeneration and an infection (LPS outer
bacterial membrane)
- worsened cumulative clinical effect with progression of
degeneration
What is acalculia, & where does it arise from? -
correct answer ✅calculation/arithmetic deficit
- parietal lobe
What is agnosia? -
correct answer ✅recognition of objects impaired, not related to
sensory loss
What is aphasia? -
correct answer ✅language deficit
What is apraxia? -
correct answer ✅problems with motor planning and actions, not
related to motor deficit
Questions And Answers
Define delirium + a potential useful/sensitive bedside marker? -
correct answer ✅the failure of cognition due to the stress of an
illness on the brain
- reverse digit span measure of WM and attention
What is the DSM-IV criteria for delirium? -
correct answer ✅- disturbance of consciousness
- change in cognition in 2+ domains, or perceptual change
- acute, usually over hours or days
- physiological precipitant
describe hyperactive delirium -
correct answer ✅- hyper-consciousness; aggression, agitation,
hyper-alert
- 20% delirium
- easily recognised
describe hypoactive delirium -
correct answer ✅- hypo-consciousness; inattentive, bewildered,
sleepy
- 80% delirium
,Clinical Neuroscience of Dementia Exam
Questions And Answers
- highest mortality
- usually unrecognised
why is delirium important? (6) -
correct answer ✅- 15% hospitals
-50% under-recognised
- 20% increased mortality
- 60% underlying dementia
- £13k/patient
-majority of causes are reversible
how are delirium and dementia different from one another
clinically? -
correct answer ✅- dementia progressive decline in cognition,
delirium acute and can fluctuate
- dementia alertness preserved, delirium altered
- dementia orientation initially preserved, delirium lost early
-dementia hallucination less prominent, delirium often prominent
- dementia aphasic features, delirium incoherent language
altogether
,Clinical Neuroscience of Dementia Exam
Questions And Answers
- dementia generally engages, delirium restless or inertia
- dementia usually not reversible, delirium usually reversible
cognition: link between delirium and dementia? -
correct answer ✅- memory clinic ps - faster cognitive decline if get
delirium
- cohort older ps - MMSE + delirium history = worse MMSE
trajectory, especially if also have dementia-related pathology @
post-mortem
what are the pathophysiological differences between delirium and
dementia? -
correct answer ✅dementia = progressive degeneration
delirium = acute injury/infection
what is the steroid explanation of delirium? -
correct answer ✅- limbic cortex, hypothalamus, pituitary, adrenal,
cortisol feedback regulation (LHPA)
- limbic system atrophy normal ageing = lower threshold stress ->
elevated cortisol -> too much = cytotoxic
- cortisol in CSF delirium elevated
, Clinical Neuroscience of Dementia Exam
Questions And Answers
what is the inflammatory explanation of delirium? -
correct answer ✅- mouse microglia only release inflammatory IL1-
beta when coupled with degeneration and an infection (LPS outer
bacterial membrane)
- worsened cumulative clinical effect with progression of
degeneration
What is acalculia, & where does it arise from? -
correct answer ✅calculation/arithmetic deficit
- parietal lobe
What is agnosia? -
correct answer ✅recognition of objects impaired, not related to
sensory loss
What is aphasia? -
correct answer ✅language deficit
What is apraxia? -
correct answer ✅problems with motor planning and actions, not
related to motor deficit
