Dementia

Mini-Mental State Exam 

• MMSE standardized BC questionnaire is used to stage cognitive impairment and classify areas of functional impairment 

• Poor sensitivity for mild/early dementia 

Montreal Cognitive Assessment  

• MoCA is a rapid screening tool for mild cognitive dysfunction

• Assesses attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations and orientation 

• Better sensitivity for mild cognitive impairment 

Ascertain Dementia-8 (AD8) 

• Self-administered or completed by caregiver

• Sensitive to detecting early cognitive changes associated with many common dementing illnesses including Alzheimer disease, vascular dementia, Lewy body dementia and frontotemporal dementia

• Given alone or in combination with Mini-cog

Mini-Cog 

• Combination of a brief memory test and a clock-drawing test that allows for rapid screening for short term memory defects, learning and different cognitive abilities that are impaired in dementia patients

Functional Assessment Staging (FAST) 

• Used to classify a patients stage of dementia 

Rx Files Geriatrics  

• A brief guide on medication use in the geriatric population 

1. Which of the following hypotheses of dementia CORRECTLY matches its definition?

a) Glutamatergic: Accumulation of beta-amyloid proteins leads to plaque formation in the brain, causing inflammation and disrupts cell signaling

b) Tau: accumulation of tau proteins causes neuronal death 

c) Cholinergic: Increased cholinergic transmission leads to memory loss and learning deficiency 

d) Beta-amyloid: accumulation of beta-amyloid proteins leads to enhanced glutamate signaling which activate NMDA receptors and cause cell death

2. Which of the following is an advantage to using the MoCA assessment tool over the MMSE scoring tool? 

a) It's faster (10 minutes) 

b) It requires no additional equipment 

c) It targets one cognitive domain 

d) It's more sensitive for mild cognitive impairment 

3. Which of the following are signs or symptoms of dementia? 

a) Poor reasoning skills

b) Speaking out of turn

c) Physical aggression

d) All of the above 

4. Which of the following medications would be the LEAST likely to contribute to worsening symptoms of dementia? 

a) Escitalopram 

b) Paroxetine

c) Diphenhydramine

d) Scopolamine 

5. Which of the following statements regarding AD therapeutics is TRUE?

a) donepezil is the most effective cholinesterase inhibitor in AD

b) memantine monotherapy is reserved for patients in which cholinesterase inhibitors are contraindicated or intolerable

c) Starting at a high dose is better to quickly achieve symptom control in patients starting cholinesterase inhibitors

d) None of the above