for the Psychiatry Clerkship

1. Jeopardy for the Psychiatry Clerkship

2. And Now Here Is The Host . . . is proud to present Insert Name Here

3. The categories for today’s Jeopardy on Neuropsychiatry will be:

4. Screening

5. Alzheimer’s signs & symptoms

6. Work up & Tx

7. AD or not AD

8. Miscellaneous

9. Screening Miscellaneous AD signs & symptoms Work up & Tx AD or not AD 100 100 100 100 100 200 200 200 200 200 300 300 300 300 300 400 400 400 400 400 500 500 500 500 500 600 600 600 600 600 700 700 700 700 700 800 800 800 800 800 900 900 900 900 900

10. Row 1, Col 1 What is the Mini Mental Status Exam (MMSE)? While the patient’s education background must be considered, in general a score of < 24 (out of 30 points) on this test is suggestive of dementia or delirium

11. 1,2 What is depression? Alzheimer’s Dementia Depression Delirium If a patient gives poor efforts on testing, has psychomotor slowing and says “I can’t do this”, the diagnosis is most likely this

12. 1,3 What is attention? The Digit span forward test, the Reverse digit span test, serial subtraction, spelling words backwards, and stating the months of the year backwards all test for this cognitive ability

13. 1,4 What isNeuropsychological testing? Most often used to clarify a diagnosis, or to guide recommendations about ability to drive, to make financial decisions, or to live independently is this test

14. 1,5 What is Dementia? Alzheimer’s Dementia Depression Delirium If a patient makes a good effort but is wrong, the diagnosis is most likely this

15. 1,6 What is Montreal Cognitive Assessment (MoCA)? While the patient’s education background must be considered, in general a score of < 26 (out of 30 points) on this test is a positive screen for mild cognitive impairment

16. 1,7 What is Mini-Cog? Inability to recall 0 of 3 unrelated words or Ability to recall 1-2 of 3 unrelated words plus inability to perform the clock drawing test is a positive dementia screen with this test

17. 1,8 What is Delirium? Alzheimer’s Dementia Depression Delirium If a patient cannot perform the Digit span forward test, the Reverse digit span test, or serial subtraction, the diagnosis is most likely this

18. 1,9 What isattention (this) and concentration (that)? Ability to resist distraction at one point in time is this; ability to resist distraction over a period of time is that

19. 2,1 What is recent memory? (formally called Declarative Episodic Memory) The hippocampus & entorhinal cortex are prominently impaired early in Alzheimer’s Dementia resulting in deficits with this cognitive process

20. 2,2 What is Immediate recall/Immediate memory? The Digit Span Forward Test shows this type of memory is impaired in delirious patients (due to deficits in attention) but is not impaired in Alzheimer’s Dementia patients

21. 2,3 What is Remote memory? Because the encoding function of the hippocampus has previously taken place, this type of memory is not affected by Alzheimer’s Dementia

22. 2,4 What is late in clinical course? Early Late: Because motor learning is served by subcorital systems (not the hippocampus), impairment of motor learning (apraxia) is seen during this part of Alzheimer’s Dementia clinical course

23. 2,5 What is middle to late? Early Late: Behaviors such as agitation, aggression, wandering, and psychosis are seen during this part of Alzheimer Dementia’s clinical course

24. 2,6 What is recent memory? (or Declarative episodic memory) Seen in Alzheimer’s Dementia, the impaired ability to learn a series of words or objects and then recall them after 5 minutes (or the ability to recall current events) involves this type of memory

25. 2,7 What is middle to late? Early Late: Deficits in language such as aphasia or problems with fluency, repetition, naming, reading, or writing are seen during this part of Alzheimer’s Dementia clinical course

26. 2,8 What is delusions? (specifically, paranoid delusions) The most common type of psychosis seen in Alzheimer’s Dementia is this

27. 2,9 What is early? Early Late: Losing things, getting lost, or difficulty navigating familiar or unfamiliar terrain is indicative of visuospatial deficits and is seen during this part of Alzheimer’s Dementia clinical course

28. 3,1 What is depression (this) dementia (that)? Patients who complain of memory loss are most likely to have this diagnosis, while patient’s whose family members complain about the patient’s memory loss are most likely to have that diagnosis

29. 3,2 What is < 1%? Reversible dementia’s prevalence now versus the 1970’s (and before) has changed and is now this %

30. 3,3 What is a reversible cause of dementia is suspected? While American Association of Neuro (AAN) recommends imaging in routine evaluation of all patients with suspected dementia, consensus reasons for imaging include: recent onset of symptoms (<2 years), Age < 60, focal signs, and this

31. 3,4 What is Age related? (Age related findings are less rapid and less severe; but not diagnostic) Age related finding Dementia finding Neuroimaging generalized atrophy & white matter lesions

32. 3,5 What is Dementia finding? (though not diagnostic) Age related finding Dementia finding Reduced hippocampal volume

33. 3,6 What are Antidepressants (SSRI’s)? Antipsychotics (FGA’s) Antipsychotics (SGA’s) Antidepressants (SSRI’s) Benzodiazepines Mood stabilizers Meds often useful in management of chronic and/or mild agitation & paranoia are these

34. 3,7 What is cholinesterase inhibitors? Donepezil (Aricept), Galantamine (Razadyne), Rivastigmine (Exelon) Patients with newly diagnosed dementia (Alzheimer’s, Lewy body, Vascular, or Parkinson’s) medications routinely recommended to decrease the rate of deterioration are this

35. 3,8 What is memantine (Namenda)? Patients with moderate-to-advanced dementia (Alzheimer’s, Lewy body, Vascular, or Parkinson’s) a medication routinely recommended be added to the patient’s treatment regimen is this

36. 3,9 What are Antipsychotics (SGA’s)? Antipsychotics (FGA’s) Antipsychotics (SGA’s) Antidepressants (SSRI’s) Benzodiazepines Mood stabilizers Despite risks, meds often used in management of severe agitation & paranoid delusions are these

37. 4,1 What is Dementia with Lewy Body? Alzheimer’s Lewy body Frontotemporal Vascular Visual hallucinations are commonly seen in dementias of this type

38. 4,2 What is Frontotemporal? Alzheimer’s Lewy body Frontotemporal Vascular Memory and visuospatial function are usually spared in dementia of this type

39. 4,3 What is Vascular? Alzheimer’s is most common (~60-80%) Alzheimer’s Lewy body Frontotemporal Vascular 2nd most common type of dementia that is frequently seen in combination with the 1st most common type of dementia is this

40. 4,4 What is Lewy Body? Alzheimer’s Lewy body Frontotemporal Vascular REM sleep behavior disorder may precede the dementia by up to 20 years and occurs in 85% of patients with dementia of this type

41. 4,5 What are all? Alzheimer’s Lewy body Frontotemporal Vascular Antipsychotics use should be minimized due to an increased risk of death in this type of dementia

42. 4,6 What is Lewy body? Alzheimer’s Lewy Body Frontotemporal Vascular Antipsychotic use has greatly increased risk of severe Parkinsonism (up to 50% of patients) with dementia of this type

43. 4,7 What is Frontotemporal? Alzheimer’s Lewy bodies Frontotemporal Vascular Early, progressive language aphasia with speech apraxia or impaired single word comprehension is seen in dementia of this type

44. 4,8 What is Alzheimer’s? Alzheimer’s Lewy body Frontotemporal Vascular Aphasia is seen in the late stage of dementia of this type

45. 4,9 What is Frontotemporal? Alzheimer’s Lewy body Frontotemporal Vascular Socially disinhibited & inappropriate behaviors along with personality changes are seen early on in this type of dementia

46. 5,1 What is Dementia with Lewy Bodies? Cognitive fluctuation episodes of blanking out, losing consciousness, becoming confused or somnolent, or having speech or motor arrest is seen in up to 80% of patients with Dementia of this type

47. 5,2 What is none?(Normal aging) Forgetfulness of people’s names or difficulty finding words (“tip of the tongue” phenomenon in which the word or name comes back some time later) is associated with this type of dementia

48. 5,3 What is False? (These point to a major cognitive problem) True False Asking questions repeatedly, forgetting details of conversations, and not recalling details of TV shows or movies are part of normal aging

49. 5,4 What is True? True False Shortened speed of processing, slowed learning, and increased difficulty with multi-tasking are seen in normal aging

50. 5,5 What is False? True False Changes in vocabulary, language ability, or reading comprehension are seen with normal aging