Dementia Mini-Cases
Introduction
For background reading, please refer to:
The following nine mini-cases describe intitial clinical presentations of seniors with memory loss. Consider a diagnosis and staging of dementia, as well as any other potential diagnoses and plans for evaluation.
Cases
Mrs. S is a 76 year-old woman with a college education who worked as an office assistant. Her MMSE is 19/30. Her son says she has no functional loss; she can cook, drive, and manage finances.
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80 year-old retired lawyer whose husband is concerned about memory loss and safety in the kitchen, as he has left a pot on the stove a number of times recently. There has been a noticeable decline over the past 10 months. You perform an MMSE, on which he scores 28/30.
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88 year-old woman who has become increasingly withdrawn and disinterested in her hobbies, such as gardening. MMSE 25/30.
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72-year old male has concerning behaviour, according to his wife. He become sexually agressive and has made a number of inappropriate comments in public. His functioning is intact and there does not appear to be any memory loss
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89 year-old man with a 4 month history of memory problems, according to family, who report wandering and safety problems in kitchen. MMSE 10/30.
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82 year-old man with memory problems for 3 years. Is on lorazepam 1 mg TID, HCTZ 25, ASA, sertraline 50 qhs. MMSE 16/30.
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65 year-old man with progressive decline in mobility, with multiple falls. eight month decline in memory. MMSE 24/30.
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74 year-old woman with several year history of memory problems and now urinary incontience and mobility issues.
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78 year-old woman with dementia brought into Emergency Department with marked shortness of breath. crackles heard on physical exam.
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Question: What are the predisposing factors for delirium in older patients?
Question: What are the criteria for diagnosis of delirium?
Resources and References
Inouye SK. Delirium in older persons. N Engl J Med. 2006: 16; 354(11): 1157-65.
Inouye SK, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999; 340(9): 669-676
Elie M, et al. Delirium risk factors in elderly hospitalized patients. J Gen Intern Med.1998: 13(3): 204-212
Inouye SK et al., Clarifying confusion: The Confusion Assessment Method (CAM). Ann Intern Med. 1990; 113 (12): 941-948.
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