1. Review Session: Cognitive and Behavioral Disorders Domain Kevin Overbeck, DO Assistant Professor UMDNJ–SOM NJISA

2. Review Session: Cognitive and Behavioral Disorders Domain This medical student presentation is offered by the New Jersey Institute for Successful Aging. This lecture series is supported by an educational grant from the Donald W. Reynolds Foundation Aging and Quality of Life program.

3. “Buzz Words/Phrases” A panel of “experts” (geriatric psychiatry and geriatric medicine physicians) rated each item from a 0-3 in how well it applied to: Dementia Delirium Depression Paniagua M, van Zuilen M, Pua R, Mintzer M and Silver I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805

4. “Buzz Words/Phrases” Caused by diazepam (a)Dementia (b)Delirium (c)Depression

5. “Buzz Words/Phrases” Caused by diazepam (a)Dementia [0.00] (b)Delirium [2.8] (c)Depression [0.33] Paniagua M, van Zuilen M, Pua R, Mintzer M and Silver I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805.

6. “Buzz Words/Phrases” Acute (a)Dementia (b)Delirium (c)Depression

7. “Buzz Words/Phrases” Acute (a)Dementia [0.13] (b)Delirium [3.0] (c)Depression [1.3] Paniagua M, van Zuilen M, Pua R, Mintzer M and Silver, I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805

8. “Buzz Words/Phrases” Anhedonia (a)Dementia (b)Delirium (c)Depression

9. “Buzz Words/Phrases” Anhedonia (a)Dementia [1.38] (b)Delirium [0.5] (c)Depression [2.75] Paniagua M, van Zuilen M, Pua R, Mintzer M and Silver, I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805

10. “Buzz Words/Phrases” Brought in by caregivers soon after onset of symptoms (a)Dementia (b)Delirium (c)Depression

11. “Buzz Words/Phrases” Brought in by caregivers soon after onset of symptoms (a)Dementia [0.43] (b)Delirium [2.9] (c)Depression [0.75] Paniagua M, van Zuilen M, Pua R, Mintzer M and Silver, I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805

12. “Buzz Words/Phrases” Brought in by caregivers with symptoms present for a while (a)Dementia (b)Delirium (c)Depression

13. “Buzz Words/Phrases” Brought in by caregivers with symptoms present for a while (a)Dementia [2.86] (b)Delirium [0.4] (c)Depression [2.5] Paniagua M, van Zuilen M, Pua R, Mintzer M and Silver, I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805

14. “Buzz Words/Phrases” Can make decisions (a) Dementia (b) Delirium (c) Depression

15. “Buzz Words/Phrases” Can make decisions (a) Dementia [1.38] (b) Delirium [0.6] (c) Depression [2.63] Paniagua M, van Zuilen M, Pua R, Mintzer M and Silver, I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805

16. “Buzz Words/Phrases” Result of Polypharmacy (a) Dementia (b) Delirium (c) Depression

17. “Buzz Words/Phrases” Result of Polypharmacy (a) Dementia [0.86] (b) Delirium [2.6] (c) Depression [1.43] Paniagua, M, van Zuilen, M, Pua, R, Mintzer, M and Silver, I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805

18. “Buzz Words/Phrases” “I Don’t Know” answers are common (a) Dementia (b) Delirium (c) Depression

19. “Buzz Words/Phrases” “I Don’t Know” answers are common (a) Dementia [1.71] (b) Delirium [0.5] (c) Depression [2.5] Paniagua M, van Zuilen M, Pua R, Mintzer M and Silver, I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805

20. “Buzz Words/Phrases” Potentially reversible (a) Dementia (b) Delirium (c) Depression

21. “Buzz Words/Phrases” Potentially reversible (a) Dementia [1.0] (b) Delirium [3.0] (c) Depression [2.5] Paniagua, M, van Zuilen, M, Pua, R, Mintzer, M and Silver, I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805

22. “Buzz Words/Phrases” Family History (a) Dementia (b) Delirium (c) Depression

23. “Buzz Words/Phrases” Family history (a) Dementia [2.43] (b) Delirium [0.1] (c) Depression [2.13] Paniagua, M, van Zuilen, M, Pua, R, Mintzer, M and Silver, I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805

24. “Buzz Words/Phrases” Hoarding (a) Dementia (b) Delirium (c) Depression

25. “Buzz Words/Phrases” Hoarding (a) Dementia [2.43] (b) Delirium [0.3] (c) Depression [0.43] Paniagua, M, van Zuilen, M, Pua, R, Mintzer, M and Silver, I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805

26. “Buzz Words/Phrases” Sleep wake cycle fluctuates hour by hour (a) Dementia (b) Delirium (c) Depression

27. “Buzz Words/Phrases” Sleep wake cycle fluctuates hour by hour (a) Dementia [0.5] (b) Delirium [2.4] (c) Depression [1.0] Paniagua, M, van Zuilen, M, Pua, R, Mintzer, M and Silver, I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805

28. “Buzz Words/Phrases” Sleep wake cycle with day night reversal (a) Dementia (b) Delirium (c) Depression

29. “Buzz Words/Phrases” Sleep wake cycle with day night reversal (a) Dementia [2.5] (b) Delirium [1.3] (c) Depression [0.75] Paniagua, M, van Zuilen, M, Pua, R, Mintzer, M and Silver, I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805

30. “Buzz Words/Phrases” Tries hard but gives incorrect answers (a) Dementia (b) Delirium (c) Depression

31. “Buzz Words/Phrases” Tries hard but gives incorrect answers (a) Dementia [2.86] (b) Delirium [1.0] (c) Depression [0.38] Paniagua, M, van Zuilen, M, Pua, R, Mintzer, M and Silver, I. The 3D's of Cognitive Impairment: An interactive card-sorting exercise. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/18805

32. Sample Case Vignettes Memory Loss Problem Solving

33. Memory Loss Problem Solving A Case: Mr. Raymond

34. A Case: Mr. Raymond HPI: Mr. Raymond is a 62 year old male reluctantly brought in for an evaluation by his distressed wife at the request of his psychiatrist after he had reviewed a recent MRI. He has been exhibiting behavior out of character from his previous personality profile. PMHx: Dyslipidemia Social Hx: Retired accountant x 4 years; denied drugs, EtOH, tobacco GDS 1/15 MMSE 29/30 deficit Pentagon Source: Microsoft Office Images #MP900443187 by iStockphoto (http://office.microsoft.com/en-us/images/)

35. A Case: Mr. Raymond The clinical presentation of the case is most consistent with which of the following conditions? (a) Delirium (b) Depression (c) Vascular dementia (d) Frontotemporal lobe dementia (e) Lewy body dementia

36. Memory Loss Problem Solving A Case: Mrs. Tindell

37. A Case: Mrs. Tindell Mrs. Tindell is an 87 year old female who carries a diagnosis of dementia. She is admitted to an Assisted Living facility following the death of her caregiver. Image copyright © 1997 PhotoDisc, Inc. (http://www.hallogram.com/photodisc/lisence1.html)http://www.hallogram.com/photodisc/lisence1.html

38. A Case: Mrs. Tindell During the course of the next 9 months, she continues to decline in functional status (i.e., requiring assistance with all ADLs except for self feeding), despite evaluations and treatments by physical therapy and occupational therapy. The family is seeking your opinion regarding this 9 month deterioration in function.

39. A Case: Mrs. Tindell Physical Exam (+) gait dysfunction with short, shuffling steps and decreased arm swing with ambulation MMSE: 20/30 3/5 deficit in time orientation 3/5 deficit in location orientation 2/3 deficit in short term recall 1/5 deficit in serial sevens 0/1 deficit with pentagon GDS: 2/15

40. A Case: Mrs. Tindell Which of the following clinical syndromes is most compatible with Mrs. Tindell’s constellation of signs and symptoms? (a)Parkinson’s disease (b)Frontotemporal lobe dementia (c)Brain tumor (d)Dementia with Lewy bodies (e)Creutzfeldt-Jakob disease

41. Memory Loss Problem Solving A Case: Mr. Gulch

42. A Case: Mr. Gulch Mr. Gulch is an 83 year old man who is brought to the physician by his daughter because she is concerned about his memory loss over the past year. Yesterday, he could not remember his 18 month old granddaughter’s name. Although he denies that there is any problem, she says he has been forgetful and becomes easily confused. There is no history of alcohol abuse. Source: Microsoft Office Images #MP900407473 (http://office.microsoft.com/en-us/images/)

43. A Case: Mr. Gulch On mental status examination, his mood is normal. He is oriented to person and place, but initially gives the wrong month, which he is able to correct. He does not know the county and has made an error on the season. He reports that it is winter, but, in fact, it has just turned into spring. He recalls memories from his youth in great detail, but only recalls one of three words after 5 minutes. He has difficulty recalling the name of the current US president.

44. A Case: Mr. Gulch His temperature is 37°C (98.6°F), pulse is 77/min, respirations are 12/min, and blood pressure is 118/84 mm Hg. Physical examination, laboratory studies, and thyroid function tests show no abnormalities.

45. A Case: Mr. Gulch Which of the following clinical syndromes is most compatible with Mr. Gulch’s constellation of signs and symptoms? (a)Alzheimer’s disease (b)Frontotemporal lobe dementia (c)Age-associated memory loss (d)Dementia with Lewy bodies (e)Delirium