Comprehensive exams for Mental Health Q 175
The nurse is aware that the following ways in vascular dementia different from Alzheimer’s disease is:
A. Vascular dementia has a more abrupt onset.
B. The duration of vascular dementia is usually brief.
C. Personality change is common in vascular dementia.
D. The inability to perform motor activities occurs in vascular dementia.
Correct Answer: A. Vascular dementia has a more abrupt onset.
Vascular dementia differs from Alzheimer’s disease in that it has a more abrupt onset and runs a highly variable course. VD is distinguished from other forms of dementia in that it results from brain ischemia, although the temporal relationship to the ischemic event may be subtle or go unnoticed. There are various subtypes and multiple terms to describe the vascular pathology and affected brain tissue, such as multi-infarct dementia, small vessel disease or Binswanger disease, strategic infarct dementia, hypoperfusion dementia, hemorrhagic dementia, hereditary vascular dementia, and AD with cardiovascular disease
Option B: The duration of delirium is usually brief. Dementia is a syndrome of chronic progressive cognitive decline resulting in functional impairment. In the Diagnostic Manual of Mental Disorders, Fifth Edition (DSM-V), cognitive decline is quantified as deficits in one or more domains (e.g., memory, executive function, visuospatial, language, attention). Second, only to Alzheimer’s disease (AD), vascular dementia (VD) is one of the most common causes of dementia affecting the elderly (aged greater than 65 years), with a variable presentation and unpredictable disease progression.
Option C: Personality change is common in Alzheimer’s disease. A thorough history should be obtained from the patient, focusing on cognitive and functional deficits, onset, and progression of symptoms. Interviewing family members and caregivers is important as patients with cognitive decline rarely have insight into their cognitive and functional limitations.
Option D: The inability to carry out motor activities is common in Alzheimer’s disease. Caregivers may report an abrupt or stepwise onset of cognitive decline, or the appearance of symptoms may be subtle without connection to an ischemic event. The functional assessment should evaluate for impairments in instrumental activities of daily living (IADLs), such as cooking, driving, and financial and medication management, and basic activities of daily living (ADLs), such as dressing, bathing, and toileting. Additionally, patient’s past medical history, current medications, and surgical history should be obtained. Regarding physical examination, one should assess patients for focal neurologic deficits.