Buy Neurocognitive Disorders Discussion Solutions

Buy Neurocognitive Disorders Discussion Solutions
Buy Neurocognitive Disorders Discussion Solutions
17.1 The essential feature of the DSM-5 diagnosis of delirium is a disturbance in attention/awareness and in cognition that develops over a short period of time,
represents a change from baseline, and tends to fluctuate in severity during the
course of a day. Which of the following additional conditions must apply?
A. There must be laboratory evidence of an evolving dementia.
B. The disturbance must be associated with a disruption of the sleep-wake cycle.
C. The disturbance must not occur in the context of a severely reduced level of
arousal, such as coma.
D. The disturbance must be a direct physiological consequence of a substance
use disorder.
E. The disturbance must not be superimposed on a preexisting neurocognitive
disorder.
Correct Answer: C. The disturbance must not occur in the context of a severely reduced level of arousal, such as coma.
Explanation: The essential feature of delirium is a disturbance of attention or
awareness (Criterion A) that is accompanied by a change in baseline cognition
(Criterion C) that cannot be better explained by a preexisting or evolving neurocognitive disorder (Criterion D1). The ability to evaluate cognition to diagnose delirium depends on there being a level of arousal sufficient for response
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to verbal stimulation; hence, delirium should not be diagnosed in the context
of coma (Criterion D2). The disturbance develops over a short period of time,
usually hours to a few days, and tends to fluctuate during the course of the day
(Criterion B). There is evidence from the history, physical examination, or laboratory findings that the disturbance is a physiological consequence of an underlying medical condition, substance intoxication or withdrawal, use of a
medication, or a toxin exposure, or a combination of these factors (Criterion E).
Both major and mild neurocognitive disorders (NCDs) can increase the risk
for delirium and complicate the course. The most common differential diagnostic issue when evaluating confusion in older adults is disentangling symptoms of delirium and dementia. The clinician must determine whether the
individual has delirium; a delirium superimposed on a preexisting NCD, such
as that due to Alzheimer’s disease; or an NCD without delirium. The traditional distinction between delirium and dementia according to acuteness of
onset and temporal course is particularly difficult in those elderly individuals
406 | Neurocognitive Disorders—ANSWER GUIDE
who had a prior NCD that may not have been recognized, or who develop persistent cognitive impairment following an episode of delirium.
17.1—Delirium / diagnostic criteria (p. 596); Diagnostic Features (p. 599); Differential
Diagnosis (p. 601)
17.2 Both major and mild neurocognitive disorders can increase the risk of delirium
and complicate its course. Traditionally, delirium is distinguished from dementia on the basis of the key features of acute onset, impairment in attention,
and which of the following?
A. Fluctuating course.
B. Steady course.
C. Presence of mania.
D. Presence of depression.
E. Cogwheeling movements.
Correct Answer: A. Fluctuating course.
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Explanation: According to Criterion B for delirium, the disturbance develops
over a short period of time, usually hours to a few days, and tends to fluctuate
during the course of the day, often with worsening in the evening and night
when external orienting stimuli decrease.
17.2—Delirium / Diagnostic Features (p. 599)
17.3 A 79-year-old woman with a history of depression is being evaluated at a nursing home for a suspected urinary tract infection. She is easily distracted, perseverates on answers to questions, asks the same question repeatedly, is unable
to focus, and cannot answer questions regarding orientation. The mental status
changes evolved over a single day. Her family reports that they thought she
“wasn’t herself” when they saw her the previous evening, but the nursing report this morning indicates that the patient was cordial and appropriate. What
is the most likely diagnosis?
A. Major depressive disorder, recurrent episode.
B. Depressive disorder due to another medical condition.
C. Delirium.
D. Major depressive disorder, with anxious distress.
E. Obsessive-compulsive disorder.
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