ALZHEIMERS Flashcards
What is the most common cause of dementia worldwide?
A) Vascular dementia
B) Frontotemporal dementia
C) Alzheimer’s disease (AD)
D) Dementia with Lewy bodies (DLB)
Answer: C) Alzheimer’s disease (AD)
Rationale: AD accounts for 60–70% of all dementia cases, making it the most common cause worldwide.
Which of the following is a major genetic risk factor for late-onset AD?
A) Presenilin 1 (PSEN1) mutations
B) Presenilin 2 (PSEN2) mutations
C) Apolipoprotein E (ApoE) ε4 allele
D) Amyloid precursor protein (APP) mutations
Answer: C) Apolipoprotein E (ApoE) ε4 allele
Rationale: While PSEN1, PSEN2, and APP mutations are associated with early-onset familial AD, the ApoE ε4 allele is the most significant genetic risk factor for late-onset AD, increasing risk up to fifteenfold in homozygous carriers.
What is the earliest clinical manifestation of typical amnestic AD?
A) Word-finding difficulty
B) Visuospatial deficits
C) Insidious episodic memory loss
D) Progressive akinetic-rigid syndrome
Answer: C) Insidious episodic memory loss
Rationale: The hallmark of typical amnestic AD is the gradual onset of episodic memory impairment, which later progresses to deficits in executive, language, and visuospatial functions.
Which brain region is the first to show atrophy in typical amnestic AD?
A) Dorsolateral prefrontal cortex
B) Medial temporal lobes
C) Occipital lobe
D) Primary motor cortex
Answer: B) Medial temporal lobes
Rationale: The earliest atrophy in AD occurs in the medial temporal lobes, particularly in the hippocampus, before spreading to other cortical areas.
What pathological hallmark of AD is primarily responsible for neuronal toxicity?
A) Amyloid beta (Aβ) plaques
B) Lewy bodies
C) Pick bodies
D) Synuclein aggregates
Answer: A) Amyloid beta (Aβ) plaques
Rationale: The accumulation of Aβ plaques is a key pathological feature of AD and contributes to neurotoxicity. Neurofibrillary tangles composed of hyperphosphorylated tau are also characteristic of the disease.
What clinical term describes self-perceived memory impairment that is not detectable on formal neuropsychological testing?
A) Mild cognitive impairment (MCI)
B) Subjective cognitive decline
C) Early symptomatic AD
D) Preclinical AD
Answer: B) Subjective cognitive decline
Rationale: Subjective cognitive decline refers to self-reported cognitive impairment without detectable deficits on formal testing, potentially representing an early stage of AD.
Which of the following is TRUE regarding mild cognitive impairment (MCI)?
A) It always progresses to AD within 2 years.
B) It is the same as subjective cognitive decline.
C) Approximately 50% of patients with MCI will progress to AD over 4 years.
D) MCI is only diagnosed when patients have significant functional impairment.
Answer: C) Approximately 50% of patients with MCI will progress to AD over 4 years.
Rationale: About 12% of MCI patients per year progress to AD, meaning ~50% convert within 4 years. MCI differs from subjective cognitive decline and does not yet cause significant functional impairment.
Which of the following is a variant presentation of AD?
A) Posterior cortical atrophy syndrome
B) Logopenic aphasia
C) Corticobasal syndrome
D) All of the above
Answer: D) All of the above
Rationale: While typical AD presents with amnestic symptoms, some patients show alternative presentations like posterior cortical atrophy (visual dysfunction), logopenic aphasia (naming and repetition deficits), and corticobasal syndrome (asymmetric rigidity and dystonia).
In late-stage AD, which of the following is a common feature?
A) Anosognosia
B) Apraxia
C) Myoclonic jerks
D) All of the above
Answer: D) All of the above
Rationale: Late-stage AD is characterized by anosognosia (unawareness of deficits), apraxia (difficulty performing learned motor tasks), and myoclonic jerks (sudden involuntary muscle contractions).
What is the main purpose of amyloid PET imaging in Alzheimer’s disease (AD)?
A) To confirm the presence of neurofibrillary tangles
B) To measure the severity of cognitive decline
C) To detect neuritic and diffuse amyloid beta (Aβ) plaques
D) To rule out all other causes of dementia
Answer: C) To detect neuritic and diffuse amyloid beta (Aβ) plaques
Rationale: Amyloid PET imaging is used to confirm the presence of Aβ plaques, which are a hallmark of AD. However, a positive scan does not always confirm AD, as some cognitively unimpaired older adults and patients with other neurodegenerative diseases can also have Aβ deposition.
Which of the following neuroimaging findings is highly suggestive of AD?
A) Hippocampal atrophy and posterior cortical thinning on MRI
B) Increased dopamine transporter uptake on PET
C) Predominant frontal lobe atrophy on MRI
D) Bilateral caudate nucleus atrophy on CT
Answer: A) Hippocampal atrophy and posterior cortical thinning on MRI
Rationale: MRI findings of hippocampal and posterior cortical atrophy are characteristic of AD. Other imaging patterns are seen in different neurodegenerative diseases (e.g., dopamine transporter loss in dementia with Lewy bodies, frontal atrophy in frontotemporal dementia).
What are the most important risk factors for Alzheimer’s disease (AD)?
A) Exposure to aluminum and mercury
B) Increasing age and a positive family history
C) High educational attainment and urban living
D) Vegetarian diet and low cholesterol levels
Answer: B) Increasing age and a positive family history
Rationale: Age is the strongest risk factor for AD, with prevalence increasing significantly after 65 years. A positive family history, particularly related to the ApoE ε4 allele, also increases risk.
Which statement about the ApoE ε4 allele and AD risk is TRUE?
A) Carrying two ε4 alleles reduces AD risk.
B) The ApoE ε4 allele is linked to autosomal dominant inheritance.
C) Female ε4 carriers are more susceptible to AD than male ε4 carriers.
D) ApoE ε4 is only associated with late-onset AD.
Answer: C) Female ε4 carriers are more susceptible to AD than male ε4 carriers.
Rationale: Women who carry one ε4 allele are at a higher risk of developing AD than men with the same genetic variant, independent of longevity.
Which condition is associated with an increased risk of AD?
A) Low cholesterol levels
B) Mild-to-severe traumatic brain injury
C) High levels of educational attainment
D) High dietary intake of fruits and vegetables
Answer: B) Mild-to-severe traumatic brain injury
Rationale: A history of traumatic brain injury increases the risk of AD, possibly due to neuroinflammation and amyloid deposition.
Which of the following statements about vascular disease and AD is TRUE?
A) Stroke lowers the threshold for clinical expression of AD.
B) AD patients never experience vascular complications.
C) Amyloid angiopathy prevents hemorrhages in AD.
D) Vascular disease and AD are mutually exclusive conditions.
Answer: A) Stroke lowers the threshold for clinical expression of AD.
Rationale: Vascular disease, including stroke, increases the likelihood of AD symptoms becoming apparent. Additionally, amyloid angiopathy in AD patients can contribute to microhemorrhages and infarctions.
Which of the following medications is NO longer used for Alzheimer’s disease (AD) treatment due to hepatotoxicity?
A) Donepezil
B) Rivastigmine
C) Tacrine
D) Memantine
Answer: C) Tacrine
Rationale: Tacrine was one of the first cholinesterase inhibitors but is no longer used due to hepatotoxicity.
What is the primary mechanism of action of donepezil, rivastigmine, and galantamine?
A) NMDA receptor antagonism
B) Beta-amyloid plaque clearance
C) Cholinesterase inhibition
D) Tau protein stabilization
Answer: C) Cholinesterase inhibition
Rationale: These drugs inhibit cholinesterases, primarily acetylcholinesterase, increasing cerebral acetylcholine levels.
What is the target dose of memantine for treating moderate-to-severe AD?
A) 5 mg daily
B) 10 mg twice daily
C) 24 mg extended-release daily
D) 6 mg twice daily
Answer: B) 10 mg twice daily
Rationale: Memantine is typically dosed at 10 mg twice daily for moderate-to-severe AD.
Which of the following statements about memantine is TRUE?
A) It is FDA-approved for mild AD.
B) It blocks overexcited NMDA glutamate receptors.
C) It primarily acts by increasing cerebral acetylcholine levels.
D) It worsens agitation in moderate-to-severe AD.
Answer: B) It blocks overexcited NMDA glutamate receptors.
Rationale: Memantine works by blocking NMDA receptors to prevent excitotoxicity and slow cognitive decline.
What is the primary benefit of memantine in moderate-to-severe AD?
A) It reverses cognitive impairment.
B) It improves motor function.
C) It slows cognitive deterioration and decreases caregiver burden.
D) It prevents amyloid plaque accumulation.
Answer: C) It slows cognitive deterioration and decreases caregiver burden.
Rationale: Memantine modestly slows cognitive decline and reduces caregiver burden but does not reverse the disease.
Which of the following statements about AD treatment is TRUE?
A) Cholinesterase inhibitors are effective for mild cognitive impairment (MCI).
B) Memantine can be used alone or in combination with cholinesterase inhibitors in moderate-to-severe AD.
C) Cholinesterase inhibitors primarily treat agitation rather than cognitive symptoms.
D) Memantine causes significant hepatotoxicity.
Answer: B) Memantine can be used alone or in combination with cholinesterase inhibitors in moderate-to-severe AD.
Rationale: Memantine can be prescribed alone or in combination with cholinesterase inhibitors for moderate-to-severe AD, but it is not effective for mild AD.
Which class of drugs used for Alzheimer’s disease (AD) may also help treat delusions and hallucinations?
A) NMDA receptor antagonists
B) Cholinesterase inhibitors
C) Beta-amyloid plaque inhibitors
D) Dopamine agonists
Answer: B) Cholinesterase inhibitors
Rationale: Cholinesterase inhibitors, such as donepezil, rivastigmine, and galantamine, may help alleviate delusions and hallucinations in AD patients.
What is a potential benefit of memantine in the treatment of AD?
A) Enhancing memory function in early AD
B) Reducing agitation in moderate-to-severe AD
C) Treating mild cognitive impairment (MCI)
D) Preventing the formation of neurofibrillary tangles
Answer: B) Reducing agitation in moderate-to-severe AD
Rationale: Memantine helps reduce agitation and caregiver burden in moderate-to-severe AD but is not effective in early AD or MCI.
