Chapter 8 Pt 3

Question 1

abnormal screening tests for mild and major NCDs indicates what

Answer 1

further testing, preferably FORMAL NEUROPSYCHOLOGICAL TESTING

Question 2

what is done on the Mini-Mental Status Exam

Answer 2

1 Orientation (awareness)

• what is the date
• where are we
  2. registration
• name 3 objects and repeat them
  3. attention
• serial 7s or spell “world” backwards
  4. recall (recent memory)
• name the 3 objects above 5 minutes later
  5. language
• naming: name a pen and a clock
• repetition: say “no ifs, ands, or buts”
• verbal comprehension: read the statement written on a piece of paper, and do what it says “close your eyes”
• writing: write a sentence
• visuospatial skills: draw two intersecting pentagons

Question 3

what is the most common underlying etiology of major NCDs (dementia)

Answer 3

Alzheimer’s Disease

Question 4

what are the clinical manifestations of Alzheimer’s disease

Answer 4

GRADUAl PROGRESSIVE DECLINE in cognitive functions
primary domains affected are MEMORY, LEARNING, and LANGUAGE
personality changes, mood swings, and paranoia are very common
motor and sensory symptoms are absent until late int he course

on average, death within 10 years

Question 5

how is Alzheimer’s diagnosed

Answer 5

can’t be definitive until POSTMORTEM

diagnosis of POSSIBLE NCD due to Alzheimers is made based on presence of:

• insidious onset
• gradual progression-imapriment in one (mild NCD) or more (major NCD) cognitive domains

Question 6

approximately 1% of AD results from an autosomal DOMINANT single gene mutation in

Answer 6

amyloid precursor protein
presenilin 1
presenilin 2

E4 varient of Apolipoprotein gene is also risk factor for early onset

Question 7

what is found in the brain of Alzheimers patients and what other disease are they found in

Answer 7

SENILE PLAQUES (beta amyloid)
NEUROFIBRILLARY TANGLES (tau)

also seen in DOWN SYNDROME and even NORMAL AGING

Question 8

what is the only way to definitively diagnose Alzheimer’s

Answer 8

postmortem pathological examination of brain

Question 9

adults with down syndrome are at increased risk of what disease in midlife

Answer 9

Alzheimers

Question 10

what is the treatment of Alzheimer’s

Answer 10

no cure or truly effective treatment
CHOLINESTERASE INHIBITORS (donepezil, rivastigmine, and galantamine) may SLOW CLINICAL DETERIORATION by 6-12 months in up to 50% of patients w/ mild-moderate

NMDA ANTAGONSIT memantine may prove modest benefit in pt with moderate-severe

Question 11

antipsychotics are often used to treat agitation and aggression in AD, how should this be done

Answer 11

LOW DOSES due to INCREASED MORTALITY

MONITOR CLOSELY for side effects

Question 12

any treatment plan for AD must include

Answer 12

CAREGIVER SUPPORT

Question 13

antipsychotics have what black box warning regarding dementia

Answer 13

increased risk of death

Question 14

a lesion to the frontal lobe can manifest with a spectrum of symptoms including what

Answer 14

personality changes
disinhibition
inappropriate behavior
aggression
apathy
amotivation
parnoia

Question 15

what is the second most common single cause of major NCD after Alzheimer’s

Answer 15

Vascular Disease

accounts for approximately 20% of major NCDs

Question 16

evidence of vascular disease is found in what percentage of all major NCDs

Answer 16

50%

most commonly comorbid with AD pathology (NCD due to multiple pathologies

Question 17

cognitive decline due to vascular disease occurs as a result of at least one of which of the following mechanisms

Answer 17

large vessel strokes, usually cortical
small vessel strokes (lacunar infarcts) to subcortical structures
microvascular disease affecting the periventricular white matter

Question 18

what are risk factors for vascular dementia

Answer 18

hypetension
diabetes
smoking
obesity
hyperlipidemia
atrial fibrillation
old age

Question 19

what is clinical manifestation of vascular dementia

Answer 19

STEPWISE deterioration
may present with acute onset followed by partial improvement
may have insidious onset with gradual decline similar to AD

COMPLEX ATTENTION and EXECUTIVE FUNCTION are the cognitive domains typically affected by SMALL VESSEL disease

Question 20

how is vascular dementia confirmed

Answer 20

neuroimaging with findings that correlate with clinical picture

Question 21

what is treatment for vascular dementia

Answer 21

no cure or truly effective treatment
manage risk factors with a goal of preventing future strokes
symptomatic treatment similar to AD