Clinical Approach to Dementia (Hon)

Question 1

What is the definition of dementia?

Answer 1

A decline in memory and at least one other cognitive function/decline in an executive function

Question 2

What are some infectious causes of dementia?

Answer 2

1) Fungal meningitis
2) Syphilis
3) AIDS
4) CJD
5) Post-herpes simplex encephalitis

Question 3

What are some toxic/metabolic causes of dementia?

Answer 3

1) Vitamin B12 deficiency
2) Thyroid deficiency
3) Heavy metals

Question 4

What is the criteria for clinical diagnosis of Alzheimer’s disease?

Answer 4

1) Deficits in 2 or more areas of cognition
2) Progressive worsening of memory and other cognitive function
3) No disturbance of consciousness
4) Onset most often after 65

Question 5

What is found on CT or MRI of the brain with Alzheimer’s?

Answer 5

Progressive atrophy

Question 6

What is the main goal of the treatment of Alzheimer’s?

Answer 6

To slow the progression of the disease

Question 7

What class of drugs are used in the treatment of Alzheimer’s? Name the Drugs

Answer 7

1) Acetylcholinesterase inhibitors; Galantamine, Rivastigmine, Donzepil
2) NMDA receptor antagonist; Memantidine

Question 8

What is a probably precursor to Alzheimer’s disease?

Answer 8

Mild Cognitive Impairment

Question 9

What is Mild Cognitive Impairment?

Answer 9

Memory complaint abnormal for age

Question 10

What should be given to a patient with mild cognitive impairment in order to slow progression to Alzheimer’s?

Answer 10

AChE inhibitor

Question 11

What is the criteria for probable vascular dementia?

Answer 11

1) Presence of focal sign (hemiparesis, lower facial weakness, Babinski sign, etc.)
2) Evidence of relevant cerebrovascular disease on brain imaging (infarcts, multiple basal ganglia and white matter lesions)

Question 12

A diagnosis of vascular dementia can be when there is a relation between cognitive problems and vascular events manifested or inferred by the presence of one or more of the following:

Answer 12

1) Onset of dementia within 3 months after a recognized stroke
2) Deterioration in cognitive functions (either abrupt or progressive)

Question 13

What are some vascular causes of dementia?

Answer 13

1) Multiple infarction
2) Stroke
3) Binswanger’s disease
4) Vasculitis
5) Subarachnoid hemorrhage

Question 14

What symptoms seen with Diffuse Lewy Body disease?

Answer 14

1) Dementia
2) Parkinsonian symptoms (bradykinesia and rigidity)
3) Prominent psychotic symptoms (generally visual hallucinations)

Question 15

Lewy Body Disease patients can experience severe, potentially life-threatening adverse reactions if treated with?

Answer 15

Antipsychotic agents

Question 16

Up to 81% of Lewy Body Disease patients have unexplained periods of?

Answer 16

Increased confusion that last days to weeks and closely mimic delirium

Question 17

What often presents early in Lewy Body Disease patients?

Answer 17

Bradykinesia, rigidity and falls

Question 18

How do Lewy Body Disease patients respond to levodopa?

Answer 18

Poor

Question 19

Parkinson’s disease

1) Where are the Lewy bodies
2) When do psychotic symptoms commonly present?
3) Are resting Tremors present?
4) Is Autonomic dysfunction present?
5) Are Hallucinations present?
6) When do executive dementia occur?

Answer 19

1) Midbrain
2) Later in disease course
3) Yes
4) Sometimes
5) Only in response to anti-parkinsonian drugs
6) Later in disease course

Question 20

Lewy Body Disease

1) Where are the Lewy bodies
2) When do psychotic symptoms commonly present?
3) Are resting Tremors present?
4) Is Autonomic dysfunction present?
5) Are Hallucinations present?
6) When does Cortical dementia occur?

Answer 20

1) Cortical and Diffuse
2) Earlier
3) No
4) Prominently
5) Yes, in absence of anti-parkinsonian drugs
6) Earlier

Question 21

What is the most common psychotic symptom of Lew Body Disease?

Answer 21

Visual hallucinations generally of animals and children

Question 22

Frontotemporal degeneration includes several forms of dementia characterized by?

Answer 22

1) Loss of social skills
2) Personality changes
3) Impairment of intellect, memory, and language

Question 23

Frontotemporal degeneration usually affects individuals between what ages?

Answer 23

40 and 60

Question 24

What is the triad of symptoms seen with normal pressure hydrocephalus?

Answer 24

Wet, Wacky, Wobbly:

1) Dementia
2) Gait disturbance
3) Urinary incontinences

Question 25

Normal Pressure Hydrocephalus is potentially reversible with?

What symptom is most likely to be reversed?

Answer 25

1) Ventriculoperitoneal shunting

2) Gait disturbance

Question 26

The definite diagnosis of degenerative causes of dementia can only be made by?

Answer 26

Autopsy