Cognitive and Behavioral Neurology

Question 1

MCI

Answer 1

Cognitive impairment in 1+ domains beyond expected for age without impairment in ADLs or general cognition

Question 2

Dementia Screening Labs?

Answer 2

B12
CBC
BMP
LFTs
TFTs
Depression screen

Question 3

Inherited Alzheimer’s
Incidence, genes/gene products

Answer 3

• 5% of cases, all AD
  1. Presenilin-1 (chromosome 14) - 80% of aggressive familial cases
  2. Presenilin-2 (chromosome 1)
  3. Apolipoprotein E4(Chromosome 19) - triples risk
  4. Amyloid Precursor Protein (Chromosome 21)

Question 4

Circuit of Papez

Answer 4

entorhinal cortex -> hippocampus -> fornix -> mammillary bodies -> Anterior n. of thalamus ->Cingulate cortex -> entorhinal cortex

Question 5

FDG-PET areas of decreased metabolism in:
AD?
Huntington’s?
Frontotemporal Dementia?
Lewy Body Dementia?
Parkinson’s?

Answer 5

AD - parietotemporal areas
Huntington’s? - head of caudate
Frontotemporal Dementia -Frontal and anterior temporal
Lewy Body Dementia - occipital lobes
Parkinson’s - None

Question 6

Nucleus basalis of meynert

NTs? Pathology?

Answer 6

Acetylcholine, lost in alzheimer’s

Question 7

Nucleus Accumbuns

NTs? Function? Pathology?

Answer 7

• Dopaminergic

Question 8

Substantia Nigra Pars Reticulata, par Compacta

NTs? Function? Pathology?

Answer 8

SNr - GABAergic Neurons, inhibit GPi

SNc - Dopaminergic, influence Direct and Indirect Pathways

Question 9

locus coeruleus

NTs? Function? Pathology?

Answer 9

Noradrenergic neurons

Question 10

Median and Dorsal Raphe Nuclei

NTs? Function? Pathology?

Answer 10

Serotonergic neurons,

Question 11

silver-staining spherical aggregations of Tau

Answer 11

Pick Bodies

Question 12

cytoplasmic inclusions with anti-ubiquitin and anti-alpha synuclein

Answer 12

Lewy Bodies

Question 13

Glodose fibrillary tangles and tuted astrocytes seen in

Answer 13

Progressive supranuclear palsy

Question 14

Memantine

Use, Mech, SEs?

Answer 14

NMDA Receptor Antagonist
Alzheimer’s Treatment

Use:
- treat moderate-severe alzheimer’s disease

Mechanism:
- NMDA Receptor Antagonist, helps prevent excitotoxiicity (mediated by Ca2+) in cholenergic neurons

Side Effects:
- Dizziness, confusion
- Hallucinations

Question 15

Donepezil
Galantamine
Rivastigmine

Answer 15

AChE Inhibitor
Alzheimer’s Treatment

Use:
- treat alzheimer’s disease

Mechanism:
- replacing ACh lost due to decreased choline acetyl transferase activity by inhibiting AChE activity and therefore increasing ACh availability
- Galantamine is also a nicotinic modulatr

Side Effects:

• Dizziness
• Nausea
• Insomnia

Question 16

Anton Syndrome

Answer 16

Cortical blindness with denial of visual loss and confabulation resulting from bilateral medial occipital lobe lesions

Question 17

Charles Bonnet Syndrome

Answer 17

Release syndrome where there are hallucinations in the visually impaired

Question 18

Symptoms from lesions of prefrontal cortex:

Orbitofrontal Cortex (Ventral frontal lobes)

Dorsomedial Prefrontal Cortex

Dorsolateral Prefrontal Cortex

Answer 18

1. Personality changes, social disinhibition, inappropriate jocularity, echopraxia, utilization behavior (mimicking use of objects in the environment)
2. apathy, loss of initiative, amotivation, abulia (loss of movement and communication due to loss of supplementary motor are. Bilateral lesions akinetic mutism. Involvement of paracentral lobule -> urinary incontinence
3. Impaired judgment, unable to plan, anhedonia