Cognitive Disorders

Question 1

Dementia with stepwise increase in severity and focal neurologic signs. Name the type of dementia and the best confirmatory test.

Answer 1

Multi-infarct dementia; CT/MRI

Question 2

Dementia + cogwheel rigidity + resting tremor. Name likely type of dementia and best confirmatory test

Answer 2

Lewy body dementia or Parkinson’s disease; diagnose clinically

Question 3

Dementia + gait apraxia + urinary incontinence + dilated cerebral ventricles. Type of dementia and confirmatory test

Answer 3

NPH; CT/MRI

Question 4

Dementia + diminished position/vibration sense + megaloblasts on CBC. Likely type of dementia and confirmatory test

Answer 4

Vitamin B12 deficiency; Serum B12

Question 5

Dementia + tremor + abnormal LFTs + Kayser-Fleischer rings

Answer 5

Wilson disease; ceruloplasmin

Question 6

Dementia + diminished position/vibration sense + Argyll-Robertson pupils

Answer 6

Neurosyphilis (CSF FTA-ABS or CSF VDRL)

Question 7

Does dementia cause altered consciousness?

Answer 7

No

Question 8

Most common and second most common types of dementia

Answer 8

Alzheimer’s; Vascular

Question 9

Alzheimer’s DSM criteria

Answer 9

Development of multiple cognitive defects manifested by both 1.) memory impairment and 2.) at least one of the following: aphasia, apraxia, agnosia, or disturbance in executive function. Finally, deficits must cause problem in functioning and not occur exclusively during delirium.

Question 10

In what percent of demented patients do delusions/hallucinations occur?

Answer 10

30-40%

Question 11

In what percent of demented patients do affective symptoms occur?

Answer 11

40-50%

Question 12

Two causes of reversible dementia?

Answer 12

Hypothyroidism (also associated with depresssed mood, lethargy) and normal pressure hydrocephalus (associated with gait apraxia and urinary incontinence)

Question 13

Should benzodiazepines be used for emotional disturbances in delirium?

Answer 13

No, they can make delirium worse.

Question 14

Which drug should be used for delirium in the elderly?

Answer 14

Haloperidol (Haldol)

Question 15

Which atypical antipsychotic is least likely to exacerbate Lewy Body Dementia?

Answer 15

Quetiapine (Seroquel)

Question 16

Are there EEG changes with Alzheimer’s?

Answer 16

No, that’s a feature of delirium.

Question 17

What are two other types of patients in which neurofibrillary tangles and plaques can be seen?

Answer 17

Normal aging patients; Down Syndrome patients (Down syndrome - increased AD risk)

Question 18

Gross brain autospy findings in Alzheimer’s?

Answer 18

Flattened sulci; enlarged ventricles

Question 19

Two broad types of drugs for AD?

Answer 19

AChE inhibitors; NMDA antagonists

Question 20

Symptoms of what three disorders can stroke to frontal lbe mimic?

Answer 20

Schizophrenia; BPAD I; Depression

Question 21

5 RFs for vascular dementia?

Answer 21

Stroke; DM; HTN; APOe4; male sex (2x more likely)

Question 22

How does deterioration in vascular dementia manifest itself?

Answer 22

In a step-wise fashion

Question 23

Two Lewy things in brain in LBD?

Answer 23

Lewy bodies and lewy neurites

Question 24

Cognition waxes and wanes in LBD. How do you differentiate this from delirium?

Answer 24

Consciousness waxes and wanes in delirium, cognition waxes and wanes in LBD

Question 25

Are hallucinations and delsuions common in LBD?

Answer 25

Yes - visual hallucinations and paranoid delusions

Question 26

What is the relationship of the time course of LBD and Parkinson dementia?

Answer 26

If sx start within 1 year of parkinsonism sx, it's lexy body dementia; if they begin more than 1 year after; it's Parkinson disease dementia

Question 27

What drug can we give for REM sleep behaviour disorder, which often happens with LBD and Parkinson's?

Answer 27

Clonazepam (Klonopin)

Question 27

What drug can we give for REM sleep behaviour disorder, which often happens with LBD and Parkinson's?

Answer 27

Clonazepam (Klonopin)

Question 28

Between what ages does FTD usually present

Answer 28

45-65

Question 28

Between what ages does FTD usually present

Answer 28

45-65

Question 29

Which sort of dementia presents with disinhibition in verbal, physical, and sexual behaviour?

Answer 29

FTD

Question 30

Which deterioration from illness to death is more rapid, Alzheimer's or FTD?

Answer 30

FTD

Question 31

Why would you give antidepressants or anticholinergics in FTD?

Answer 31

They improve behavioural symtpoms, even if they do not improve cognition.

Question 32

What is the most common form of dementia caused by infectious disease?

Answer 32

HIV-associated dementia

Question 33

Is HIV-associated dementia caused by other infections or HIV itself?

Answer 33

Both

Question 34

3 RFs for HIV-associated dementia?

Answer 34

Duration of illness, low CD4, high viral load

Question 35

What good is HAART in HIV-assoc dementia?

Answer 35

It improves cognition and extends life

Question 36

When does dementia in Huntington Disease present, relative to chorea?

Answer 36

1 year before or 1 year after the chorea

Question 37

What percent of patients with Parkinson's disease develop dementia?

Answer 37

30-40%

Question 38

Dementia symptoms in Alzheimer's resemble what other type of dementia?

Answer 38

Alzheimer's (not Lewy Body, interestingly)

Question 39

List some features of parksonism proper

Answer 39

Bradykinesia, cogwheel rigidity, resting tremor, masklike facial expression, shuffling gait, dysarthria

Question 40

What effect do antipsychotic medications have on Parkinson's dementia?

Answer 40

Exacerbate it

Question 41

What sort of muscle problems accompany Creutzfelt-Jacob disease in 90% of patients?

Answer 41

Myoclonus (sudden spasms of muscles)

Question 42

Describe the time course of CJD dementia progression?

Answer 42

Rapid progression - to stupor/coma/death in months/years

Question 43

Tell me the cause of dementia: Enlarged ventricles, increased CSF pressure, dementia reverses upon surgical internvetion

Answer 43

Normal Pressure Hydrocephalus (shunt = shunt from cerebral ventricles into abdomen)

Question 44

Name the clinical triad of normal pressure hydrocephalus

Answer 44

Gait apraxia; urinary incontinence; dementia of mild/insidious onset

Question 45

Which of the NPH clinical triad is least likely to improve

Answer 45

Dementia

Question 46

Name the potential delirium cause: delirium + hemiparesis or other focal neuro signs

Answer 46

CVA or mass lesion; do a brain CT/MRI

Question 47

Name the potential delirium cause: delirium + high BP + papilledema

Answer 47

Hypertensive encephalopahty; do a brain CT/MRI

Question 48

Name the potential delirium cause: delirium + tachycardia + dilated pupils

Answer 48

Drug intoxication; do a UDS

Question 49

Name the potential delirium cause: delirium + fever + nuchal rigidity + photophobia

Answer 49

Meningitis; do a lumbar puncture

Question 50

Name the potential delirium cause: delirium + tachycardia + tremor + thyromegaly

Answer 50

Thyrotoxicosis; T4 and TSH screen