Dementia Flashcards
65 yo M with 6 month hx of confusion, disorientation, visual hallucinations of children playing. Wife says he is normal between episodes. Exam: normal language, memory, mod dif with trails test, mild diff with serial substractions, mild symmetric rigidity and bradykinesia. Brain MRI unremarkable. CSF, routine labs and UDS normal. Dx?
Lewy body dementia.
When combined with functional neuroimaging, which of the following biomarkers is most likely to ID those geriatric its with mild cognitive impairment most at risk for developing Alz disease?
E-4 apolipoprotein E allele
80 yo with visual hallucinations and worsening gait, episodic confusion, fighting in sleep, bilateral rigidity, masked facies. Levodopa/carbidopa improved movement temporarily. Dx?
Dementia with Lewy bodies
80 yo pt with Alz is brought in for increasingly combative behavior. Daughter would like to keep him at home if possible. What interventions would be most helpful in this situation?
Assessing for caregiver burnout.
91 yo hospice pt with cachexia, end stage dementia, and renal impairment has stopped eating and drinking. What comfort measure would be most appropriate
Refrequent small sips of water
Which of the following is the most specific factor for distinguishing delirium from dementia of the Alz type
Fluctuating arousal
Neurocognitive fx most likely to show decline in people over 65 years of age?
Information in processing speed
Over the course of several months, a 46 yo pt with no past psych hx becomes emotionally labile/irritable. Pt undergoes personality changes, is observed to laugh inappropriately when neighbor kids taunt stray cat. Within 2 yrs is convinced all food has germs. Memory is preserved. Pt is no longer able to work/live independently. Neurpsych testing shows impaired language/attention
Frontotemporal dementia
Most accurate genetic testing for Alz?
The testing has limited predictive value for alz disease in sx free individuals
What sx is most commonly associated with aggressive behavior in Alz pts?
Concurrent psychosis
Hippocampal tissue, tau stained, pt with progressive dementia, what is the dx?
Alz disease
What is the initial diagnostic study for an elderly male endorsing memory difficulty, loss of energy, and difficulty concentrating?
Neuropsychological testing
MRI of the brain shows ventriculomegaly of 65 yo with progressive cognitive decline. Normal OP in LP. Likely to found on exam?
Gait apraxia
Subcortical dementia is suggested by which of the following in regards to a pt with early stage cognitive impairment
Preserved calculation skills
Which neurocognitive disorder has more severe EPS Session from antipsychotics
Lewy body disease
Excess activation of which R contributes to cell death in Alz dx
NMDA
Loss of nicotinic R sites and potentiation of remaining R sites are involved in the pathophysiology of what
Alz
Test that differentiates Alz from frontal temporal dementia
Single photo emission CT
Neurocognitive disorder with fluctuating rate of progression, visual spatial impairment and early unilateral resting tremor and increased muscle tone
Dementia with body Lewy
67 yo male with visual hallucinations, behavioral disturbances, confusion, staring episodes, kicking in sleep, memory loss, dishinbition, and smaller steps.
Lewy body dementia
Confabulation is
Unconscious filling in of memory gaps
What test is most helpful to distinguish dementia vs delirium
EEG
Suggests delirium rather than dementia
Clouding of consciousness
85 yo patient with hx of dementia admitted for agitation becomes more confused and angry. What lab should you get
UA
Picture of tau staining for pt with progressive dementia. Dx?
Alz
80 yo patient with forgetfulness f/b progressive language impairment. 2 yr later with difficulty using common tools/appliances. Dx
Alz
Which cancer treatment may be followed by a subcortical dementia due to a leukoencephalopathy with onset after 6 months post-treatment?
Whole brain radiation
A pt who has been receiving dialysis tx for years has become more disoriented, has memory loss. PE normal, nursing staff report that the pt has begun to have seizures. Labs normal. What accounts for this ppt?
Dialysis dementia
FTD with mutation in chromosome 17 is associated with abnormal intraneuronal deposition of which protein
TAU
A doctor meets with a pt and family to discuss tx of pmts mild Alz disease. There are no other neurological sx. The most appropriate course of action would be to
Begin cholinesterase inhibitor tx
74 y/o, R handed patient presents with significant memory loss, expressive aphasia, and left plantar extensor response. The most likely dx
Vascular dementia
Earliest evidence of cell loss in its with Alz typically occurs in which of the following areas of the brain
Entorhinal cortex
74 y/o F suspicious, poor ADLs, personality changes, most likely dx
Pick’s disease
Protein mutation associated with Alz disease in people younger than 60 yo
Amyloid precursor
80 y/o pt with no prior psych hx, more forgetful, having difficulty with ADLs. However, pt is able to conduct routine social activities so that casual acquaintances don’t notice. Dx?
Alz
Neurofibrillary tangles in Alz are composed of
Hyperphophorylated Tau proteins
80 yo Alz patient with increasingly combative behavior. Family wants to keep at home. Give what med?
Haldol
Dementia characterized by personality change, attention deficit, impulsivity, affect lability, indifference, perseveration, and loss of executive fx. Ass with dysfunction in what area of the brain?
Frontal lobe
Early stage HIV type 1 ass dementia as compared to early onset dementia has which of the following deficits?
Decreased processing speed
Which meds have best results for treating agitation in dementia
Antipsychotics
Amyloid precursor protein in what cognitive disorder?
Alz
MCC of dementia in its >65
Alz
Characteristic MRI scan finding in Alz
Reduce hippocampal volumes
Known risk factors for dementia
Age, fam hx, female, down’s
Pt with vascular dementia typically has neuropathological changes associated with
Basal ganglia
An 82 yo pt has falls, ophthalmoplegia, Parkinsonism, and progressive dementia. Autopsy shows
Tau positive neurofibrillary tangles
65 yo is brought to the ED with disorientation and mild agitation and experiencing vivid VH of children. Two similar episodes in the past, normal between episodes. mild symmetric rigidity and bradykinesia.
Dementia with Lewy bodies
A medicine most likely to slow the progression of vascular dementia
ASA
Best rationale for using cholinesterase I in pts with Alz
To reduce neuropsychiatric sx
The most important tool for evaluation of early and moderate dementia
MMSE
Dementia rather than depression in regards to memory has
Naming deficits (rather than impaired nonverbal intelligence)
Which of the following brain regions is affected earliest in the course of Alz
Hippocampus
Bilateral loss of neurons in the CA1 segment of the hippocampus is the MC histologic finding in its with
Alz
Patient with Alz dementia. Daughter is frutated and is considering leaving church group
Tell her to continue going to her church group
PET scan shows bitemporoparietal hypo perfusion in early stages of which dementia
Alz
What deficit includes significant word-finding difficulties when attempting to label pictured objects but can describe how to use objects?
Anomia
65 yo pt brought in by family for gradual onset and very slow progression of mental confusion with respect to orientation, anomia, slowness of comprehension, neglect of personal hygiene and grooming, apathy, and alterations of personality and behavior, impairment of gait and upright stance, and prominent grasp and suck reflexes. Dx? The clock drawing test administered and sensitive screen for
Frontotemporal dementia or Alz
65 yo high school grad has MMSE score of 23, this score would suggest
Dementia, mild cognitive impairment
Individuals over 40 with Downs frequently develop
Alz
HIV patient with memory loss, inattention, lack of motivation, and poor coordination. Normal LP. CT shows atrophy. MRI shows diffuse and confluent white matter changes in T2, w/o any mass effect or gadolinium enhancement. Dx?
HIV ass dementia
Binswanger disease has pseudo bulbar state, gait disorder, and..
Dementia
Clock drawing test is quickly administered and sensitive screen for which d/o
Alz
Brain of football player who died by suicide has finings typical of chronic traumatic encephalopathy, what is the most typical pathology for this behavior?
Tauopathy
54 y/o pt dies from rapidly progressing dementia ass with myoclonus, what is most likely finding at autopsy?
Microvacuolation of glia and neuronal dendrites
Psych eval of 82 yo F with memory loss (mostly working memory): she frequently calls for help with the bathroom but will urinate on herself. Pt frustrated with staff bc she feels the sudden need to void without much warning and wishes the staff would arrive sooner bc she is embarrassed about it. MSE significant for memory loss. What to do?
Schedule regular voiding, independent of pt requests, and sufficiently frequent to eliminate accidents
Which is important when working with family members who are caregivers to pts with dementia?
Work with family should enhance effectiveness of care to pt
What characterizes executive abilities in healthy individuals > 65?
Show no significant change
Fluent speech with preserved comprehension, inability to repeat statements is consistent with what type of aphasia?
Conduction
In normal aging, last cognitive abilities to decline
Work knowledge
Medicare pays for hospice care when a physician declares that a patient has a maximum life expectancy of
6 months
Two days after bowel surgery, 53 yo is delirious. Correctly draws a square when asked, but then continues to draw squares when asked to draw other shapes. MSE would reveal
Perseveration
Cancer patient on chemo is disoriented and agitated. Afebrile. Poor attention, cognitive impairment. Held for observation. EEG= diffuse slowing
Haldol
78 yo pt with Alz living with spouse and daughter, starting to accuse the spouse of infidelity. He is on donepezil. Next?
Arrange for regular evaluations of the pt and reassure the fam
Family of a 75 yo pt is concerned about his safety b/c he has been forgetting to turn off the stove. What is most likely to be the earliest impairment to occur in the pt?
Inability to recall 3 words after a 3 min delay
85 yo nursing home pt with hx of dementia being more confused and screaming fire whenever the light next to bed is turned on. next step?
Urinalysis
Epigenetic drift has been postulated to contribute to what disorder?
Late onset alz disease
Which cognitive enhancer circulates unbound to serum proteins and has limited drug interactions?
Rivastigmine
