Dementia

Question 1

Behaviours that antipsychotics don’t help with

Answer 1

Wandering
Social withdrawal
Vocalizing
Pacing
Touching
Incontinence

(From online module)

Question 2

Discontinuation of chol. Inhibitor should be considered when:

Answer 2

-clinically meaningful worsening of dementia
-no clinically meaningful benefit observed at any time of treatment
-severe end stage dementia
-development of intolerable side effects
-poor medication adherence
-patient preference
-swallowing difficulties

Question 3

Factors predicting progression from MCI

Answer 3

-Increased clinical severity
-APO E4 carrier status
-Atrophy on MRI, 2-3x rate if hipp. Small or very large
-Fdg scan showing temp or parietal hypometabolsim
-Low AB42 and elevated tau in CSF

Question 4

4 types of AD

Answer 4

-posterior cortical atrophy
-frontal ad
-logopenic variant PPA
-rapid progressive AD

Question 5

Differences in LBD vs PDD

Answer 5

Temporal course
Greater attention deficits, postural instability and gait difficulties in LBD
Symmetrical Parkinsonian symptoms in LBD
More severe reaction to antipsychotics in LBD

Question 6

When do you stop dementia meds, after a trial of 12 months

Answer 6

-worsening of dementia over 6 months
-no benefit at any time of treatment
-severe or end stage dementia
-develop bad side effects
-poor medication adherence

Question 7

Limitations of MMSE

Answer 7

-rough memory assessment
-floor and ceiling effects
-language/culture issue
-no executive functioning or visual memory
-blindness/deafness issue
-copyright
-limited sensitivity to frontal and subcortical changes

Question 8

MMSE vs mica

Answer 8

Mica is more sensitive, but specificity drops off if use 26 as cut off

Question 9

Memory storage deficit

Answer 9

Those with hippocampus l damage (ad, korsakiff,herpes)

Don’t benefit from cueing-CORTICAL

VS SUBCORTICAL
(pD, TBI, HIV) improve with cues showing a retrieval deficit

Question 10

Management of MCI

Answer 10

-yearly follow up on Adls and cognition
-treat depression
-screen and treat vascular risk factors
-promote active lifestyle
-

Question 11

Treatment for apathy in AD

Answer 11

-chI
-stimulants
-non pharm: multi sensory stimulation, live music, art therapy, cognitive stimulation, physical exercise

Antidepressants do not significantly improve apathy

Question 12

Delirium vs LBD

Answer 12

-attentional process preserved in dementia
-acute vs insidious
-visual hall are prolonged complex and not necessarily distressing in LBD, less diurnal variation
-Parkinsonism absent vs could be present
-infrequent neuroleptic sensitivity vs frequent
-insight might be present while lucid vs often lacking

Question 13

3 neurological conditions from AUD

Answer 13

-alcohol related dementia : ataxia, peripheral sensory polyneuropathy, with improved cognition and Neuro imaging with abstinence
-wernickes (due to thiamine def) opthalmoplegia, ataxia, confusion
-korsakoffs (due to thiamine def) anterograde and retrograde amnesia, confabulation, no insight

Question 14

RF preventable that could contribute to decline in AD

Answer 14

-smoking
-physical inactivity
-HTN
-depression
-diabetes
-obesity
-lower educational attainment

Question 15

5 reasons to order CT head or MRI

Answer 15

-age <60
-rapid decline (over 1-2 months)
-recent head trauma
-unexplained CNs symptom (headache, seizures)
-past history of cancer
-hx of urinary incontinence and gait disorder
-localizing sign

Question 16

Why use the MMSE over moca

Answer 16

Advanced dementia
Lower education
ESL
Delirium

Question 17

Approach to intolerance of AchI

Answer 17

-tx side effects or decrease dose
-inform that deteriorating is possible
-stop first, wait until SE gone
Switch to new and tirade normally (<50% tolerate)

Question 18

Approach to non response to AchI

Answer 18

-ensure compliance
-make sure on max dose for at least 3 months
-(>50% show improvement with switch)
-initiate new at rec dose, increase twice as fast to avoid deterioration