Dementia

Question 1

Pseudodementia time course

Answer 1

Cognitive deficits typically manifest after mood symptoms. Sudden onset.

Question 2

Pseudodementia is strongly associated with:

Answer 2

major depressive disorder

Question 3

Pseudodementia is strongly associated with:

Answer 3

major depressive disorder

Question 4

Distinctive clinical features of pseudodementia

Answer 4

• Patients able to recall onset of Sx
• Mostly depressed mood
• Patient gives short answers
• Cognition usually improves after effective antidepressant therapy

Question 5

Pathological findings in pseudodementia

Answer 5

Structural or metabolic abnormalities that are associated with depression e.g. lesions of the limbic system.

Question 6

Alzheimer’s disease time course

Answer 6

Slowly progressive over 8-10 years

Question 7

Distinctive clinical features of Alzheimer’s disease

Answer 7

• Episodic impairment of memory.
• Characteristic order of language impairment (naming → comprehension → fluency)

Question 8

Diagnosis of Alzheimer’s disease is made:

Answer 8

clinically

Question 9

MRI findings in Alzheimer’s disease

Answer 9

Diffuse cortical atrophy and hippocampal atrophy.

Question 10

CSF findings in Alzheimer’s disease

Answer 10

Decreased beta amyloid, increased phosphorylated tau

Question 11

Pathological findings in Alzheimer’s disease

Answer 11

Neuritic plaques (amyloid beta peptides, mainly accumulating extracellularly)

Neurofibrillary tangles (abnormally phosphorylated tau protein, which accumulates intracellularly).

Question 12

Vascular dementia time course

Answer 12

May present with abrupt cognitive decline and stepwise deterioration.

Question 13

Distinctive clinical features of vascular dementia

Answer 13

Asymmetric or focal deficits (e.g. hemiparesis)

Question 14

CT/MRI findings in vascular dementia

Answer 14

Multiple cortical and lacunar infarcts, white matter lesions

Question 15

Lewy body dementia time course

Answer 15

Steady decline, usually over 8-10 years but more rapid progression is possible

Question 16

Distinctive clinical features of lewy body dementia

Answer 16

Visual hallucinations and Parkinsonian motor disorders, attention impairment.

Question 17

MRI features of lewy body dementia

Answer 17

Diffuse mild cortical atrophy, atrophy of substantia innominata and mesopontine grey matter

Question 18

SPECT findings in lewy body dementia

Answer 18

Decreased occipital perfusion/metabolism.

Question 19

Pathological features of lewy body dementia

Answer 19

Lewy bodies (intracellular aggregations of mainly a-Synuclein)

Question 20

Risk factors for Alzheimer disease

Answer 20

Age > 60, cerebrovascular disease, Down’s syndrome, smoking, family history

Question 21

Early-onset familial Alzheimer’s disease is inherited:

Answer 21

in an autosomal dominant pattern.

Question 22

MOA of anticholinesterases

Answer 22

Decrease breakdown of Ach reducing the apparent deficiency of cholinergic neurotransmitter activity in AD.

Question 23

Anticholinesterase precautions and contraindications

Answer 23

GI/ureteric obstruction, active PUD, pregnancy

Question 24

Adverse effects of anticholinesterases

Answer 24

Vivid dreams, depression, increased sweating

Question 25

What are the three drugs used for AD in the anticholinesterase class?

Answer 25

Donepezil
Galantamine
Rivastigmine