Dementia Flashcards
Short-term memory impairment in Alzheimer’s disease is reversed by reversible
inhibition:
a. acetylcholinesterase enzyme
a. acetylcholinesterase enzyme
In Alzheimer’s disease, we find an increase in everything but:
a. Acetylcholine
b. Aβ-42
c. Brain ventricles
d. Tau proteins in cerebrospinal fluid
e. Cognitive decline
a. Acetylcholine
Dementia with frontal lobe symptoms and special histology is:
a. Pick’s dementia
a. Pick’s dementia
Medial temporal lobe atrophy is assessed using the MTA index. Valid for:
a. Over 75 years, MTA 2 is still suitable
a. Over 75 years, MTA 2 is still suitable
Which neurotransmitter receptors are affected in Alzheimer’s disease?
a. Acetylcholine
a. Acetylcholine
Which diseases of the nervous system are among the 3 most common causes of
death according to the World Health Organisation?
a. Alzheimer’s disease
b. Cerebrovascular diseases
a. Alzheimer’s disease
b. Cerebrovascular diseases
Risk factor for familial Alzheimer’s disease in later life
lifetime is:
a. Inheritance of the E4 allele of apolipoprotein E
a. Inheritance of the E4 allele of apolipoprotein E
What is characteristic of normal ageing?
a. Slowly, the total volume of the brain decreases
a. Slowly, the total volume of the brain decreases
For aggregated amyloid beta protein:
a. Accumulation is linked to the inflammatory response of surrounding glial
cells
a. Accumulation is linked to the inflammatory response of surrounding glial
cells
What is the most characteristic disorder in Alzheimer-type dementia?
a. Episodic memory disorders
a. Episodic memory disorders
Suspected Creutzfeld Jacobs disease. Which tests do you order?
a. EEG, MRI, liquor diagnostics for protein 14-3-3
b. serum tests, liquor diagnostics for protein 14-3-3, MRI
c. serum tests, liquor diagnostics for protein 14-3-3, EEG
d. brain biopsy, EEG, MRI
a. EEG, MRI, liquor diagnostics for protein 14-3-3
Pseudodementia occurs when:
a. psychogenic disorders
b. depression
b. depression
Which secretases are responsible for the formation of the insoluble amyloid A-beta?
a. Alpha secretases
b. beta-secretases
c. gamma secretase
b. beta-secretases
c. gamma secretase
Which disease increases the incidence of AB?
a. Type 2 diabetes.
a. Type 2 diabetes.
Which protein is responsible for the accelerated formation of the bows?
a. Tau kinase.
a. Tau kinase.
Beta and gamma secretase action results in:
a. Amyloid breakdown of APP.
a. Amyloid breakdown of APP.
Alzheimer’s disease can be caused by mutations in the gene for:
a. presenilin
b. tau
c. alpha-synuclein
d. prion protein
b.tau
A 73-year-old accountant with mild parkinsonism was admitted for disorientation and
vivid visual hallucinations. He received risperidone and became very sleepy,
unresponsive. We were unable to wake him for the whole day. He has:
a. Alzheimer’s disease
b. frontotemporal dementia
c. vascular dementia
d. Lewy body dementia
The most likely reason for his unresponsiveness is:
e. hypersensitivity to neuroleptics
f. excellent responsiveness to risperidone
g. non-convulsive status epilepticus
h. progressive supranuclear palsy
d. Lewy body dementia
e. hypersensitivity to neuroleptics
The pathogenetic feature we are exploiting in the treatment of Alzheimer’s dementia is:
a. aggregation of cytotoxic beta amyloid
b. inhibition of synaptic conduction by insoluble amyloid plaques
c. lower acetylcholine levels due to the breakdown of
cholinergic fibres in the Meynert nucleus
d. none of the above
c. lower acetylcholine levels due to the breakdown of
cholinergic fibres in the Meynert nucleus
It is normal with age-related changes:
a. increased atrophy of the white matter
b. increased atrophy of the grey matter
c. the little brain
a. increased atrophy of the white matter
What is not a neurodegenerative disease:
a. Alzheimer’s disease
b. Parkinson’s disease,
c. Wilson’s disease
d. ALS
e. Creutzfeldt-Jakob disease
c. Wilson’s disease
Liquor in Alzheimer’s disease:
a. normal tau
b. increased tau
c. oligoclonal bands
d. Elevated cells
e. elevated proteins
b. increased tau
Oligoclonal bands in MS
What is not typical of Alzheimer’s disease:
a. Lewy bodies
b. neurofibrillary bows
c. senile plaques
d. granulovacuolar degeneration
e. Chirped bodies
a. Lewy bodies
Lewy bodies are from accumulating alfa sinuclein
Early symptoms of Alzheimer’s include:
a. amnesia.
a. amnesia.
Depression is a common symptom in people with dementia. Which of the
antidepressants does not
will be used in a patient with dementia?
a. selegiline
b. amitriptyline
c. Two more SSRI
antidepressants
Why?
d. because anticholinergic effects affect cognitive abilities
e. because they cause drowsiness
f. because they cause walking disorders
g. because hypersensitivity reactions to this drug are common in patients with
dementia
b. amitriptyline
d. because anticholinergic effects affect cognitive abilities
Which aphasia occurs early in the Alzheimer’s process:
a. nominal
b. motor
c. Sensory
d. dysarthria
a. nominal
EEG in patients with frontotemporal dementia shows:
a. generalised slow activity
b. normal activity
c. generalised outbreaks of sharp waves
d. paroxysmal lateralising epileptiform seizures
b. normal activity
Generalised slow activity in encephalitis
The diagnosis of Creutzfeldt Jakob disease is made by:
a. the presence of 14-3-3 protein in the liquor
b. hyperintense signal in the basal ganglia on head MRI
c. spongiform changes in the cerebral cortex
d. immunohistochemical staining of the cerebellum for PrP protein
a. the presence of 14-3-3 protein in the liquor
Where is acetylcholine produced?
a. Meynert’s basal nucleus
b. Substance nigra
c. locus cereleus
a. Meynert’s basal nucleus
Age-related atrophy occurs first:
a. white matter
b. grey matter
a. white matter
Which dementia is subcortical:
a. frontotemporal
b. Lewy body dementia
c. Alzheimer’s disease
d. vascular dementia
e. none of the following
b. Lewy body dementia
d. vascular dementia
Which sign is found in Alzheimer’s disease?
a. apraxia
b. ataxia
c. ophthalmoplegia
d. normal reflexes
e. agnosia
a. apraxia
e. agnosia
For Pick’s dementia:
a. atrophy on head MRI
b. reduced venous blood acetylcholine concentration
c. brick-coloured liquor due to amyloid
d. Senile lesions and neurofibrillary tangles on FDG-PET imaging
e. all of the above
a. atrophy on head MRI
Which is not cortical dementia?
a. Huntington’s.
a. Huntington’s.
A description of a 37 year old woman, double images, ataxia, then confusion and
amnesia?
a. Wernicke-Korsakoff syndrome
a. Wernicke-Korsakoff syndrome
What’s in the hay bales?
a. amyloid β
b. heavy metals
c. neurofibromatosis
d. HIV
e. tuberous sclerosis
a. amyloid β
The improvement in cognitive function with anticholinesterase therapy will be most
evident in:
a. Alzheimer’s
b. frontotemporal
c. multi-infarct
d. Lewy body dementia
d. Lewy body dementia
Secondary haemorrhages in the trunk due to tonsillar herniation are not seen in:
a. Alzheimer’s dementia
a. Alzheimer’s dementia
Vascular dementia is not characteristic:
a. sudden start
b. progress in spurts
c. amnesia
d. psychomotor slowdown
c. amnesia
A 52-year-old woman, who has been in good health until now, comes to the
neurology clinic for a check-up. At the check-up, she says that she feels that recently
(a month or two) she has no motivation to do the things she used to like to do, she
feels that she has to be told the same things repeatedly. She denies having
headaches. The condition is slowly deteriorating. She cannot pass the Luria test at
the neurological examination, has problems with the verbal fluency tests, otherwise
the examination is normal. Which of the following statements is correct:
a. most likely to be a stroke in the left temporal lobe
b. the most likely diagnosis is multiple sclerosis
c. immediate treatment with a psychiatrist is reasonable
d. suspecting a left frontal expansion, we will perform a head
imaging scan
e. most likely early-onset dementia
d. suspecting a left frontal expansion, we will perform a head
imaging scan
A lady with PB, after 3 months of L-dopa treatment, her son is not noticing any
changes, he is becoming demented, hallucinating at night. What he has:
a. dementia with Lewy bodies
b. idiopathic PB
a. dementia with Lewy bodies
MRI of the atrophied brain, which dementia is
a. Alzheimer’s disease
b. frontotemporal dementia
c. Creutzfeldt-Jakob disease
a. Alzheimer’s disease
This image shows a Florida plaque. Where does it occur?
a. sporadic CJD
b. variant CJB
c. Alzheimer’s disease
d. Pickova
b. variant CJB
Evidence-based medicine offers Alzheimer’s dementia patients the following
options to slow the progression of their disease in the long term:
a. surgery, deep brain stimulation
b. pharmacological treatment with Ach esterase inhibitors
and NMDA receptor antagonists
c. increased physical activity, healthy diet, increased mental activity
d. Food additives: ginkgo biloba extract, antioxidants, coenzyme Q
e. there is currently no reliable and evidence-based option for slowing
the progression of Alzheimer’s dementia in the long term
b. pharmacological treatment with Ach esterase inhibitors
and NMDA receptor antagonists
Where do the pathological changes in Alzheimer’s disease first appear?
a. In the hippocampus.
a. In the hippocampus.
Which of the following dementias is progressive and so far incurable?
a. Alzheimer’s disease
a. Alzheimer’s disease
You test speech and language. What do you find most often in Alzheimer’s disease?
a. transcortical global aphasia
b. transcortical sensory aphasia
c. Mutism
d. no abnormalities
e. Conductive aphasia
b. transcortical sensory aphasia
How do Alzheimer’s drugs work?
a. acetylcholinesterase inhibitors, which is an extracellular enzyme
b. acetylcholinesterase inhibitors, which is an intracellular enzyme
c. to a conveyor for AcH.
a. acetylcholinesterase inhibitors, which is an extracellular enzyme
Patient with rapid cognitive decline, dies within half a year, spontaneous brain
changes:
a. CJB.
a. CJB.
A misfolded protein in Alzheimer’s dementia?t
a. tau
b. beta amyloid
b. beta amyloid
Which part is damaged in Alzheimer’s
disease?
a. Meynart’s core.
a. Meynart’s core.
Subcortical dementia is:
a. Alzheimer’s disease
b. Dementia with Lewy bodies
c. Pick’s dementia
d. dementia in Huntington’s
disease
d. dementia in Huntington’s
disease
How do we diagnose AB?
a. Clinically, it can be suspected,
but the final diagnosis is
pathological.
a. Clinically, it can be suspected,
but the final diagnosis is
pathological.
Frontotemporal dementia, isn’t it:
a. on the T2 sequence, the
larger signal is
frontotemporal
b. the insula and a few other things don’t atrophy
c. the frontal and anterior temporal
lobes are atrophied
d. the anterior horn of the lateral
ventricle is more dilated
b. the insula and a few other things don’t atrophy
AB, which are the most amyloidogenic:
a. APβ-42
b. with a shorter chain
c. ADDL
a. APβ-42
ApoE, why it is a risk factor:
a. because amyloid is not transported into microglia
a. because amyloid is not transported into microglia
Excessively phosphorylated tau, consequences:
a. transport and cytoskeletal disorders
a. transport and cytoskeletal disorders
MRI of one very atrophic brain with almost absent hippocampus:
a. Alzheimer’s disease.
a. Alzheimer’s disease.
Alpha-secretase:
a. cleaves the APP in the middle of the APβ-containing section so that no
APβ can form
a. cleaves the APP in the middle of the APβ-containing section so that no
APβ can form
They are mainly toxic:
a. short amyloid chains
b. soluble diffusible non-fibrillar oligomers of APβ-42 called ADDLs
b. soluble diffusible non-fibrillar oligomers of APβ-42 called ADDLs
HIV dementia is not specific to HIV:
a. the most common neurological syndrome in AIDS
b. cortical dementia
c. subcortical dementia
d. apathy
b. cortical dementia
What is not characteristic of dementia?
a. apraxia
b. agnosia
c. somnolence
c. somnolence
What does it take to diagnose dementia?
a. impairment of multiple cognitive functions
b. progression over time
c. exclusion of pseudodedemnity
d. all of the above
d. all of the above
What do we call it if the atrophy in frontotemporal process is mainly in the left
temporal lobe?
a. Pickova
b. frontotemporal dementia
c. progressive motor aphasia
d. semantic dementia
d. semantic dementia
What investigations are not done to look for reversible causes of dementia?
a. CT scan and tau test - for evidence of AB, which is an irreversible cause
b. thyroid hormones, calcium, folate, B12 - to rule out metabolic causes
c. MRI - to exclude tumours, normotensive hydrocephalus …
d. psychometrics - to rule out pseudodementia seen in psychiatric patients
e. X-ray of the lungs - to exclude pulmonary involvement, e.g. tuberculosis
or SCLC, which can cause paraneoplastic limbic encephalitis
a. CT scan and tau test - for evidence of AB, which is an irreversible cause
Which dementia has a step-wise course (gradual cognitive decline):
a. Alzheimer’s
b. frontotemporal
c. Vascular
d. Creutzfeldt-Jakob
c. Vascular
Alzheimer’s disease:
a. CT scan shows hydrocephalus ex vacuo
a. CT scan shows hydrocephalus ex vacuo
What is the proportion of reversible dementias?
a. 10-15%.
a. 10-15%.
When early diagnosis is most urgent:
a. Alzheimer’s disease
b. Creutzfeldt-Jakob disease
c. Wilson’s disease
d. tuberculous meningitis
d. tuberculous meningitis
What is not transcortical sensory aphasia, which occurs in dementia:
a. normal repetition
b. echolalia
c. arcuate fascicle involvement
c. arcuate fascicle involvement
MRI images of the patient’s brain at one-year intervals. Visible white “dots” in the
basal ganglia (i.e. haemorrhages) and extensive atrophy of the cerebellum. the
patient has:
a. Alzheimer’s dementia
b. vascular dementia
c. frontotemporal dementia
d. mixed vascular and Alzheimer’s dementia
d. mixed vascular and Alzheimer’s dementia
A long-term consequence of several cerebral infarctions is:
a. cognitive decline
a. cognitive decline
What is considered a hereditary form of Alzheimer’s disease?
a. Autosomal dominant with defective genes for APP, presenilin 1 and 2.
a. Autosomal dominant with defective genes for APP, presenilin 1 and 2.
Who is at higher risk of Alzheimer’s?
a. Trisomy 21.
a. Trisomy 21.
What is found in the blood fluid of someone who is about to develop Alzheimer’s
disease?
a. elevated hyperphosphorylated tau,
b. increased free tau,
c. reduced amyloid β.
a. elevated hyperphosphorylated tau,
b. increased free tau,
c. reduced amyloid β.
A patient who developed Alzheimer’s dementia at a very young age has a
genetic defect:
a. sinuklein
b. for amyloid precursor protein
c. trisomy 21
b. for amyloid precursor protein
c. trisomy 21
The first sign of Alzheimer’s disease?
a. episodic memory loss
b. Behaviour
a. episodic memory loss
Which symptom in dementia is caused by elevated acetylcholine?
a. tremor
b. akinesia
c. depression
d. indifference
a. tremor
In which dementia are hallucinations not found?
a. vascular dementia
b. diffuse Lewy body disease
c. late Parkinson’s with dementia
d. delirium
e. Wernicke encephalopathy
a. vascular dementia
Identify the incorrect statement regarding amyloid precursor protein (APP):
a. APP dephosphorylates tau protein
b. APP is located in the cytoplasm
c. APP is found cortically
b. APP is located in the cytoplasm
What investigations you don’t do to rule out reversible causes of dementia
a. folic acid in the blood
b. TSH
c. OGTT
d. none of the above
d. none of the above
In a demented patient, extremely elevated levels of tau protein are found in the
fluid. Which disease is this most likely?
a. for Alzheimer’s disease
b. for Creutzfeldt-Jakob disease
c. for frontotemporal dementia
d. for diffuse Lewy body disease
a. for Alzheimer’s disease
Which brain structure is affected in dementia:
a. hippocampus
b. thalamus
c. amygdaloid nucleus
d. gyrus cingulum
a. hippocampus
In sporadic Alzheimer’s disease, we may find:
a. APP mutation
b. presenilin-1 mutation
c. presenilin-2 mutation
d. presence of the ApoE4 allele
e. α-synuclein mutation
d. presence of the ApoE4 allele
In which impairment are cognitive functions always checked?
a. CIPD
b. Transverse myelitis
c. Motor neurone disease
d. Mononeuritis multiplex
c. Motor neurone disease
For which disease are heavy metals a proven risk factor?
a. Alzheimer’s disease
b. Parkinson’s disease
c. multiple sclerosis
a. Alzheimer’s disease
b. Parkinson’s disease
Reduced activity of the keterg enzyme will lead to more amyloidogenic cutting?
a. α-secretase
b. β-secretase
c. γ-secretases
d. β-secretases and γ-secretases
a. α-secretase
Which receptors are defective in Alzheimer’s disease
a. for insulin and insulin-like growth factors?
a. for insulin and insulin-like growth factors
