Dementia

Question 1

Alzheimer demetia ?

Answer 1

1. Normal neurologic exam
2. No motor or sensory abnormalities
3. MMSE score = Mini Mental State Examination
4. MMSE score normally = 20-30
5. USMLE = MMSE score 28+
6. Brain biopsy= Beta amyloid plaque + Neurofibrillary tangles
7. Alzheimer in down syndrome=Cchromosome 21
8. Gene mutation = Presenilin
9. Presinilin = Protein = Involved in cleavage of amyloid
10. Dementia worsen in Night may resemble delirium
11. Tx= Cholineesterase inhibitors=Donepezil Galantamine Rivastigmine

1st-line Tx for sundowning on NBME is “decrease ambient noise and distractions.”
“Bright illumination of the room at all times” is wrong answer.

Question 2

Which gene mutation in AD ?

Answer 2

Presenilin

Question 3

MMSE score in Alzheimer dementia ?

Answer 3

28+

Mini MentaL State Examination

Question 4

Alzheimer dementia brain biopsy outcome ?

Answer 4

Beta-amyloid plaques and neurofibrillary tangles (hyperphosphorylated tau
protein)

Question 5

Which chromosme in AD ?

Answer 5

Early-onset Alzheimer in Down syndrome (amyloid precursor protein gene is
located on chromosome 21)

Question 6

Frontotemporal dementia ?

Pick disease

Answer 6

1. Personality change
2. Apathy
3. Disinhibition
4. Accumulation of hyperphosphorylated tau protein (similar to Alzheimer), except
   rather than accumulating as neurofibrillary tangles, it accumulates as round, silver staining inclusions knowns as Pick bodies.

Question 7

A dementia and frontotemporal dementia corelate ?

Answer 7

AD= hyperphosphorylated tau protein+ Neurofibrillary tangles
Frontotemporal Dementia = h t p + Pick bodies
silver staining -Pick bodies

Question 8

Lewy body dementia/

Answer 8

1. Dementia + visual hallucinations + Parkinsonism.
2. Lewy bodies are collections of alpha-synuclein. This protein is deposited
   throughout the brain in Lewy-body dementia.
   3.In Parkinson disease, in contrast, it is
   deposited primarily in the substantia nigra pars compacta of the midbrain.

Question 9

Vascular dementia ?

Answer 9

1. Multi infract dementia
2. Dementia + Motor/Sensory abnormalities
3. Patient=Repeated MINI stroke = HTN
   4.Step wise decline

USMLE likes is giving motor and/or sensory deficits – i.e., you’ll get a big paragraph with dementia, and you’ll notice
somewhere in the stem that the patient has, e.g., 3/5 strength in the right upper
extremity. This indicates Hx of stroke.

Question 10

Senile plaque = Beta amyloid core = Amyloid angiopathy ?

Answer 10

Alzheimer dementia

Question 11

Hirano bodies = Intracellular eosinophilic proteinaceous rods in hippocampus ?

Answer 11

Alzheimer dementia

Question 12

Creutzfeldt Jakob disease ?

FA

Answer 12

1. Rapidly progressive
2. Myoclonus
3. Startle myoclonus
4. Ataxia
5. Caused by - PRIONS
6. Fatal
7. Trasmitted by contaminated materials
8. Corneal transplant , Neurosurgical equipment
9. Spongiform cortex
10. Sharp wave ECG
11. inc 14-3-3 protein in CSF

1. 535