Dementia

Question 1

What are the six cognitive domains that dementia can affect?

Answer 1

Complex Attention
Executive Function
Learning & Memory
Language
Perceptual MF
Social Cognition

Question 2

Describe the “Dementia” pneumonic for remembering the reversible cognitive impairment contributors.

Answer 2

D - Drugs
E - Emotional
M - Metabolic
E - Eyes & Ears
N - Nutrition
T - Tumors
I - Infection
A - Anemia

Question 3

What two physiological changes occur within the brain in Alzheimer’s Disease?

Answer 3

1) Neurofibrillary Tangles

2) Beta Amyloid Plaques

Question 4

What gene increases one’s risk of developing Alzheimer’s?

Answer 4

APOE4

Question 5

What symptoms are more common early on in Vascular Dementia than Alzheimer’s?

Answer 5

Changes to complex thinking & personality

Agitation & Moodiness

Question 6

What dementia subtype has an earlier onset (40-50yrs) & often involves disinhibited behavior?

Answer 6

Frontotemporal Dementia

Question 7

In Frontotemporal Dementia, what changes occur before memory loss?

Answer 7

Speech
Language
Personality

Question 8

What type of protein deposits within neurons in Lewy Body Dementia?

Answer 8

Alpha-Synuclein

Question 9

What presents either before or concurrently with motor symptoms in Lewy Body Dementia?

Answer 9

Cognitive Impairment & Visual Hallucinations

Question 10

Along with previously listed presentations, what other distinct clinical feature is present in Lewy Body Dementia?

Answer 10

Postural Instability & Backwards Falls

Question 11

What is most important in the diagnosis of dementia?

Answer 11

Collateral information

Question 12

An MMSE score of </= ___ / 30 is considered to be abnormal & a positive flag for potential dementia.

Answer 12

26 / 30

Question 13

T or F: A higher FAQ score indicates poorer function.

Answer 13

True!

Question 14

When are benefits from Cholinesterase Inhibitors most commonly seen?

Answer 14

Within 3-6mths of initiation

Question 15

Common Cholinesterase Inhibitor side effects?

Answer 15

NVD
Loss appetite
Urinary incontinence
Insomnia

Question 16

Contraindications to using Cholinesterase Inhibitors?

Answer 16

Unctrl’ed Asthma / COPD
Bradycardia
Cardiac Conduction Abnormalities

Question 17

Donepezil patients can continue receiving the drug so long as their MMSE score does not decrease by >__ pts & FAQ increases by __ pt(s).

Answer 17

MMSE: > 2pts
FAQ: 1pt

Question 18

Explain Memantine’s MOA.

Answer 18

Blocks Glutamate at NMDA Receptors

Question 19

Side effects of Memantine?

Answer 19

Dizzy / Confused
Insomnia
Akathisia
HTN
Headache

Question 20

If discontinued, over what length of time should dementia drugs be tapered?

Answer 20

2-4wks

Question 21

Lecanemab & Donanemab work by increasing what?

Answer 21

Beta Amyloid clearance

Question 22

Major side effect to monitor for if newer MAB drugs are being used to treat dementia?

Answer 22

Brain bleeds & swelling

Question 23

What are the only two indications for MAB usage?

Answer 23

Mild Cognitive Impairment

Early Alzheimer’s Disease

Question 24

T or F: Methylphenidate usage is more effective in treating apathy & motivational losses than changes to external activity or environmental stimulation.

Answer 24

False!

Question 25

If Z Drugs or Benzos are elected to be used in an older patient to help with sleep, what length of time should they be used for?

Answer 25

</= 2wks