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724: Medical Lectures > Dementia > Flashcards

Dementia Flashcards

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USMLE® Step 1 flashcards
1
Q

What can be defined as a progressive decline in intellectual function that is severe enough to compromise social or occupational functioning?

A

dementia

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2
Q

What can be defined as a decline that has not resulted in a change in the level of function?

A

mild cognitive impairment

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3
Q

When does dementia typically begin?

A

after 60

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4
Q

The prevalence of dementia ______ every 5 years after the age of 60, so that in persons 86 or older ____ have dementia

A

doubles

half

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5
Q

Is dementia more common men or women?

A

Women

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6
Q

What are the 2 general causes of dementia?

A
  • Sporadic primary neurodegenerative disease

- As a result of another disease (i.e. stroke)

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7
Q

What is thought to be a protective mechanism against dementia?

A

ongoing intellectual stimulation

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8
Q

What are 5 risk factors for dementia?

A
  • Age
  • Family history
  • Vascular disease risk factors
  • Diabetes
  • History of significant head injury
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9
Q

What can be defined as an acute confusional state that often occurs in response to an identifiable trigger?

A

delirium

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10
Q

What does delirium involve?

A

fluctuating levels of arousal (drowsiness or agitation)

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11
Q

What typically improves delirium?

A

treatment or removal of the trigger

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12
Q

Describe the relationship between dementia and delirium

A

Dementia patients are especially susceptible to episode of delirium, however recognition of dementia is not possible until the delirium lifts. This leads to the diagnosis of dementia in otherwise medically stable patients.

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13
Q

______ disease sometimes leads to complaints of impaired cognition

A

Psychiatric

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14
Q

When should symptoms of psychiatric disease resolve?

A

Following appropriate psychiatric treatment

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15
Q

_____ disorders are commonly seen in patients with neurodegenerative disease

A

Mood

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16
Q

True or False

Persistent untreated mood disorders may predispose to the development of age-related dementia

A

True

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17
Q

What do symptoms depend on?

A

area of the brain affected

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18
Q

What are 6 signs and symptoms of dementia?

A
  • Short Term Memory Loss
  • Word-Finding Difficulty
  • Visuospatial Dysfunction
  • Executive Dysfunction
  • Apathy
  • Apraxia
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19
Q

Short-term memory loss results from pathologic changes in what area of the brain?

A

hippocampus

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20
Q

Difficulty finding words results from pathologic changes in what area of the brain?

A

temporoparietal junction of the left hemisphere

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21
Q

Visuospatial dysfunction results from pathologic changes in what area of the brain?

A

right parietal lobe

22
Q

Executive dysfunction results from pathologic changes in what areas of the brain?

A
  • frontal Lobe

- subcortical areas (basal ganglia and cerebral white matter)

23
Q

Apathy results from pathologic changes in what areas of the brain?

A
  • frontal Lobe

- subcortical areas (basal ganglia and cerebral white matter)

24
Q

Apraxia results from pathologic changes in what areas of the brain?

A
  • frontal lobe

- parietal lobe (especially left)

25
Q

What are 2 exams used to asses the neuropsychological aspect?

A
  • Folstein Mini Mental State Exam (MMSE)

- Montreal Cognitive Assessment

26
Q 
\_\_-\_\_ = normal cognition
\_\_-\_\_ = mild cognition impairment
\_\_-\_\_ = moderate cognition impairment
\_\_-\_\_ = severe cognition impairment
A

27-30

21-26

11-20

0-10

27
Q

What are the 2 goals of the neuropsychological assessment?

A
  • To enhance localization by defining the cognitive domains that are impaired
  • To quantify the degree of impairment
28
Q

What imaging modality is preferred in the diagnosis of dementia?

A

MRI

29
Q

What do the MRI findings reveal?

A

Global or focal brain atrophy worse than expected based on patient age

30
Q

What imaging modality allows for the assessment of metabolic activity of the brain?

A

PET imaging with fluorodeoxyglucose

31
Q

What special imaging technique should be done in patients suspected of Alzheimer’s disease?

A

PET imaging with radiolabeled ligand for beta-amyloid

32
Q

What 3 serum values must be measured in order to diagnose dementia?

A
  • Vitamin B₁₂
  • Free T₄
  • Thyroid-stimulating hormone
33
Q

What 3 diseases are common in dementia patients?

A
  • Vitamin B₁₂ deficiency
  • Hypothyroidism
  • Syphilis
34
Q

What lab testing must be done if Alzheimer’s is suspected?

A

ApoE genotyping

35
Q

The presence of - ApoE epsilon-4 alleles indicates increased risk

A

1-2

36
Q

Spinal fluid measurements indicate ____ levels of beta-amyloid and _____ levels of tau protein

A

decreased

increased

37
Q

What are the 4 common causes of age-related dementia?

A
  • Alzheimer Disease
  • Vascular Dementia
  • Dementia with Lewy bodies
  • Frontotemporal Dementia (FTD)
38
Q

What is the pathology behind Alzheimer disease?

A

Plaques containing beta-amyloid peptide, and neurofibrillary tangles containing tau protein, occur throughout the neocortex

39
Q

What is the pathology behind vascualr dementia?

A

multifocal ischemic damage

40
Q

What is the pathology behind dementia with Lewy bodies?

A

Alpha-synuclein-containing Lewy bodies occur in the brainstem, midbrain, olfactory bulb, and neocortex.

41
Q

What is the pathology behind frontotemporal dementia?

A

Tau protein, TAR DNA-binding protein 43 (TDP-43), or fused-in-sarcoma (FUS) protein

42
Q

What is a difficult diagnosis to establish from dementia?

A

Normal Pressure Hydrocephalus

43
Q

What are the symptoms of normal pressure hydrocephalus?

A
  • Gait apraxia
  • Urinary incontinence
  • Dementia
44
Q

How is normal pressure hydrocephalus differentiated from dementia?

A

The MRI image reveals enlarged ventricles and overall atrophy of the brain

45
Q

What are the nonpharmacological approaches to treating dementia?

A
  • aerobic exercise

- mental stimulation

46
Q

What 2 drugs are used in the treatment of cognitive symptoms?

A
  • Cholinesterase Inhibitors

- Memantine

47
Q

What drugs are considered to the first-line therapy for Alzheimer disease and dementia with Lewy bodies?

A

Cholinesterase Inhibitors

48
Q

True or False

Cholinesterase inhibitors treat symptoms, but do not reverse the progression of the disease

A

True

49
Q

What are the 3 most commonly used cholinesterase inhibitors?

A
  • donepezil (Aricept)
  • rivastigmine (Razadyne)
  • galantamine (Exelon)
50
Q

What drug treats moderate-severe Alzheimer disease?

A

Memantine

51
Q

How does memantine work?

A

It acts on the glutamatergic system by blocking NMDA receptors

724: Medical Lectures (42 decks)

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