Dementia

Question 1

dementia

Answer 1

impair 2/5 functional domains: memory, emotion, executive, language, visuospatial- impacts ADL

Question 2

mild cognitive impairment

Answer 2

doesn’t meet criteria for dementia bc no impairment in function. RF for alzheimer’s bc 15% dev dementia annually

Question 3

types of memory

Answer 3

episodic- persoanl experiences, primary affected in AD. semantic memory- facts. declarative memory- semantic + episodic memory.. procedural - how do do things= less affected

Question 4

AD v brain areas

Answer 4

atrophy of medial temporal lobe (hippocampi). preserve primary motor and visual cortices. over time –> diffuse brain atrophy.

Question 5

pittsburg compound B

Answer 5

used in PET scans to image beta amyloid plaques in the brain and is used in research for AD

Question 6

cholinesterase inhibitors

Answer 6

used to improve functional and psychiatric sx in early stages of alzheimers. but don’t delay natural history of alzheimer. works bc acetylcholine is made in nucleus baseless of meynert. ex donepezil

Question 7

memantine (damenda)

Answer 7

improve AD pt’s functional ability. dear glutaminergic overstimulation by inhibiting NMDA R.

Question 8

familial AD

Answer 8

mut amylod precursor. age of onset of AD decr as #apolipoprotein E e4 alleles incr

Question 9

AD patho

Answer 9

cortical neuritic plaques and neuronal loss in cerebral cortex. -these are seen in elderly pt without clinical dementia too.

Question 10

down syndrome

Answer 10

neurodev model for alzhmeimers inevitable

Question 11

AD

Answer 11

age is most important RF. W>M. high edu is protective, most common demential in pt >65. dx can’t be made solely on MRI findings.

Question 12

delirium v AD

Answer 12

there are fluctuations of arousal in delirium

Question 13

evaluate pt with dementia

Answer 13

goal: find reversible cause- in minority of pt.
1) electrolyte panel, renal func, hepatic func, TSH, serologic test for syphilis, B12, UA, tox screen, HIV test
2) neuroimaging
3) complete list of medication looking specifically for anticholinergic med, benzodiazepine, opiates
5) LP and EEG only when there are red flags - early onset or rapidly progressing dementia, IC pt, focal neurological findings, sign of systemic illness
6) demential v delirium

Question 14

diffuse lewy body disease (DLBD)

Answer 14

Main: cog decline. fluctuating condition with variation in attention and alertness. prominent visual hallucinations, may have sx of parkinsonism, motor sx (bradykinesia and gain abn). pt are hypersensitive to antipsychotics. sleep disturbance and orthostatic hypotension. def of executive fun

Question 15

lewy body

Answer 15

composed of alpha synuclein. seen in many neuro D like parkinson

Question 16

parkinson v DLBD

Answer 16

both have parkinsonism, motor sx, gait abn, deficits of executive fun. fluctuating cognition and attention/alertness supports DLBD

Question 17

charles bonnet syndrome

Answer 17

mentally healthy with sig visual loss. visual hallucination- animal ppl. know they aren’t real.

Question 18

frontaltemporal lobe degeneration

Answer 18

aka pick’s disease. 1) behavioral disinhibition/poor judgment( conduct prob, antisocial, substance use, novelty seeking, impulsitivity, HIV related risk behavior) can get 2) apathy, abulia. 3) language disturbance- dv global language difficulties- primary progressive aphasia.
unusual features include: dev new artistic skills. norm memory and general intelligence, basic labs, to screen
occur at younger age and more rapid than other demential. memory is often unaffected

Question 19

ropinirole (requip)

Answer 19

dopamine agonist for parkinson disease. one SE is incr impulsivity like gambling or hyper sexual behavior

Question 20

wenicke-korsakoff syndrome. patho,

Answer 20

necrosis of maxillary bodies. due to def of thiamine/vit B1. giving glu bc thiamine trigger change in Mental status

Question 21

wenicke-korsakoff syndrome sx

Answer 21

1) ataxia- mainly gait
2) encephalopathy
3) eye movement abn including nystagmus and ophthalmoparesis
amnesia and confabulation= unintentional creation of false memories or beliefs. rapid clinical onset.

Question 22

korsakoff pt types

Answer 22

1) chronic alcoholic + IV glucose in ER
2) ICU pt
3) post gastric bypass pt

Question 23

ganser’s syndrome

Answer 23

= prison psychosis- syndrome of approximate answers. in prison inmates to manipulate legal situation. form of malingering

Question 24

vascular dementia

Answer 24

present in step wise fashion. focal neuro deficit. RF- stroke (age, HTN, DM, smoking, lipids). can present after stragitacally placed lesion to hippocampus, medial thalamus, or caudate nucleus. often occur in conjunction with other dementing processes like alzheimers

Question 25

normal pressure hydrocephalus

Answer 25

triad: magnetic gait, dementia, urinary urgency/ freq (wobbly, weird, wet) gait is apraxia and pt can mimic walking while lying or sitting. tx. ventriculoperitoneal shunt (at risk for dev subdural hematoma due to dear ICP that pulls brain away from meninges --> tears veins). dx: continuous lumbar drain. cause: previous pathology in subarachnoid space (meningitis, subarachnoid blood) that interfere with reabsorption of CSF in arachnoid granulation

Question 26

shunt surgery pt need

Answer 26

1 of 4. 1) clearly identified etiology of hydrocephalus 2) gait difficulties >cog impairment 3) substantial improvement after CSF removal 4) no atrophy and WM lesions on imaging

Question 27

transient global amnesia

Answer 27

complete and reversible anterograde and retrograde memory loss lasting up to 24hr. often occur in emotional or sexual activity. migraine phenomenon. rarely recurs though pt need to be worked up for vascular disease and epilepsy. tx with observation bc self limited disorder. MRI show temporary abn in hippocampus

Question 28

limbic encephalitis

Answer 28

MRI: bilateral hyperintesity of mdial temporal lobe and frontal lobes. CSF show anti-Hu ab.

Question 29

paraneoplastic limbic encephalitis

Answer 29

most commonly associated with small cell lung carcinoma. in young otherwise health girls, more likely associated with ovarian tumor

Question 30

kluver-bucy syndrome

Answer 30

hypersexuality, plaicidity - decr fear response. docile in settings that should trigger fear, aggressiveness, anger. hyperphagia and hyperorality-overeat + examine obj with mouth, pica. visual agnosia- can't rec familiar faces or obj

Question 31

wenicke's aphasia

Answer 31

receptive, sensory, fluent aphasia. can't understand language. correct grammar but nonsensical. can't repeat phrases or follow complex commands. not aware of deficit. not associated with weakness

Question 32

transcortical sensory aphasia

Answer 32

lesion in arcuate fasiculus. mild word finding problem, sig trouble naming obj, can't repeat phrases, can follow simple commands

Question 33

abnormal prosody

Answer 33

lesion in right inferior frontal gyrus. improper intonation.

Question 34

pure word deafness

Answer 34

bilateral lesion in primary auditory cortex in the superior temporal lobe or disruption of connection between these areas. can't comprehend speech meaning, but can hear sounds, speak, read, write

Question 35

akinetic mutism

Answer 35

lesion in cingulate gyrus bilaterally - only speak in extreme duress

Question 36

cingulate gyrus

Answer 36

involve in emotions and reg aggressive behavior. abn found in schizophrenia and OCD

Question 37

MCA v aphasia

Answer 37

supply bloc's and wernicke's

Question 38

dysphonia

Answer 38

due to problem of vocal cord- sound hoarse or breathy

Question 39

dysarthria

Answer 39

speech problem due to bad M of articulation

Question 40

aphasia

Answer 40

language problem from brain injury

Question 41

broca's

Answer 41

expressive, non-fluent aphasia. can't produce language or repeat phrases, intact comprehension, aware of deficit. associate with weakness. when recovery can become a transcortical motor aphasia

Question 42

transcortical motor aphasia

Answer 42

as per broca with intact repetition

Question 43

transcortical sensory aphasea

Answer 43

as per wernicke's with intact repetition

Question 44

global aphasia

Answer 44

broc + wernicke. mute. sig weakness

Question 45

mixed transcortical aphasia

Answer 45

~ global with intact repetition

Question 46

anomic aphasia

Answer 46

can't name obj

Question 47

neologism

Answer 47

make up words

Question 48

phonemic paraphrasia/ literal paraphrasia

Answer 48

mispronuciation, syllables out of seq.

Question 49

semantic paraphrasia

Answer 49

substituted word is related to intended word.

Question 50

gerstmann's syndrome

Answer 50

lesion to dominant angular gyrus-area of parietal lobe near superior edge of temporal lobe. agraphia-def in writing. acalculia- def in learning or comprehending math. finger agnosia- can't distinguish fingers on hand. left-right confusion

Question 51

apraxia

Answer 51

disorder of skilled mvt not caused by weakness, akinesia, deafferentation, ab tone or posture, mvt disorders like tremor or chorea, intellectual deterioration, poor comprehension or uncooperativeness

Question 52

right parietal lobe

Answer 52

neglect. don't realize there is a problem with CL side of body

Question 53

prosopanosia

Answer 53

fusiform gyrus of temporal lobe. lose facial recognition

Question 54

astereoagnosia

Answer 54

parietal lobe/primary somatosensory cortex lesion. can't rec obj by touch

Question 55

alexia without agraphia

Answer 55

lesion in left occipital lobe ++ splenium. could be caused by infarction of PCA. visual info only reach only the right occipital lobe but can't be processed by language areas on left. so can't read but can write.

Question 56

anton's syndrome

Answer 56

denial of blindness due to damage in bilateral occipital lobes.

Question 57

balint's syndrome

Answer 57

damage to both posterior parietal lobes. 1) optic ataxia- incoordination of hand and eye mvt 2) oculomotor apraxia- no voluntarily guide eye mvt 3) simultanagnosia- inaility to perceive more than 1 obj at a time in one's visual field

Question 58

kleine-levin syndrome

Answer 58

sleep a lot. awake-spacey, childlike. at times, hungry and hypersexual

Question 59

pseudobulbar palsy

Answer 59

emotional outburst without matching feelings. tx by dextromethorphan/quinidine. seen in MS, ALS, AD

Question 60

alien hand syndrome

Answer 60

associated with demential, it occur in corticobasal dengeneration. cones of epilepsy surgery where corpus callosum is severed to prevent generalization of seizures.