Dementia

Question 1

Is dementia an inherent aspect of aging?

Answer 1

no!

Question 2

what percentage of patients over 65 years old have alzheimer’s dementia?

Answer 2

6-8 percent

Question 3

after the age of 65, at what rate does the prevalence increase every 5 years?

Answer 3

doubles every 5 years after 65

Question 4

what percentage of people over the age of 85 have alzheimers dementia?

Answer 4

45 percent

Question 5

what percentage of vascular dementia cases co-occur with AD?

Answer 5

15-20 percent

Question 6

what is the second most common cause of dementia?

Answer 6

lewy body dementia

Question 7

what percentage of caregivers suffer psychological distress (esp. depression)

Answer 7

nearly half

Question 8

what will you see on imaging of an alzheimer’s dementia brain?

Answer 8

amyloid plaques/oligomers

tau neurofibrillary tangles

Question 9

cytoplasmic alpha-synuclein inclusion bodies should make you think of which two diagnoses?

Answer 9

lewy body dementia

parkinsons dementia

Question 10

tau or ubiquitin proteins should make you think of what type of dementia?

Answer 10

frontotemporal

Question 11

what are the four DEFINITIVE risk factors for developing alzheimer’s dementia?

Answer 11

1) age
2) family history
3) APOE4 allele
4) down syndrome

Question 12

what are four POSSIBLE risk factors for developing alzheimer’s dementia?

Answer 12

1) head trauma
2) fewer years of formal education
3) late onset MDD
4) cardiovascular RF (HTN, DM, etc)

Question 13

the presence of amyloid precursor proteins (APP) and presenilin proteins (PS1 and PS2) should make you think what?

Answer 13

early onset alzheimers

diagnosed usually before 60

Question 14

APOE 2/3/4 on chromosome 19 should make you think of what?

Answer 14

late onset alzheimers

APOE4 carries greatest risk

Question 15

APOE2 is considered to be what in terms of dementia?

Answer 15

protective!

Question 16

what is the highest score you can get on the MMSE? what areas of functioning does the MMSE address?

Answer 16

highest score = 30

orientation, registration, attention, recall, naming, repetition, 3-step command, language, visuospatial

Question 17

how many items are on the mini-cog? whats the highest score?

Answer 17

2 items (score = 5)

assesses visuospatial, executive functions, recall

Question 18

besides the MMSE and the minicog, what are two other commonly used assessments?

Answer 18

SLUMS and MoCA

Question 19

when should you consider brain imaging in your patient who is presenting with dementia-like symptoms?

Answer 19

1) age less than 65
2) neurologic signs are asymmetric or focal
3) clinical picture suggests normal-pressure hydrocephalus
4) patient has had recent fall or head trauma

Question 20

normal aging is characterized by what type of performance on memory tests?

Answer 20

no evidence consistent, progressive deviations

some decline in processing and recall of new information (slower, harder)

Question 21

will a patient with normal aging have difficulty on their ADLs due to cognition?

Answer 21

no

weird question

cognition remains mostly intact just slow

Question 22

subjective complaint of decline in at least ONE domain that is noticeable and measurable but NO impairment in independent living is considered what level of cognitive impairment?

Answer 22

mild

Question 23

what percentage of people with amnestic mild cognitive impairment maintain a stable level of impairment or return to normal cognitive status in 3-5 years?

Answer 23

50 percent

Question 24

what are the 4 distinguishing signs of delirium?

Answer 24

1) ACUTE onset
2) cognitive fluctuations over hours or days
3) impaired consciousness and attention
4) altered sleep cycles

Question 25

once delirium has cleared in your otherwise healthy patient, what is the first thing you should start working up?

Answer 25

dementia

Question 26

the symptoms of ______ and _____ often overlap and can be hard to differentiate

Answer 26

depression and dementia

Question 27

what are some overlapping symptoms between depression and dementia?

Answer 27

impaired concentration, lack of motivation, loss of interest, apathy, psychomotor retardation, sleep disturbance

Question 28

what are three key findings that will clue you into depression over dementia?

Answer 28

depressed people:

1) demonstrate decreased motivation during cognitive testing
2) express cognitive complaints that exceed measured deficits
3) maintain language and motor skills

Question 29

what percentage of people presenting with reversible dementia and depression progress to true dementia within 5 years?

Answer 29

50 percent

Question 30

memory impairment and difficulty learning new information is the core feature of this disease

Answer 30

alzheimer’s

Question 31

are motor symptoms common in alzheimer’s disease?

Answer 31

rare early

apraxia later (difficulty performing purposeful actions)

Question 32

what will lab tests of a person with alzheimers look like?

Answer 32

normal

Question 33

what will imaging of a person with alzheimer’s brain look like?

Answer 33

possible global atrophy

small hippocampal volumes

Question 34

what about onset will help you differentiate between alzheimer’s dementia and vascular dementia?

Answer 34

alzheimers dementia = insidious onset

vascular dementia = sudden or stepwise

Question 35

what are the cognitive symptoms of vascular dementia?

Answer 35

depend on the anatomy of the ischemia

dysexecutive syndrome common (cognitive, behavioral, emotional disturbances occurring together)

Question 36

what will a person with vascular dementia’s motor skills be like?

Answer 36

depends on location of ischemia

Question 37

what is the prognosis of vascular dementia?

Answer 37

it is a stepwise progression with further ischemia

Question 38

labs of a person with vascular dementia?

Answer 38

normal

Question 39

imaging of a person with vascular dementia?

Answer 39

cortical or subcortical changes on MRI

Question 40

onset of lewy body dementia? how do these patients typically progress?

Answer 40

onset is gradual

memory and visuospatial difficulties, hallucinations

Question 41

will a person with lewy body dementia have symptoms throughout the day? what is a hallmark of this disease?

Answer 41

NO

fluctuations of are common

Question 42

which progresses faster, lewy body dementia or alzheimers?

Answer 42

both are quite gradual, but lewy body dementia is faster than AD

Question 43

what will labs and imaging of lewy body dementia look like?

Answer 43

normal labs

imaging = possible global atrophy

Question 44

motor symptoms of lewy bodydementia?

Answer 44

parkinsonism

Question 45

for a diagnosis of lewy body dementia, both dementia and at least one of the these symptoms must be present (4):

Answer 45

1) detail visual hallucinations
2) parkinsonian signs
3) changes in alertness or attention
4) poor visuospatial abilities often out of proportion to other cognitive deficits

Question 46

if parkinson’s disease has been diagnosed or present for over 2 years before cognitive symptoms are seen, is the person’s dementia more likely alzheimer’s dementia or parkinson’s dementia?

Answer 46

parkinson disease dementia

Question 47

if parkinsonian symptoms are present at the same time as cognitive symptoms, what diagnosis should we consider?

Answer 47

lewy body dementia

Question 48

this type of dementia is characterized by executive, language, and behavioral dysfunction

Answer 48

frontotemporal dementia

Question 49

this type of dementia is characterized by disinhibition and hyperorality

Answer 49

frontotemporal dementia

Question 50

what are the motor symptoms of frontotemporal dementia?

Answer 50

none; but may be associated with ALS in rare cases

Question 51

is the onset of frontotemporal dementia gradual or sudden?

Answer 51

gradual, usually under 60 years old!

Question 52

what will imaging of a person with frontotemporal dementia’s brain look like?

Answer 52

atrophy in frontal and temporal lobes