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Neuro Clerkship > Dementia > Flashcards

Dementia Flashcards

1
Q

What are some of the symptoms of dementia in newly diagnosed (MCI) patients? (2)

What are some hallmarks to look for?

A
  • Poor orientation to time or place
  • Impaired recent memory

**Look for mood changes

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2
Q

Alzheimer’s disease (AD):

  • Definition
  • Disease Characteristics (2)
  • Risk factors (3)
A

Degenerative brain disorder leading to progressive loss of memory and other cognitive functions

  • Changes in personality, bx, judgment
  • Loss of ADLs

Risks: Advanced age, family hx, Downs’ Syndrome

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3
Q

After age 65 what happens to the prevalence of alzheimer’s disease?

A

Doubles with every decade; 50% patients over 85 have alzheimer’s

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4
Q

What is the third leading cause of death in the US?

What is the #1 cause of dementia?

A

Alzheimer’s disease

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5
Q

Describe the general progression of Alzheimer’s disease:
How long is the average course of disease?
Which symptoms show up first?

A
  • Average course of disease = 1 decade

- Memory impairment–> cognitive impairment +/- changes in mood and bx

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6
Q

What are the diagnostic criteria for alzheimer’s disease? (5)

A
  • Memory impairment
  • Aphasia, Apraxia, or Agnosia (1 of 3)
  • Altered Executive function
  • Decline in social/ occupational function
  • Gradual onset cognitive decline
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7
Q

What should you look for in the physical exam to dx alzheimer’s?

A

Subtle signs of neglect and parkinsonian features

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8
Q

What will you seen in the MMSE of a patient with alzheimers?

A

Decreased recall and reasoning (proverbs) abilities

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9
Q

What 4 things are evaluated by the mini mental status exam?

A
  • Performance of simple tasks
  • Abstract thought
  • Addition and subtraction
  • Communication
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10
Q

Which neurotransmitter is decreased in patients with alzheimer’s dementia?

In which parts of the brain is it decreased?

A

Acetylcholine: connects these structures to basal forebrain (degenerates w low Ach)

  • Hippocampus
  • Cerebral cortex
  • Amygdala
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11
Q

What are the characteristic senile plaques seen in Alzheimer’s made of?

Where are they located?

A

Degenerative presynaptic endings +/- astrocytes and microglia (AB peptide)

Located in the neurophil of the cerebral cortex

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12
Q

What are the characteristics neurofibrillary tangles seen in alzheimer’s dementia?

A

Intracytoplasmic proliferation of twisted filaments located in the pyramidal cells of the hippocampus and cerebral cortex

**Hyperphosphorylated tau

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13
Q

Where is the earliest brain lesion seen in alzheimer’s disease?

What is seen on fMRI?

A

Physiologic lesion in the hippocampus

Decreased oxidative metabolism seen in fMRI

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14
Q

List three treatment options for patients with Alzheimer’s:

A
  • Cholinesterase inhibitors
    (mild to moderate disease)
  • Antipsychotics/ Antidepressants
    (For bx symptoms)
  • Estrogen replacement therapy
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15
Q

Which AchEi has less neuropsych sx and why?

A

Rivastigmine; can via patch form for sustained release

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16
Q

How does food affect tacrine metabolism (AchEi)

A

Decreases bioavailability 30-40%

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17
Q

How does food affect donepezil (AchEi) metabolism?

A

NOT AT ALL

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18
Q

How does food affect rivastigmine metabolism?

A

Slows rate and increases absorption 30%

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19
Q

How is galantine metabolism affected by food?

A

Slows rate but not extent of absorption

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20
Q

Memantine/ Namenda:
What is the MOA?
What does it treat?

A

Binds NMDA receptors (ANTAgonist)

Given in does of 5-20mg per day to treat Alzheimers

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21
Q

What vitamin is given as a treatment for alzheimers?

A

Vitamin E (1000U BID)

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22
Q

What are two important preventative measures against developing alzheimers?

A

Smoking cessation and aerobic exercise

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23
Q

5 Symptoms typically inconsistent with Alzheimer’s Dementia:

A 
1-  Sudden onset 
2- Focal neurologic findings 
3-  Seizures (early in the course) 
4- Abnormal gait/coordination
5- Preservation of memory function
24
Q

7 Signs Atypical of Alzheimer’s Disease:

A

1- Dominant non-memory sx
2- Prominent behavioral, personality, psychotic Sx
3- Early parkinsonism
4- Early bulbar/ brainstem signs
5- Unexplained motor or reflex asymmetries
6- Unexplained (early) UMN or LMN signs

25
Q

What is the clinical triad for Hydrocephalic Dementia (Normal Pressure Hydrocephalus)?

Which symptoms improve first with spinal tap?

A
  • Dementia
  • Gait Apraxia (magnetic gait)
  • Urinary incontinence

Gait–> dementia–> incontinence

26
Q

How is Normal pressure hydrocephalus diagnosed? (2)

A
  • Enlarged ventricles on imaging

- Spinal tap is diagnostic and therapeutic

27
Q

List the 6 Frontotemporal Dementias?

A
  • Pick’s Disease
  • Dementia lacking distinctive histopathologic features
  • Progressive subcortical gliosis
  • Primary Progressive Aphasia
  • ALS Dementia/ MND Dementia
  • Disinhibition- Dementia- Parkinsonism-Amyotrophy
28
Q

What are the diagnostic criteria for Frontotemporal Dementia? (4)

A
  • Language impairment (echolalia, stereotypy, progressive reduced speech)
  • Frontal deficits (Decrease drive, interests; increased mental rigidity, social impropriety)
  • Change in Affect
  • Frontotemporal changes on imaging
29
Q

What characteristics are preserved in frontotemporal dementia? (2)

A
  • Praxis and visuospatial skills

- Memory

30
Q

Pick’s Disease:

  • Age and population
  • 4 symptoms of disease
  • Imaging and Path
A
  • 60+ yof

Symptoms:

  • Aphasia
  • Dementia (spares praxis + visuospatial fxn)
  • Personality changes
  • Frontal Release signs

Imaging: Frontotemporal atrophy sparing 1/3 superior temporal gyrus; intracytoplasmic PICK BODIES , ballooned neurons

31
Q

Where in the brain are pick bodies found? (3)

A
  • Cortex
  • Basal ganglia
  • Brainstem
32
Q

Which drugs shouldn’t be given to patients with Lewy Body Dementia?

A

Antipsychotics–May worsen sx

33
Q

What are the diagnostic criteria for Lewy Body Dementia? (3 core features, 5 accessory features)

A

Core Features (2/3 probable):

  • Fluctuating cognition: attention/ alertness
  • Well formed visual hallucinations
  • Parkinsonism

+/- falling, syncope, LOC, neuroleptic sensitivity, delusions/ other hallucinations

34
Q

What are Lewy bodies?

A

Eosinophilic cytoplasmic inclusions within substantial nigra (Seen in Lewy body Dementia)

35
Q

Progressive Supranuclear Palsy
(Steel Richardson Olsezewski Syndrome):

  • Age and population
  • Presentation (4 features)
A
  • 40+ yo men

Presentation

  • Supranuclear gaze deficits
  • Parkinsonism
  • Pseudobulbar palsy, dysphagia, dysarthria
  • Echolalia, Palilalia
36
Q

What is seen on imaging with Progressive Supranuclear Palsy (2 areas damaged)?

Pathology?
Which parts of the brain are spared?

A

Imaging:
Atrophic pons + midbrain

Path:

  • NF TANGLES* in midbrain
  • *Spared cortex and cerebellum
37
Q

Which supra nuclear gaze deficits manifest first in PSP?

A

Down gaze–> up gaze–> horizontal

Apraxic eyelid opening evident

38
Q

Cortical-Basal Ganglionic Degneration:

  • Age, population
  • Presentation (3)
A
  • 70+ M=F
  • Presents asymmetrically, unilaterally
  • Extrapyramidal rigidity
  • ***Alien Hand Syndrome; agosnia of limbs and upper extremities
  • Supranuclear palsy
39
Q

What is seen on imaging in Cortical-Basal Ganglionic Degeneration?
Path?

A

Imaging: Asymmetric parietal lobe atrophy

Path: Degenerating cortex + substantia nigra, WITHOUT PICK BODIES OR, TANGLES

40
Q

Which NT is deficient in Huntington’s Disease?

2

A

GABA and Ach in striatum

41
Q

What are the three treatments for Huntington’s?

A
  • Haldol
  • Tetrabenazine
  • Klonopin
42
Q

Wilson’s Disease: Inheritance pattern, Chromosome, age of onset?

A

AR, Chromosome 13

Onset 11-25 years

43
Q

How does wilson’s disease present clinically? (4)

Labs (2)?

A
  • Subcortical dementia w psychosis
  • Dysphagia, dysarthria
  • Rigidity, tremor
  • KF rings
  • Labs: ^ Cu, Low Ceruloplasmin
44
Q

Which area of the brain is atrophic in Wilson’s disease?

Describe the path findings:

  • What type of cells?
  • What type of degeneration and where specifically?
A

Brick red, atrophic Basal ganglia

  • Opalski cells (Astrocytes)
  • spongy degeneration/ cavation of putamen
45
Q

Treatment for wilson’s disease?

A

Penicillamine, Pyridoxine, Zinc Acetate, liver transplant

46
Q

What are the diagnostic criteria for AIDS dementia

A

2 of the following cognitive declines for at least 1 month:

  • Attention/ concentration
  • Info processing
  • Abstract reasoning
  • Visuospatial skill
  • Memory/ learning
  • Speech/ language
47
Q

Progressive Multifocal Leukoencephalopathy:

  • Viral etiology?
  • Who gets this?
  • How does it present?(3)
  • Describe the Path?
A
  • Papovirus (JC Virus, SV- 40 Virus)
  • Immunosuppressed

Presents with dementia, visual loss, Progressive hemiparesis

Path: occipital demyelination

48
Q

What are the treatments for PML?

A
  • Vistidide
  • Cytarabine
  • HAART
49
Q

Which Major Human Slow Virus is Sporadic?

What do you see on FLAIR MRI?

Path Changes?

A

CJD; patients die within 12 mos

  • Bilateral high signal in anterior basal ganglia on MRI
  • Spongiform changes in brain
50
Q

What are the 5 types of vascular dementia?

A
  1. Multi infarct (large vessel)
  2. Strategic single infarct (PCA, ACA, Thalamic, BF)
  3. Small Vessel with Multiple Lacunes (Binswanger)
  4. Hypoperfusion
  5. Hemorrhagic
51
Q

What is the most common cause of dementia?

A

Small vessel changes

52
Q

What is seen on MRI that indicates small vessel ischemic change?

A

Hypodense areas around vessels

53
Q

What are the diagnostic criteria for Binswanger’s Type Vascular dementia?

A

Dementia on clinical exam + 2 of the following :

  1. HTN or vascular disease
  2. Cerebrovascular disease
  3. Subcortical brain dysfunction (gait, rigidity, neurogenic bladder)

Will see bilateral subcortical leukokariosis (Attenuated white matter) on CT/ MRI

54
Q

What does “CADASIL” stand for?
How does the disease present and on what chromosome is the gene?

When in lifedoes the disease present? (4)

A 
Cerebral 
Autosomal 
Dominant 
Arteriopathy w/
Subcortical Infarcts + 
Leucoencephalopathy

Disease on Chromosome 19

Presents 20-40 yoa with recurrent stroke, dementia, classical MIGRAINE, depression/ mania

55
Q

What should be done in a nutritional workup for dementia? (5)

A
  • B12, B1
  • Vit D
  • TSH, Free T4
  • RPR
  • Paraneopalstic panel
56
Q

Dementia with NF tangles in midbrain?

A

PSP

Neuro Clerkship (13 decks)

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