Dementia

Question 1

Disorder that causes significant decline in one or more areas of cognitve functioning severe enough to result in functional decline

Answer 1

Dementia

Question 2

6-8 percent of those >/= 65 have AD, T/F?

Answer 2

True

Question 3

Second most common cause of dementia in those over 65

Answer 3

Dementia w/ Lewy Bodies

Question 4

Amyloid plaques and tau tangles

Answer 4

AD

Question 5

Cytoplasmic alpha synuclein inclusion bodies

Answer 5

Lewy body and Parkinson Dementia

Question 6

Tau or ubiquitin proteins

Answer 6

Frontotemporal dementia

Question 7

Definite RF of dementia

Answer 7

Age, Fam Hx, APOE4 allele, Down syndrome

Question 8

Possible protective factors of dementia

Answer 8

NSAIDs, antioxidants, intellectual activity, statin

Question 9

Possible RF of dementia

Answer 9

Head trauma
Fewer years of formal education
CV RF

Question 10

Examine the status of these 3 things on physical for dementia

Answer 10

Neurologic status
Mental Status
Functional Status

Question 11

Labs for assesment of dementia

Answer 11

RPR, CBC, B12, TSH, Na, Ca, BUN/Cr, folate level, HIV Screen

Question 12

When to consider imaging

Answer 12

• onset of <65 y/o
• sudden sx
• neuro deficits
• NPH clinical picture
• Recent fall or head trauma

Question 13

Order what type of imaging when looking at dementia/possible trauma

Answer 13

Noncontrast head CT
MIRI
PET scan (when dx uncertain)

Question 14

Mild decline in memory
Needs more effort and time to recall new info
No impaired functioning
New learning slow, but still occurs

Answer 14

Normal aging

Question 15

No impairment in independent living

Some convert to AD

Answer 15

Mild NCD/MCI

Question 16

AD: Progression is gradual or rapid?

Answer 16

Gradual over 8-10 years on average

Question 17

Labs for AD will be ____

Answer 17

Normal

Question 18

imaging for AD will show ___

Answer 18

possible global atrophy, small hippocampal volumes.

Question 19

Vascular dementia onset is __

Answer 19

Rapid

Question 20

Vascular dementia progression is ____

Answer 20

gradual or stepwise w/ further ischemia

Question 21

Lab test for vascular dementia are ____

Answer 21

normal

Question 22

Imaging for vascular dementia shows ____

Answer 22

cortical or subcortical changes on MRI

Question 23

Dementia w/ Lewy bodies have these cognitive sx

Answer 23

memory, visuospatial, hallucinations, fluctuating sx

Question 24

Motor sx of Dementia w/ Lewy bodies

Answer 24

parkinsonism

Question 25

Progression of Dementia w/ lewy bodies

Answer 25

gradual, but faster than AD

Question 26

Lab tests for dementia w/ lewy bodies are ___

Answer 26

Normal

Question 27

imaging for dementia w/ lewy bodies shows ___-

Answer 27

possible global atrophy

Question 28

Onset of frontotemporal dementia

Answer 28

gradual, usually age <60

Question 29

Executive, disinhibition, apathy, language, +/- memory deficits seen in this dementia

Answer 29

Frontotemporal dementia

Question 30

Motor sx for frontotemporal dementia

Answer 30

None

Question 31

Frontotemporal dementia progression

Answer 31

Gradual but faster than AD

Question 32

Lab tests for frontotemporal dementia are ____

Answer 32

Normal

Question 33

Imaging for frontotemporal dementia shows ____

Answer 33

atrophy in frontal and temporal lobes

Question 34

Patients w/ primary depression are generally unlike those w/ dementia in that they ___

Answer 34

- demonstrate decreased motivation during cognitive testing - express cognitive complaints that exceed measured deficits - maintain intact language and motor skills

Question 35

Primary goal of dementia tx

Answer 35

Enhance quality of life | Maximize functional performance by improving or stabilizing cognition, mood, behavior

Question 36

Nonpharm management of dementia

Answer 36

- Cognitive rehab - therapy - physical, mental activity - appts q 3-6 months - family/caregiver education and support - attention to safety - Environmental modification

Question 37

Pharm tx for dementia

Answer 37

- Cholinesterase inhibitors: donepezil, rivastigmine, galantamine - Memantine - cognitive enhancers - antidepressants - psychoactive meds

Question 38

SE of cholinesterase inhibitors

Answer 38

GI SE common

Question 39

Cholinesterase inhibitors NOT recommended for these dementias

Answer 39

Vascular | Frontotemporal (may worsen)

Question 40

These dementias can benefit from cholinesterase inhibitors

Answer 40

Lewy body dementia and Parkinson dementia

Question 41

Neuroprotective med that reduces glutamine-mediated excitotoxicity

Answer 41

Memantine

Question 42

Mematine has these benefits for AD

Answer 42

Benefits cognition, ADLs and behavior in AD

Question 43

SE of memantine

Answer 43

Constipation, dizziness, headache

Question 44

Vitamin E effects on AD

Answer 44

may lower rate of functional decline

Question 45

Selegiline effect on AD

Answer 45

may lower rate of functional decline

Question 46

SE of antidepressants

Answer 46

Falls, anticholinergic effects may worsen confusion

Question 47

Is demenitia an inherent part of aging?

Answer 47

Nope.

Question 48

Most common type of dementia

Answer 48

AD

Question 49

Which is most likely to indicate pathologic neurologic decline?

Answer 49

Forgetting to pay mortgage and credit card bills.

Question 50

Which of the following meds should not be used in this patient? Patient w/ hx of frontotemporal dementia that was not reactive to psychoactive meds.

Answer 50

Haloperidol

Question 51

What is the risk of prescribing psychotropic meds to patients w/ dementia?

Answer 51

First and second generation antipsychotics increase morbidity and all-cause mortality.