dementia Flashcards
65 y/o M with 6 mo h/o confusion episodes, disorientation, VHs of children playing in his room. Hallucinated images are fully formed, colorful, vivid and pt has little insight into their nature. No AH. Wife says he is normal between episodes. Exam: Normal language, memory, mod diff with trails test, mild diff with serial subtractions, mild symmetric rigidity and bradykinesia. Brain MRI unremarkable. CSF, routine labs and UDS normal. Diagnosis: (7x)
LEWY BODY DEMENTIA
When combined with functional neuroimaging, which of the following biomarkers is most likely to identify those geriatric pts with mild cognitive impairment most at risk for developing Alzheimer’s disease? (7x)
E-4 APOLIPOPROTEIN E ALLELE
80 y/o with VH and worsening gait, episodic confusion, disturbed sleep, fighting in sleep, bilateral rigidity, masked facies. Levodopa/carbidopa improved movement temporarily. Diagnosis? (4x)
DEMENTIA WITH LEWY BODIES
80 y/o pt with Alzheimer’s is brought in for increasingly combative behavior. Daughter would like to keep the pt at home if possible. What interventions would be most helpful in this situation? (3x)
ASSESSING FOR CAREGIVER BURNOUT
91 y/o hospice pt w/ cachexia, end stage dementia, and renal impairment has stopped eating and drinking. What comfort measure would be most appropriate? (3x)
FREQUENT SMALL SIPS OF WATER
Which of the following is the most specific factor for distinguishing delirium from dementia of the Alzheimer type? (2x)
FLUCTUATING AROUSAL
Neurocognitive functions most likely to show decline in people over 65 years of age? (x2)
INFORMATION PROCESSING SPEED
Over the course of several months, a 46 yo pt w no past psych hx becomes emotionally labile/irritable. Pt undergoes personality changes, is observed to laugh inappropriately when neighbor kids taunt stray cat. Within 2 yrs pt is convinced all food has germs. Memory is preserved. Pt is no longer able to work/live independently. Neuropsych testing shows impaired language/attn. (2x)
FRONTOTEMPORAL DEMENTIA
Excess activation of which receptor contributes to cell death in Alzheimer dx?
NMDA
Test that differentiates Alzheimer’s from frontal-temporal dementia
SINGLE PHOTON EMISSION CT SCAN
Neurocog d/o with fluctuating rate of progression, visual spatial impairment and early unilateral resting tremor and increased muscle tone.
DEMENTIA WITH LEWY BODIES
Confabulation is:
UNCONSCIOUS FILLING IN OF MEMORY GAPS
What test is most helpful to distinguish dementia vs delirium
EEG
Suggests delirium rather than dementia:
CLOUDING OF CONSCIOUSNESS
85 yo patient with hx of dementia admitted for agitation becomes more confused and angry. What lab should you get?
UA
Picture of tau staining for pt with progressive dementia. Dx?
ALZHEIMER’S
80yo p/w insidious forgetfulness f/b progressive language impairment 2yr later with difficulty using common tools/appliances. Dx?
ALZHEIMER’S DISEASE
Which cancer treatment may be followed by a subcortical dementia due to a leukoencephalopathy with onset after 6 months post-treatment?
WHOLE BRAIN RADIATION
A pt who has been receiving dialysis tx for years has become more disoriented, has memory loss. Physical exam normal, nursing staff report that pt has begun to have seizures. Blood lab testing shows no obvious etiology, neurodiagnostics show no suggestive findings. What most likely accounts for this presentation?
DIALYSIS DEMENTIA
FTD with mutation in chromosome 17 is assoc with abnormal intraneuronal deposition of which protein?
TAU
A doc meets with a pt and family to discuss treatment of pt’s mild Alzheimer’s disease. There are no other neurological or psychiatric symptoms or findings. The most appropriate course of action would be to:
BEGIN CHOLINESTERASE INHIBITOR TREATMENT
74 y/o, right-handed patient presents with significant memory loss, expressive aphasia, and left plantar extensor response. The most likely diagnosis is:
VASCULAR DEMENTIA
Earliest evidence of cell loss in pts with Alzheimer’s Dz typically occurs in which of the following areas of the brain?
ENTORHINAL CORTEX
74 y/o F suspicious, poor ADLs, personality changes, most likely dx:
PICK’S DISEASE
Protein mutation associated with Alzheimer disease in people younger than 60 yo
AMYLOID PRECURSOR
80 y/o pt w/ no prior psych hx, more forgetful, having difficulty with ADLs. However, pt is able to conduct routine social activities so that casual acquaintances don’t notice abnormalities. What is the dx?
ALZHEIMER DEMENTIA
Neurofibrillary tangles in Alzheimer’s are composed of:
HYPERPHOSPHORYLATED TAU PROTEINS
80 y/o Alzheimer’s with increasingly combative behavior. Family wants to keep at home. Give what medication?
HALDOL
Dementia characterized by personality change, attention deficit, impulsivity, affect lability, indifference, perseveration, and loss of executive function. Assoc. with dysfunction in what area of the brain?
FRONTAL LOBE
Early stage HIV type I associated dementia as compared to early onset dementia has which of the following deficits?
DECREASED PROCESSING SPEED
Which meds have best results for treating agitation in dementia?
ANTIPSYCHOTICS
Amyloid precursor protein in what cognitive disorder?
ALZHEIMER’S DZ
Most common cause of dementia in pts > 65 yrs of age:
ALZHEIMER’S DZ
Characteristic MRI scan finding in Alzheimer disease:
REDUCED HIPPOCAMPAL VOLUMES.
Known risk factors for dementia:
AGE, FAM HX, FEMALE, DOWN’S SYNDROME
Pt with vascular dementia typically has neuropathological changes assoc with:
BASAL GANGLIA
An 82-yo pt has falls, ophthalmoplegia, parkinsonism and progressive dementia. Autopsy shows:
TAU POSITIVE NEUROFIBRILLARY TANGLES
65 y/o is brought to the ED with disorientation and mild agitation, and is experiencing vivid VH of several children playing inside the house. Two similar episodes in the past, normal in between episodes. Normal language and memory, normal CN, mild symmetric rigidity and bradykinesia, no deficits. MRI, drug screen, CSF normal:
DEMENTIA WITH LEWY BODIES
A med that is most likely to slow the progression of vascular dementia:
ASPIRIN
Best rationale for using cholinesterase inhibitors in pts with Alzheimer:
TO REDUCE NEUROPSYCH SYMPTOMS
The most important tool for evaluation of early and moderate dementia:
MMSE
Dementia rather than depression in regards to memory has
NAMING DEFICITS (RATHER THAN IMPAIRED NONVERBAL INTELLIGENCE)
Bilat loss of neurons in the CA1 segment of the hippocampus is the most common histologic finding in patients with:
ALZHEIMER DEMENTIA
Patient is Alzheimer’s dementia in clinic. Patient’s daughter is frustrated with having to care for her mother more and is considering removing her from her church group because of it. What is the most initial response by the psychiatrist?
TELL HER TO CONTINUE GOING TO HER CHURCH GROUP
PET scan shows bitemporoparietal hypoperfusion in early stages of which dementia?
ALZHEIMERS
65 y/o pt brought in by family for gradual onset and very slow progression of mental confusion with respect to place and time, anomia, slowness of comprehension, neglect of personal hygiene and grooming, apathy, and alterations of personality and behavior, impairment of gait and upright stance, and prominent grasp and suck reflexes. Dx? The clock drawing test is a quickly administered and sensitive screen for:
FRONTOTEMPORAL DEMENTIA OR ALZHEIMER DEMENTIA
65 y/o high school grad has a MMSE score of 23, this score would suggest which of the following:
DEMENTIA, MILD COGNITIVE IMPAIRMENT
Individuals over 40yo with Down’s syndrome frequently develop:
ALZHEIMER’S DZ
HIV+ pt w/ memory loss, inattention, lack of motivation, & poor coordination. Normal LP. CT scan shows atrophy. MRI shows diffuse & confluent white matter changes in T2, w/o any mass effect or gadolinium enhancement. Dx?
HIV- ASSOCIATED DEMENTIA
Binswanger disease has pseudobulbar state, gait disorder, AND:
DEMENTIA
Clock drawing test is quickly administered and sensitive screen for which d/o?
ALZHEIMER’S DZ
Brain of football player who died by suicide has findings typical of chronic traumatic encephalopathy, what is most typical pathology for this behavior?
TAUPATHY
54yr old pt dies from rapidly progressing dementia associated with myoclonus, what is most likely finding at autopsy?
MICROVACUOLATION OF GLIA AND NEURONAL DENDRITES
Psych eval of 82 y/o F with memory loss (mostly working memory): she frequently calls for help with bathroom but will urinate on herself (staff feel pt is doing this to get back at them). Pt frustrated with staff because she feels the sudden need to void without much warning and wishes the staff would arrive sooner because she’s embarrassed about this. MSE significant only for mod memory loss, labs are normal. Which behavioral intervention should be attempted with pt?
SCHEDULE REGULAR VOIDING, INDEPENDENT OF PT REQUESTS, AND SUFFICIENTLY FREQUENT TO ELIMINATE THE ACCIDENTS
Which is important when working w/ family members who are caregivers to pts w/dementia?
Work w/fam should enhance effectiveness of care to pt.
What characterizes executive abilities in healthy individuals >65?
SHOW NO SIGNIFICANT CHANGE
Fluent speech w preserved comprehension, inability to repeat statements is consistent with what type of aphasia?
CONDUCTION
In normal aging, last cognitive abilities to decline
WORD KNOWLEDGE
Medicare pays for hospice care when a physician declares that a patient has a maximum life expectancy of how long?
6 MONTHS
Two days after bowel surgery, 53 y/o is delirious. Correctly draws a square when asked, but then continues to draw squares when asked to draw other shapes. MSE would reveal:
PERSEVERATION
Cancer patient on chemo is disoriented and agitated. Afebrile VSS. Neg neuro exam. Poor attention, cog impairment. Held for observation. CT neg, EEG diffuse slowing. Treat with:
HALDOL
78 y/o pt with Alzheimer’s dementia living with spouse and daughter, starting to accuse the spouse of infidelity. On evaluation, he asserts that the spouse is unfaithful. He is alert and acts congenially with the spouse, he is on donepezil. Labs and medical workup is unrevealing of any disorder outside of dementia. Next?
ARRANGE FOR REGULAR EVALUATIONS OF THE PT AND REASSURE THE FAMILY.
Family of 75 y/o pt is concerned about his safety b/c he has been forgetting to turn off stove. Psych MD suspects an evolving cognitive d/o. What is most likely to be the earliest impairment to occur in the pt?
INABILITY TO RECALL 3 WORDS AFTER A 3 MIN DELAY
85 y/o nursing home pt w/ hx of dementia being more confused and screaming “fire” whenever the light next to the bed is turned on. Next step?
URINALYSIS
Epigenetic drift has been postulated to contribute to what disorder?
LATE ONSET ALZHEIMER’S DISEASE
