Dementia

Question 1

core clinical criteria for dementia

Answer 1

cognitive/behavioral symptoms that:

1. interfere with the ability to function at work
2. represent decline from previous levels of functioning
3. not explained by delirium or major psychiatric disorder
4. cognitive impairment is detected and diagnosed through history taking and objective cognitive assessment
5. involves >/= 2 domains

Question 2

domains in core clinical criteria

Answer 2

1. impaired ability to acquire and remember new information
2. impaired reasoning and handling of complex tasks, poor judgment
3. impaired visuospatial abilities
4. impaired language functions
5. changes in personality, behavior, or comportment

Question 3

normal aging vs dementia

Answer 3

table 2

9 items

Question 4

potentially reversible causes of dementia

Answer 4

drugs
endocrinopathies
metabolic disorders
emotional depression
nutritional deficiencies
tumor/trauma
infection/infirmities of the senses
arteriosclerosis

Question 5

most frequent dementing disease

Answer 5

cerebral atrophy maiinly alzheimer but including lewy-body, parkinison, frontotemporal, and pick disease

Question 6

what is mild cognitive impairment

Answer 6

aka pre-dementia

• memory complaints that are mild and do not interfere with daily functioning but still disproportionate to patient’s age and education
• normal process of aging

Question 7

treatment for pre-dementia

Answer 7

observe, cholinesterase inhibitors

Question 8

definition of alzheimer’s disease

Answer 8

neurodegenerative disease characterized by a clinical dementia with prominent memory impairment and specific microscopic pathology including senile plaques and neurofibrillary tangles

Question 9

treatment for alzheimer’s disease

Answer 9

cholinesterase inhibitors for mild, moderate, and severe AD

memantine for moderate and severe AD

Question 10

NIA-AA cirteria: probable ad dementia

Answer 10

insidious onset, gradual

clear cut history of worsening condition

Question 11

NIA-AA criteria: probably ad dementia categories

Answer 11

amnestic presentation (most common, learning and recall impairment)
non-amnestic presentation (language, word finding)
visuospatial presentation (spatial cognition)
executive dysfunction (impaired reasoning, judgment, and problem solving)

Question 12

NIA-AA criteria: probable ad dementia with increased level of certainty

Answer 12

probable ad dementia with documented decline on subsequent evaluations
probably ad dementia in a carrier of causative ad genetic mutation

Question 13

NIA-AA criteria: possible ad dementia

Answer 13

atypical course: meets the core clinical criteria, sudden onset or insufficient historical detail

etiologically mixed presentation: meets all core criteria but has (1) cerebrovascular disease (2) dementia with lewy bodies ( 3) other neurological disease/medication

Question 14

DSM 5 criteria for AD

Answer 14

• meet criteria for major or minor neurocognitive disorder
• insidious onset
• not explained by other diseases

Question 15

DSM 5 criteria for major neurocognitive disorder

Answer 15

probable AD: 2 present, possible AD: 1 present

1 evidence of a causative ad genetic mutation
2a clear decline in memory and learning
2b steadily progressive, gradual decline in cognition
2c no evidence of mixed etiology

Question 16

DSM 5 criteria for mild neurocognitive disorder

Answer 16

probable ad: evidence of causative ad genetic mutation
possible ad: no evidence of a causative ad mutation and ALL 3 PRESENT
- clear evidence of decline in memory and learning
- progressive, gradual decline
- no evidence of mixed etiology

Question 17

features of familial alzheimer

Answer 17

earlier onset (<65 yo)
associated with asynchronous myoclonus, epilepsy, aphasia, paratonia

Question 18

genetic defect in familial alzheimer

Answer 18

amyloid precursor protein
presenilin 1
presenilin 2

Question 19

main pathology of AD

Answer 19

amyloid neurotoxicity

Question 20

factors related to amyloid neurotoxicity

Answer 20

apo e: modifies formation of plaques (apo e2 is PROTECTIVE)
apo e4: elevated serum ldl, results in inadequate clearance of ab 42 promoting amyloid toxicity
tau protein: promotes microtubule assembly and structure

Question 21

typical locations of reduced brain weight

Answer 21

bilateral hippocampal or medial temporal lobes

Question 22

patho hallmarks of AD

Answer 22

neurofibrillary tangles and neuritic plaques in parietal lobe

granulovacular degeneration of neurons (pyramidal layer)

Question 23

what are neurofibrillary tangles

Answer 23

helical filaments composed of hyperphosphorylated microtubular protein (tau)

Question 24

what are neuritic plaques

Answer 24

spherical deposits composed of amyloid (B amyloid) surrounded by degenerating nerve terminals

Question 25

cholinergic therapies available

Answer 25

choline, lecithin muscarininc cholinergic agonist drugs cholinesterase inhibitors

Question 26

cholinesterase inhibitors availbale

Answer 26

donepezil, rivastigmine, galantamine GI side effects are most common

Question 27

nmda receptor antagonists

Answer 27

moa: vs glutamic acid memantine

Question 28

current recommended practice for AD treatement

Answer 28

mid/early stage: cholinesterase inhibitor mild to mod stage: cholinesterase inihibitor or nmda antagonist or both severe late stage: both

Question 29

definition of vascular dementia

Answer 29

cognitive decline in the setting of cerebrovascular disease | - cognitive impairment is early with deficits in executive dysfunction

Question 30

proposed mechanism critically located single infarcts

Answer 30

MCA: severe aphasia with additional cognitive impairment PCA: amnesia with bilateral inferomedial temporal or thalamic damage ACA: abulia, memory impairment or language disturbance MCA: acute confusion or psychosis with non-language dominant parietal lobe damage

Question 31

symptoms of binswanger disease

Answer 31

``` abulia abnormal behavior pseudobulbar palsy pyramidal signs disturbed gait urinary incontinence ```

Question 32

features of lewy body dementia

Answer 32

dementia, visual hallucinations, parkinsonism, and rem sleep behavior disorder

Question 33

treatment for lewy body dementia

Answer 33

cholinesterase inhibitors

Question 34

most common differential diagnoses for lewy body dementia

Answer 34

alzheimer's disease and mixed dementia

Question 35

dementia with lewy bodies vs parkinson's disease dementia

Answer 35

DLB: cognitive impairments are coincident with or appear within 1 year of the motor signs PDD: cognitive decline occurs in the course of well established parkinson disease

Question 36

core features of dementia with lewy bodies

Answer 36

fluctuating cognition visual hallucinations spontaneous features of parkinsonism

Question 37

suggestive features of dementia with lewy bodies

Answer 37

REM sleep behavior disorder sever neuroleptic sensitivity low dopamine transporter uptake in basal ganglia (SPECT/PET)

Question 38

probably and possible dementia with lewy bodies

Answer 38

probable: >/= 1 suggestive + core feature possible: >/=1 suggestive

Question 39

patho in dementia with lewy bodies

Answer 39

- (neuron loss) neurodegeneration associated with abnormal a-synuclein metabolism + formation of lewy bodies - neuronal loss in substantia nigra (dopamine) and nucleus basalis of meynert (acetylcholine)

Question 40

treatment for dementia with lewy bodies

Answer 40

``` cholinesterase inhibitors (rivastigmine, donepezil) memantine (namenda) SSRI (sertaline and escitalopram) dopaminergic agents (levodopa/carbidopa) atypical antipsychotics (quetiapine) ```

Question 41

definition of frontotemporal dementia

Answer 41

progressive neurodegenerative disorder with - behavioral or frontal variant frontotemporal dementia* - semantic variant primary progressive aphasia - non-fluent/agrammatic variant primary progressive aphasia

Question 42

symptoms of behavioral variant frontotemporal dementia

Answer 42

at least 3 - early behavioral dishibition - early apathy or inertia - early loss of sympathy or empathy - early perservative, stereotypes, or compulsive/ritualistic behavior - hyperorality and dietary changes - executive or generation deficits with relative sparing of memory and visuospatial functions

Question 43

seven pathologies of frontotemporal dementia

Answer 43

pick's disease (tau- and ubiquitin positive spherical inclusions) familial ftd with tau positive inclusions argyrophilic grain disease ubiquitin positive inclusions tdp-43 immunoreactive inclusions neuronal filament inclusions

Question 44

treatment of frontotemporal dementia

Answer 44

management of symptoms | SSRIs (sertaline, citaloprams, escitalopram) and atypical antipsychotics