Dementia - Aziz Flashcards
(98 cards)
1
Q
older patients will exhibit which symptoms first?
A
memory loss
2
Q
younger pts in the late 40s to 50s will exhibit which symptoms first?
A
changes in behavior and personality
3
Q
What part of the brain atrophies in dementia?
A
frontal atrophy
4
Q
What does HMPAO SPECT scans show of a brain with dementia?
A
hypoperfusion in the areas of atrophy
5
Q
Are the acts of finding and recognizing words the same act?
A
no, two different acts
6
Q
Dementia is a decline of…
A
cognition
7
Q
What are some of the aspects of cognition beyond memory?
A
executive function
8
Q
Most actions happen in which half of the brain while perceptions happen in which half?
A
actions in front
perceptions in back
9
Q
Association is (uni/multi)modal
A
unimodal
10
Q
T/F: all types of dementia affect the frontal lobe
A
false
11
Q
Temporal lobe dementia indicates…..
A
deeper and usually alzheimers
12
Q
Hippocampal dementia affects…
A
short term memory
13
Q
Frontal-temporal dementia on the (right/left) can lead to broca’s and wernicke’s
A
left
14
Q
Broca’s, wernicke’s, Auditory association cortex, somatosensory association, and visual association are all (uni/multi)modal areas
A
unimodal
15
Q
What parts of the brain are used in cognition, emotion, and behavior?
A
thalamus
basal ganglia
pons
cerebellum
16
Q
T/F: dementia is a purely cortical problem
A
false
17
Q
what is the function of the caudate nucleus? what is it a part of?
A
controls movement
part of basal ganglia
18
Q
What is the function of the nucleus accumbens?
A
processes motivation, pleasure, and reward.
part of the basal ganglia
19
Q
what are the descending pathways from the cortex involved in cognition?
A
- cortex to pons to cerebellum
2. cortex to basal ganglia
20
Q
What are the ascending pathways involved in cognition?
A
- cerebellum to thalamus to cortex
2. basal ganglia to thalamus to cortex
21
Q
what are the cognitive domains tested in dementia?
A
Memory (Episodic, Attention Executive function (working memory, mental flexibility, inhibition, fluency, abstract reasoning). Language Visuospatial abilities Behavior assessment Functional status
22
Q
What are the two most commonly used neuropsych screening tests?
A
MMSE
MOCA
23
Q
What is MILD cog impairment?
A
doesn’t interfere with ADLs; not severe enough to meet dementia criteria
24
Q
mild cog impairment is in one or multiple domains?
A
single OR multiple
25
80% of pts with MCI convert to dementia in what time period?
6 years
26
What are the risk factor for progression from MCI to dementia?
Apolipoprotein E e4 allelle
poor performance on semantic cueing memory test
reduced hippocampal volumes
27
Mild cogntive impairment shows the impairment how during assessment?
can drive, handle money, etc, but when you stress them out you see that they are not normal for their age
28
What is dementia?
PROGRESSIVE deterioration of cognitive function; IMPAIRMENT of social and occupational skills
29
What is the pathophys of dementia?
relentless brain tissue loss due to multiple degnerative processes
30
If the loss of function happens in days to weeks, then you don't have dementia but....
delirum
31
Dysfunction in dementia occurs at what level?
the neuronal level
32
Describe the histological changes to the neurons in dementia?
accumulation of protein inside of the cells
neuronal loss
affected glial cells
neurons become swollen and redundant
33
Neuronal loss in dementia is often secondary to...
protein dysfunction
34
What are the neurodegenerative types of dementia?
```
Alzheimer dementia
Dementia with Lewy Bodies
Frontotemporal dementia
Vascular dementia
Parkinson Disease Dementtia
Corticobasalar degeneration
Normal Pressure Hydrocephalus
```
35
Alzheimer's typically have what types of problems?
memory
36
What are the risk factors for Alzheimer's?
```
Age
female
low level of education
Down syndrome
head trauam
ApoE e4
Genetic: APP, PS1, PS2
CV factors: HTN, hypercholesterolemia, sendentary lifestyle
```
37
t/F; Alzheimer's has modifiable and non-modifiable risk factors
true
38
what areas of the brain are heteromodal association areas?
prefrontal cortex
part of the temporal lobe
heteromodal means that they take somatosensory, visual, audio, and combine it all together to analyze it, while a unimodal just looks at one sense and what to do with it
39
the language area of the right temporal lobe is responsible for what?
emotion of language and prosody
40
the anterior nuclei of the thalamus have what function?
involved in emotion
| VA and mediodorsal groups are the main ones for behavior and cognition
41
which neurotransmitter in which brain structure is essential for LTP?
glutamate in the hippocampus
42
which neurotransmitter is used in the basal forebrain?
ACh
43
Accumulation of plaques in Alzheimers is (intercellular/interstitial)
interstitial
44
What is the protein that makes up the plaques?
Myeloid beta protein
45
what type of meyloid beta protein the abnormal protein?
AB42
46
neurofirbrillary tangles are (intraneruonal/interstitial) pathology
intraneuronal!
47
Alzheimer's Dx needs impairment in two domains, one of which must be...
memory
48
What are the "cognitive" disturbances that must be present along with memory issues for Alzheimer's dx?
aphasia
apraxia
agnosia
distrubed executive function
49
What are the components of an initial demential eval?
```
CBC
Glucose, electrolytes, BUN/creatinine, LFTs
Serum B12
Thyroid function
Noncontrast CT or MRI
Depression Screening
```
50
T/F: dementia is often related to vascular issues
true
51
what are the screening tests not recommended?
```
Syphilis
EEG
LP
linear or volumetric MR or CT
SPECT
APOE-e4 genotyping
```
52
What are the exceptions for an indicated LP in dementia screening?
mets
CNS infx
Hydrocephalus
<55 yo onset/unusual dementia
53
What tests have insufficient evidence to support or refute them?
PET
genetic markers for AD
CSF or other biomarkers for AD
54
ApoE gene is found on which csome?
19
55
T/F: ApoE-e4 allele add substantially to Dx confidence
false; not recommended for routine screening
56
what are the three phases of AD?
presymptomatic
Symptomatic (MCI)
Dementia
57
What are the changes that you see in the presymptomatic phase of AD?
changes in biomarkers
58
what changes do you see in the symptomatic phase of AD?
MCI
59
What changes do you see in the dementia phase of AD?
insidious onset over months to years
| cognitive decline
60
What are the markers of Amyloid-B accumulation?
CSF AB1-42
| PET amyloid imaging
61
What are the markers of neuronal injury or degeneration?
1. CSF phosphorylated tau and total tau
2. imaging markers of synaptic dysfunction
3. imaging markers of neuronal loss and atrophy
62
Where should tau protein be located normally?
inside the cell; leaks outside of the cell during neuronal damage
63
what is the first biomarker to show large change in AD?
Amyloid-B accumulation
64
is amyloid protein high or low in the CSF?
LOW
65
What are the cholinesterase inhibitors for AD?
Donepizil
Glantamine
Rivastigamine
66
What are the SE of the cholinesterase inhibitors?
N/V
diarrhea
vivid dreams
67
What is the non-cholinesterase inhibitor for AD?
Memantine
68
What are the SE for Memantine?
confusion
HA
dizziness
69
AD is associated with decreased (blank) activity
cholinergic
70
glutamate is released in a (tonic/phasic) manner
phasic
71
Increased (tonic/phasic) glutamate triggers NMDA receptor activation
TONIC
72
tonic glutamate activating NMDA receptors leads to....
toxiciity
73
what is the MOA of memantine?
NMDA inhibitor
74
In what severities of dementia can you use memantine?
moderate to severe
75
T/F: memantine OD can cause glutamate excitotoxicity
false; prevents it!
76
what are the side effects of memantine?
```
dizziness
confusion
HA
constipation
but similar to placebo
```
77
What is primary prevention of dementia?
no dementia present and doing things to keep it from ever happening
78
what is the most important factor in primary dementia prevention?
middle aged BP needs to be tightly controlled
79
what is secondary prevention of dementia?
limit progression of already present dementia
80
What are the preventative measures against dementia/
```
1ry prevention
2ry prevention
diet
exercise
intellectual activities
management of CVD risk factors
```
81
What is the best prevention against dementia?
taking vascular protection
82
what are the vascular protective factors against dementia?
```
exercise (walk >2 miles per day)
high fish/DHA, low sat. fat
green tea
red wine and modest alcohol
Mediterranean diet
```
83
what is the average survival from AD onset to death?
4 years
84
As you get older, what happens to your survival time after AD onset?
goes down
85
```
what is this?
lack of insight
hyperorality
apathy
irritability
disinhibition
lack of empathy
rudeness
```
Behavioral Variant Frontal Temporal Dementia
86
What is this?
speech is fluent, effortless, and grammatically correct, but word finding difficulty = empty speech, naming deficits, and loss of word knowledge
Semantic Variant f Frontotemporal dementia
87
What is this?
| agrammatism, speech apraxia, word finding difficulties, speech slow, effortful, and sometimes telegraphic
progressive nonfluent aphasia frontotemporal dementia
88
The genetics for frontotemporal dementia are on which two chromosomes?
17 and 9
89
What proteins are involved in frontotemporal dementia?
taupathy
| TDP-43 proteinopathy
90
T/F: vascular dementia may arise from single or multiple ischemic infarcts
true
91
Where must the single ischemic infarcts happen to cause vascular dementia?
Caudate nucleus
Hippocampi
Paramedian thalamus
Rt. parietal lobe
92
T/f: cerebral hemorrhage can cause vascular dementia
true
93
Lacunar states and Binswanger's disease are states of extensive (blank) damage
microvascular
94
What are the three types of hereditary vascular disease?
CADASIL
MELAS
Fabry's disease
95
Vascular dementia can result from (hyper/hypo)perfusion injuries, vasculitis, and other angiopathies
hypoperfusion injury
96
what are the three types of fibers in the white matter?
association: short
projection: body to brain
commisural: side to side
97
What type of dementia is this?
fluctuating cognition/alertness
recurrent visual hallucinations
spontaneous motor symptoms of parkinsonims
Dementia with lewy bodies
98
What is the MRI like in dementia with lewy bodies?
normal OR whole brain atrophy
