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Block 8 Week 5 Colt > Dementia - Aziz > Flashcards

Dementia - Aziz Flashcards

1
Q

older patients will exhibit which symptoms first?

A

memory loss

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2
Q

younger pts in the late 40s to 50s will exhibit which symptoms first?

A

changes in behavior and personality

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3
Q

What part of the brain atrophies in dementia?

A

frontal atrophy

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4
Q

What does HMPAO SPECT scans show of a brain with dementia?

A

hypoperfusion in the areas of atrophy

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5
Q

Are the acts of finding and recognizing words the same act?

A

no, two different acts

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6
Q

Dementia is a decline of…

A

cognition

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7
Q

What are some of the aspects of cognition beyond memory?

A

executive function

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8
Q

Most actions happen in which half of the brain while perceptions happen in which half?

A

actions in front

perceptions in back

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9
Q

Association is (uni/multi)modal

A

unimodal

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10
Q

T/F: all types of dementia affect the frontal lobe

A

false

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11
Q

Temporal lobe dementia indicates…..

A

deeper and usually alzheimers

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12
Q

Hippocampal dementia affects…

A

short term memory

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13
Q

Frontal-temporal dementia on the (right/left) can lead to broca’s and wernicke’s

A

left

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14
Q

Broca’s, wernicke’s, Auditory association cortex, somatosensory association, and visual association are all (uni/multi)modal areas

A

unimodal

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15
Q

What parts of the brain are used in cognition, emotion, and behavior?

A

thalamus
basal ganglia
pons
cerebellum

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16
Q

T/F: dementia is a purely cortical problem

A

false

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17
Q

what is the function of the caudate nucleus? what is it a part of?

A

controls movement

part of basal ganglia

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18
Q

What is the function of the nucleus accumbens?

A

processes motivation, pleasure, and reward.

part of the basal ganglia

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19
Q

what are the descending pathways from the cortex involved in cognition?

A
  1. cortex to pons to cerebellum

2. cortex to basal ganglia

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20
Q

What are the ascending pathways involved in cognition?

A
  1. cerebellum to thalamus to cortex

2. basal ganglia to thalamus to cortex

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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
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22
Q

What are the two most commonly used neuropsych screening tests?

A

MMSE

MOCA

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23
Q

What is MILD cog impairment?

A

doesn’t interfere with ADLs; not severe enough to meet dementia criteria

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24
Q

mild cog impairment is in one or multiple domains?

A

single OR multiple

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25
Q

80% of pts with MCI convert to dementia in what time period?

A

6 years

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26
Q

What are the risk factor for progression from MCI to dementia?

A

Apolipoprotein E e4 allelle
poor performance on semantic cueing memory test
reduced hippocampal volumes

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27
Q

Mild cogntive impairment shows the impairment how during assessment?

A

can drive, handle money, etc, but when you stress them out you see that they are not normal for their age

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28
Q

What is dementia?

A

PROGRESSIVE deterioration of cognitive function; IMPAIRMENT of social and occupational skills

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29
Q

What is the pathophys of dementia?

A

relentless brain tissue loss due to multiple degnerative processes

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30
Q

If the loss of function happens in days to weeks, then you don’t have dementia but….

A

delirum

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31
Q

Dysfunction in dementia occurs at what level?

A

the neuronal level

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32
Q

Describe the histological changes to the neurons in dementia?

A

accumulation of protein inside of the cells
neuronal loss
affected glial cells
neurons become swollen and redundant

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33
Q

Neuronal loss in dementia is often secondary to…

A

protein dysfunction

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34
Q

What are the neurodegenerative types of dementia?

A 
Alzheimer dementia
Dementia with Lewy Bodies
Frontotemporal dementia
Vascular dementia
Parkinson Disease Dementtia
Corticobasalar degeneration
Normal Pressure Hydrocephalus
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35
Q

Alzheimer’s typically have what types of problems?

A

memory

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36
Q

What are the risk factors for Alzheimer’s?

A 
Age
female
low level of education
Down syndrome
head trauam
ApoE e4
Genetic: APP, PS1, PS2
CV factors: HTN, hypercholesterolemia, sendentary lifestyle
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37
Q

t/F; Alzheimer’s has modifiable and non-modifiable risk factors

A

true

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38
Q

what areas of the brain are heteromodal association areas?

A

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

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39
Q

the language area of the right temporal lobe is responsible for what?

A

emotion of language and prosody

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40
Q

the anterior nuclei of the thalamus have what function?

A

involved in emotion

VA and mediodorsal groups are the main ones for behavior and cognition

41
Q

which neurotransmitter in which brain structure is essential for LTP?

A

glutamate in the hippocampus

42
Q

which neurotransmitter is used in the basal forebrain?

A

ACh

43
Q

Accumulation of plaques in Alzheimers is (intercellular/interstitial)

A

interstitial

44
Q

What is the protein that makes up the plaques?

A

Myeloid beta protein

45
Q

what type of meyloid beta protein the abnormal protein?

A

AB42

46
Q

neurofirbrillary tangles are (intraneruonal/interstitial) pathology

A

intraneuronal!

47
Q

Alzheimer’s Dx needs impairment in two domains, one of which must be…

A

memory

48
Q

What are the “cognitive” disturbances that must be present along with memory issues for Alzheimer’s dx?

A

aphasia
apraxia
agnosia
distrubed executive function

49
Q

What are the components of an initial demential eval?

A 
CBC
Glucose, electrolytes, BUN/creatinine, LFTs
Serum B12
Thyroid function
Noncontrast CT or MRI
Depression Screening
50
Q

T/F: dementia is often related to vascular issues

A

true

51
Q

what are the screening tests not recommended?

A 
Syphilis
EEG
LP
linear or volumetric MR or CT
SPECT
APOE-e4 genotyping
52
Q

What are the exceptions for an indicated LP in dementia screening?

A

mets
CNS infx
Hydrocephalus
<55 yo onset/unusual dementia

53
Q

What tests have insufficient evidence to support or refute them?

A

PET
genetic markers for AD
CSF or other biomarkers for AD

54
Q

ApoE gene is found on which csome?

A

19

55
Q

T/F: ApoE-e4 allele add substantially to Dx confidence

A

false; not recommended for routine screening

56
Q

what are the three phases of AD?

A

presymptomatic
Symptomatic (MCI)
Dementia

57
Q

What are the changes that you see in the presymptomatic phase of AD?

A

changes in biomarkers

58
Q

what changes do you see in the symptomatic phase of AD?

A

MCI

59
Q

What changes do you see in the dementia phase of AD?

A

insidious onset over months to years

cognitive decline

60
Q

What are the markers of Amyloid-B accumulation?

A

CSF AB1-42

PET amyloid imaging

61
Q

What are the markers of neuronal injury or degeneration?

A
  1. CSF phosphorylated tau and total tau
  2. imaging markers of synaptic dysfunction
  3. imaging markers of neuronal loss and atrophy
62
Q

Where should tau protein be located normally?

A

inside the cell; leaks outside of the cell during neuronal damage

63
Q

what is the first biomarker to show large change in AD?

A

Amyloid-B accumulation

64
Q

is amyloid protein high or low in the CSF?

A

LOW

65
Q

What are the cholinesterase inhibitors for AD?

A

Donepizil
Glantamine
Rivastigamine

66
Q

What are the SE of the cholinesterase inhibitors?

A

N/V
diarrhea
vivid dreams

67
Q

What is the non-cholinesterase inhibitor for AD?

A

Memantine

68
Q

What are the SE for Memantine?

A

confusion
HA
dizziness

69
Q

AD is associated with decreased (blank) activity

A

cholinergic

70
Q

glutamate is released in a (tonic/phasic) manner

A

phasic

71
Q

Increased (tonic/phasic) glutamate triggers NMDA receptor activation

A

TONIC

72
Q

tonic glutamate activating NMDA receptors leads to….

A

toxiciity

73
Q

what is the MOA of memantine?

A

NMDA inhibitor

74
Q

In what severities of dementia can you use memantine?

A

moderate to severe

75
Q

T/F: memantine OD can cause glutamate excitotoxicity

A

false; prevents it!

76
Q

what are the side effects of memantine?

A 
dizziness
confusion
HA
constipation
but similar to placebo
77
Q

What is primary prevention of dementia?

A

no dementia present and doing things to keep it from ever happening

78
Q

what is the most important factor in primary dementia prevention?

A

middle aged BP needs to be tightly controlled

79
Q

what is secondary prevention of dementia?

A

limit progression of already present dementia

80
Q

What are the preventative measures against dementia/

A 
1ry prevention
2ry prevention
diet
exercise
intellectual activities
management of CVD risk factors
81
Q

What is the best prevention against dementia?

A

taking vascular protection

82
Q

what are the vascular protective factors against dementia?

A 
exercise (walk >2 miles per day)
high fish/DHA, low sat. fat
green tea
red wine and modest alcohol
Mediterranean diet
83
Q

what is the average survival from AD onset to death?

A

4 years

84
Q

As you get older, what happens to your survival time after AD onset?

A

goes down

85
Q 
what is this?
lack of insight
hyperorality
apathy
irritability
disinhibition
lack of empathy
rudeness
A

Behavioral Variant Frontal Temporal Dementia

86
Q

What is this?
speech is fluent, effortless, and grammatically correct, but word finding difficulty = empty speech, naming deficits, and loss of word knowledge

A

Semantic Variant f Frontotemporal dementia

87
Q

What is this?

agrammatism, speech apraxia, word finding difficulties, speech slow, effortful, and sometimes telegraphic

A

progressive nonfluent aphasia frontotemporal dementia

88
Q

The genetics for frontotemporal dementia are on which two chromosomes?

A

17 and 9

89
Q

What proteins are involved in frontotemporal dementia?

A

taupathy

TDP-43 proteinopathy

90
Q

T/F: vascular dementia may arise from single or multiple ischemic infarcts

A

true

91
Q

Where must the single ischemic infarcts happen to cause vascular dementia?

A

Caudate nucleus
Hippocampi
Paramedian thalamus
Rt. parietal lobe

92
Q

T/f: cerebral hemorrhage can cause vascular dementia

A

true

93
Q

Lacunar states and Binswanger’s disease are states of extensive (blank) damage

A

microvascular

94
Q

What are the three types of hereditary vascular disease?

A

CADASIL
MELAS
Fabry’s disease

95
Q

Vascular dementia can result from (hyper/hypo)perfusion injuries, vasculitis, and other angiopathies

A

hypoperfusion injury

96
Q

what are the three types of fibers in the white matter?

A

association: short
projection: body to brain
commisural: side to side

97
Q

What type of dementia is this?
fluctuating cognition/alertness
recurrent visual hallucinations
spontaneous motor symptoms of parkinsonims

A

Dementia with lewy bodies

98
Q

What is the MRI like in dementia with lewy bodies?

A

normal OR whole brain atrophy

Block 8 Week 5 Colt (12 decks)

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