Dementia/MCI

Question 1

Approximately ___% of people over age 65 have symptoms consistent with AD.

Answer 1

10%, the rates double every 4-5 years

Question 2

Percentage of people double every ____ years.

Answer 2

4-5 years

Question 3

Average age of diagnosis is ____.

Answer 3

75

Question 4

By age 85, about ___% of individuals have AD.

Answer 4

50%

Question 5

African Americans are ____ as likely to develop AD compared to whites.

Answer 5

twice; moderated by increased prevalence of related medical conditions, access to/utilization of health care, and quality of education

Question 6

Latin/x are ____ as likely to develop AD compared to whites

Answer 6

1.5x; moderated by increased prevalence of related medical conditions, access to/utilization of health care, and quality of education

Question 7

About ___% of sporadic AD and ___% have familial AD.

Answer 7

95%; 5% (between ages 40-60)

Question 8

APOE e4 on chromosome 19 is involved in what?

Answer 8

breaking down the amyloid precursor protein (APP); less effective than other alleles, which is why individuals with the APOE e4 allele may be at higher risk for AD given higher risk for beta-amyloid plaques.

Question 9

Normal breakdown of the APP involves __- and __-secretase.

Answer 9

alpha and gamma

Question 10

Abnormal breakdown of APP can involve what?

Answer 10

beta

Question 11

PSEN-1 and PSEN-2 are associated with which secretase enzyme?

Answer 11

gamma; abnormal breaking down of the APP (different location) causing clumping, even sticker than when broken down with beta secretase

Question 12

Trisomy 21 is associated with increased risk of AD, why?

Answer 12

the extra chromosome 21 is associated with greater expression of APP, which may explain why there may be higher accumulation of beta amyloid.

Question 13

Clinical diagnosis of AD is ___% accurate

Answer 13

85-90%

Question 14

Clinical diagnosis of AD includes (neuroimaging, etc.):

Answer 14

MRI, biomarker/blood chemistry studies, neurodiagnostic workup, neurologic exam, and neuropsychological evaluation (with good clinical history)

PET amyloid scans have been shown to be effective as well, but can yield false positive, as this can be found in normal brains.

Question 15

The progression of AD:

- length of illness (in years)

Answer 15

range 2-20 years; average 7-10 years

Question 16

What are the 4 domains of MCI?

Answer 16

amnestic, single domain
amnestic, multiple domains
non-amnestic, single domain
non-amnestic, multiple domains

Question 17

Symptoms of AD in stage 1 (1-3 years)

Answer 17

worsening of recent memory, learning problems, decline in initiation/apathy, social isolation, dysnomia, anosognosia

Question 18

Symptoms of AD in stage 2 (2-10 years)

Answer 18

Amnesia, aphasia, visuospatial difficulties (commonly topographical disorientation), personality/emotional changes (guardedness/suspiciousness)
Neuroimaging may show significant ventricular dilation and enlarged sulci.

Question 19

Symptoms of AD in stage 3 (8-12 years)

Answer 19

Severe dementia, global aphasia, and mutism; sleep disturbance and behavioral disturbance (hallucinations and nighttime wandering)
Leads to severe dementia and complete dependence

Question 20

End stage of AD:

Answer 20

may be nonambulatory, noncommunicative, increased difficulty chewing and swallowing; increased vulnerability to pneumonia (most AD patients die from pneumonia).

Question 21

The largest known risk factor of AD

Answer 21

age

Question 22

___% of those with MCI go on to develop a dementia, most of them AD

Answer 22

10%

Question 23

Pure VaD occurs in ___% of cases.

Answer 23

3% Most are mixed/comorbid

Question 24

Mixed pathology was found in ___% of VaD cases

Answer 24

77%; majority are VaD + AD

Question 25

The most common domains if cognitive impairment associated with VaD

Answer 25

executive dysfunction, slowed processing speed, and impaired attention

Question 26

Approximately ___% of individuals with VCI go on to develop VaD.

Answer 26

12%

Question 27

A patient presents with slowed gait, frequent falls, swallowing problems, and blurry vision. Differential diagnosis?

Answer 27

Parkinson’s disease; progressive nuclear palsy (FTD motor variant)

blurry vision can be a sign of vertical gaze palsy

Question 28

A patient presents with problems coordinating movement to pour a glass of water in their right hand, but not left. Differential diagnosis?

Answer 28

Corticobasal syndrome

Question 29

A patient has a raw score of 6 on the Boston Naming Test. Differential?

Answer 29

Semantic dementia (naming and visuospatial component)
less: logopenic, Alzheimer

Question 30

What is most associated with ALS?

Answer 30

FTD-MND