Dementias

Question 1

what is the pathophysiology behind Alzheimer’s

Answer 1

• neuritic plaques
• neurofibrillary tangles
• decreased Ach

Question 2

what is one of the first areas of the brain affected in Alzheimer’s

Answer 2

hippocampus

Question 3

___ is when one is unaware of their own mental health condition

Answer 3

anosognosia

Question 4

Pt presents with apraxia, olfactory dysfunction, sleep disturbances, and visuospatial deficits.
What do you suspect?

Answer 4

Alzheimer’s

Question 5

In Alzheimer’s, slight issues with recent memory suggests ___ progression

Answer 5

mild

Question 6

In Alzheimer’s, having impaired language, confusion, mild apraxia, and visuospatial suggests ___ progression

Answer 6

moderate

Question 7

In Alzheimer’s, having delusions, disinhibition, and wandering suggests ___ progression

Answer 7

severe

Question 8

how would you assess a patient’s cognition

Answer 8

MMSE, MoCA, SLUMS

Question 9

Tx of mild-moderate dementia

Answer 9

Cholinesterase inhibitors

• Donepezil (Aricept)
• Rivastigmine (Exelon)
• Galantamine (Razadyne)

Question 10

Tx for moderate-severe dementia

Answer 10

NMDA receptor antagonist

- Namenda

Question 11

Tx for neuropsychiatric Sx

Answer 11

• antidepressants (Celexa)
• antiseizure (Depakote)
• AVOID BENZOs
• antipsychotics last resort

Question 12

2nd most common form of dementia?

Answer 12

Vascular dementia (multi-infarct)

Question 13

VaD from cortical infarct - presentation?

Answer 13

• stepwise/fluctuant decline
• speech difficulty
• trouble with tasks
• executive dysfunction

Question 14

VaD from subcortical (lacunar) infarct - presentation?

Answer 14

• gait dysfunction
• personality & mood changes
• urinary frequency/urgency
• cognitive dysfunction

(more subtle)

Question 15

VaD Tx

Answer 15

Ach-ase inhibitors

- donepezil, galantamine, rivastigmine

Question 16

____ is a neurodegenerative disease characterized by dementia with or preceding parkinsonian Sx

Answer 16

Lewy Body Dementia (LBD)

Question 17

early impairments of LBD

Answer 17

• attention
• executive function
• visuospatial function

Question 18

Pt must have 2 of what 3 clinical features to have LBD

Answer 18

• cognitive fluctuations
• visual hallucinations
• parkinsonism

Question 19

first-line Tx for LBD

Answer 19

cholinesterase inhibitors – Exelon (PO or patch)

Question 20

differentiate between clinical presentation of pseudodementia and real dementia

Answer 20

• depressed = “I don’t know”
  (dementia = act like they know)
• depressed = emphasize failure
  (dementia = delight in accomplishments)
• depressed = complain about memory issues
  (dementia = cover up memory probs)

Question 21

frontotemporal dementia is the degeneration of the frontal/temporal lobes characterized by changes in _____, _____, _____

Answer 21

• personality
• language
• behavior

Question 22

Pt presents with disinhibition, apathy/loss of empathy, hyperorality, and compulsive behaviors.

… Dx?

Answer 22

frontotemporal dementia - behavioral variant

Question 23

Pt presents with difficulty articulating words, halting speech, distortion, and agrammatism.

… Dx?

Answer 23

frontotemporal dementia - nonfluent variant PPA

Question 24

pt presents with impaired single word comprehension & object naming as well as mispronouncing of words.

… Dx?

Answer 24

frontotemporal dementia - semantic variant PPA

Question 25

pt presents with impaired single word retrieval & repetition, errors in naming, and lack descriptive detail.

… Dx?

Answer 25

frontotemporal - Logopenic variant PPA

Question 26

Tx for frontotemporal dementia

Answer 26

• SSRI trial
• atypical antipsychotic trial

(cholinesterase inhibitors dont help)

Question 27

Tx for HIV-associated dementia

Answer 27

• antiretroviral therapy

must penetrate CNS well