Dementias (Denburg)

Question 1

____ in layers ____&____ disconnect hippocampi from association and limbic cortices, disrupting input and output communication entirely and rendering a person unable to lay down new memories.

Answer 1

NFTs; layers II and IV

Question 2

form an extracellular disruption between functioning neurons to block communication

Answer 2

neuritic plaques

Question 3

_____ concentration is highest (while ______ concentration is lowest) in entorhinal cortex

Answer 3

NFTs; neuritic plaques

Question 4

these two processes have a synergistic effect on one another, ultimately leading to neuronal dysfunction and dementia

Answer 4

ß-amyloid production and vascular insufficiency

Question 5

Which of the following is the #1 modificable risk factor for developing vascular dementia?

A. Hypertension

B. Heart disease

C. Diabetes

D. High BMI

E. Smoking

Answer 5

C. Diabetes is #1 and smoking is #2.

Question 6

this has been proposed to be the most robust measure of cognitive reserve across the lifespan

Answer 6

education

*people with higher cognitive reserve don’t seem to manifest the negative clinical symptoms of Alzheimer’s in the same way

Question 7

Which of the following is NOT a gene identified in the pathogenesis of Alzheimer’s disease?

A. BACE

B. PS1

C. PS2

D. APOE4

E. APP

Answer 7

A. This is an enzyme that cleaves ß-Amyloid from APP.

Question 8

Which of the following is NOT a diagnostic criteria for Alzheimer’s?
A. Defecits in 2 or more spheres of cognition

B. Abnormal results on cognitive screening and neuropsychological tests

C. No disturbance of consciousness

D. Aged 60-90

E. Progression of amnesia and other conitive deficits

Answer 8

D. Age range should be 40-90 years.

Question 9

Which of the following is correctly matched with Alzheimer’s disease course?

A. Anterorgrade amnesia: Late

B. Agnosia: Early

C. Gait disorder: Middle

D. Aphasia: Middle

E. Apraxia: Late

Answer 9

D.

Early course = anterograde amnesia, subtle personality changes, MCI

Middle course = aphasia, agnosia, apraxia and loss of ADLs

Late course = motor signs/symptoms (ie, myoclonus, gait disorder, parkinsonism)

Question 10

What would you expect to see on a PET scan in a person with Alzheimer’s?

Answer 10

frontal/parietal lobes are metabolically underactive

Question 11

what 3 cholinesterase inhibitors were mentioned as treatments to slow decline of AD, but what major drawback do they have for 1/3 of AD patients?

Answer 11

donepezil

galantamine

rivastigmine

*cause GI upset in 1/3

Question 12

an NMDA antagonist that is used in more severe cases of AD

Answer 12

memantine (Namenda)

Question 13

why is procedural memory largely preserved in AD?

Answer 13

involves the striatum, cerebellum and motor cortex, all of which are largely uninvolved in AD

Question 14

this is diagnosed when an individual has isolated subjective and objective memory problems, but no clear impairment in everyday living

Answer 14

amnesic MCI (mild cognitive impairment)

*conversion from MCI to dementia is high, ~20% per year

Question 15

often the first sign of Alzheimer’s disease

Answer 15

anterograde memory loss

Question 16

disease characterized by a step-wise deterioration in cognition, coupled with evidence for cerebrovascular disease on neuroimaging

Answer 16

vascular dementia