Final

Question 1

percentage of cases for AD

Answer 1

50-70%

Question 2

percentage of cases for VD

Answer 2

10-17%

Question 3

Neuropathology of AD

Answer 3

loss of neurons
synapses in the cerebral cortex
restricted subcortical regions
marked in the medial temporal lobe
hippocampus and entorhinal cortex
parietal lobe and parts of the frontal cortex and cingulate gyrus.
Earliest appearing hallmark = beta-amyloid plaques and neurofibrillary tangles.
Neurotransmitters = acetylcholine and glutamate.
pharmacological treatment has been influenced by neurotransmitters.

Question 4

MCI

Answer 4

Mild Cognitive Impairment: preclinical state between cognitive changes in a typical ageing brain and pathological changes with AD or another type of dementia.

Question 5

MCI core clinical criteria

Answer 5

Concern in the change of cognition.
impairment in one or more cognitive domains.
preservation in independence in functional abilities.
NO dementia

Question 6

DSM-5 Mild Neurocognitive Disorder (MCI)

Answer 6

evidence of a MODEST cognitive decline in one or more domains (attention, executive function, learning/memory, language, perceptual-motor, social cognition); concern of patient/informant/clinician.
DO NOT interfere with independence in everyday activities = IADLs may require greater effort, compensatory strategies/accommodation.
NOT due to delirium.
NOT due to another mental disorder.
- specify with or without behavioral disturbance ( and specify what behavioral disturbance: psychotic symptoms, mood disturbance, agitation, apathy or other behavioral symptoms.

Question 7

DSM-5 Major Neurocognitive disorder
(Dementia)

Answer 7

evidence of a SIGNIFICANT cognitive decline in one or more domains (attention, executive function, learning/memory, language, perceptual-motor, social cognition): concern of patient/informant/clinician. INTERFERES with everyday activities; needs assistance with IADLs at least.
NOT due to delirium.
NOT due to another mental disorder.
- specify with or without behavioral disturbance.

Question 8

Symptoms of language expression in AD

Answer 8

EARLY STAGE:
- writing is more affected than oral language.
- can answer questions & decline words.
- miss the point of a joke, don’t understand sarcasm.
MIDDLE STAGE:
word finding difficulties are more obvious, ideational repetition, missing the point of jokes, attempting to interpret nonliteral language literally, difficulty defining words and repeating phrases.

Question 9

Symptoms of cognitive and communicative functions in AD

Answer 9

EARLY STAGE:
Mental stage: disorientated to time but not place/person.
Motor function: good & ambulatory.
memory function: episodic memory.
NO issues with ADLs.
DIFFICULTIES with IADLs.
longer hesitations and slower speech rate in spontaneous speech.
MIDDLE STAGE:
scoring 16 or below on MMSE
Mental status: more dependency on others. Disorientations worsens, and confusion of time and place.
Motor function: good but restlessness is common.
Memory: worsening episodic memory, decrease in memory span, encoding and retrieval deficits, and semantic memory.
Difficulty focusing attention.
Continence: continence of the bladder becomes problematic.
Basic ADLs are ok, instrumental ADLs need assistance, and driving becomes an issue.
LATE STAGE:
Disorientated to person, place, and time.
MMSE scores 0-9
Incontinence of bladder and later bowel.
Communication abilities: incontinent only for the bladder had more communication skills than that incontinent for the bowel and bladder.
Speech is slower with more halting, a form of language remains intact, some are mute, and reading comprehension is severely impaired.

Question 10

Risk Factors of MCI

Answer 10

Most significant risk factor is age.
Apolipoprotein APOE carrier status: 3 variants e2, e3, e4.
Diabetes, hyperlipidemia, current smoking, depression, high blood pressure, increased cholesterol, and lack of exercise.

Question 11

Risk Factors of AD

Answer 11

age, family history of disease, less education, head trauma, loneliness, gender, and age of mother at individual’s birth.

Question 12

Protective factors

Answer 12

higher level of education, socially and cognitively active lifestyle, and regular physical exercise.

Question 13

hallmark impairment of MCI and AD

Answer 13

episodic memory impairment

Question 14

Ceiling effect

Answer 14

Test to characterize cognitive communicative functioning in late-stage dementia is usually too easy for individuals in mild stages.

Question 15

Floor effect

Answer 15

If a test is challenging for patients with MCI, it’ll probably be too hard for someone with moderate dementia.

Question 16

Dementia

Answer 16

insidious onset, impaired vary late conscious state, the mood is stable, duration is long term, cognitive features are reduced short-term memory greater than long-term memory.

Question 17

Delirium

Answer 17

a confused state developed over a short period of time. affects patients with disturbances in consciousness, attention, cognition & perception, and fluctuations.
Identifying delirium = confusion assessment method (CAM).