Lecture 86 - Dementia

Question 1

Delerium differs from Dementia in that it is acute and tends to fluctuate, while Dememntia is ______ (so look for chronic issues leading to slow decline in cognition).

Answer 1

Progressive

Question 2

Keep in mind one of the diagnostic criteria for Dementia is _______ (decreased or normal?) daily function.

Answer 2

Decreased

Question 3

A score less than ______ on the MMSE is considered abnormal, but this cannot be the sole diagnostic criterion for neurocognitive disease/dementia.

Answer 3

24

Question 4

The _______, though it cannot differentiate between types of dementia, CAN detect even mild dementia with 100% sensitivity, provided there are no language or educational barriers.

Answer 4

MoCA

Question 5

Early stages of Alzheimer disease are characterized my _______ impairment. The next things to go are typically associated with the ______ and _______ lobes and include visuoconstructional/perceptuomotor functions, language functions, and social cognition.

Middle to late stages tend to affect ______ lobe functions, leading to irritability, agitation, combativeness, and sometimes wandering.

Very late stages may show gait impairment, dysphagia, incontinence, and even seizures.

Answer 5

Memory

Temporoparietal

Frontal lobe

Question 6

APOE ___ allele increases risk of Alzheimer disease (AD), while APOE ____ confers protection.

Answer 6

APO Eepsilon4

APO E2

Question 7

Treatment for AD should first focus on lifestyle modification, but ________ inhibitors (e.g. Donepezil, Galantamine, Rivastigmine) can be used. Keep in mind these medications do NOT show any benefit for the treatment of ______ ______ impairment.

NMDA receptor antagonist ______ can be used for the treatment of _______ (mild, moderate, or severe?) to ________ (mild, moderate, or severe?) AD.

Answer 7

Acetylcholinesterase inhibitors

Mild Cognitive Impairment

Memantine

Moderate to Severe

Question 8

_______ Variant Frontotemporal Dementia (FTD) is the most common FTD and has a mean age of onset of 58 (so typically younger onset than AD). Initial symptoms are often mistaken as “Midlife crisis” or depression.

One of the causes of this disease is ______ disease. The brains of these patients will show frontal lobar atrophy with “______” gyri. _____ bodies, which are phosphorylated tau proteins, can be found within neurons. Look for these patients to present with classic disinhibition AND a strong desire for _______ (what kind of food?) with relentless eating behaviors.

Answer 8

Behavioral variant FTD

Pick’s disease

“Knife-like” gyri

Pick bodies

Sweets

Question 9

Dementia with Lewy Bodies (DLB) presents very similar to late-stage ________. Keep in mind a good way to distinguish between the two is with the onset of Dementia. When does demention appear as a symptom in each?

Lewy bodies are intraneural _____ _____ inclusions.

Answer 9

Parkinson’s

Dementia is an EARLY symptom of DLB, but is a LATE symptom in Parkinson’s

Alpha synuclein inclusions

Question 10

Corticobasal Degeneration dementia patients will present with Rigidity, _______ (not a tremor, but unsteadiness bc of discongruous firing in flexors and extensors), Alien hand syndrome, and Eye movement abnormalities.

Answer 10

Dystonia

Question 11

Vascular Dementia patients experience a greater decline in ______ _____ than in memory. Otherwise, they present very similar to a patient with AD.

Answer 11

Cognitive Speed

Question 12

Spongiform Encephalopathies are ______ diseases. In humans, ______-_____ is the most common. The dementia in these patients is _______ (slowly or rapidly?) progressing, and they often experience Startle ______.

Answer 12

Prion diseases

Creuztfeldt-Jacob

Rapidly

Startle Myoclonus