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Neuro. CM3 > Leftovers 2 > Flashcards

Leftovers 2 Flashcards

1
Q

What is sarcopenia?

A

Muscle atrophy

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2
Q

What are the 6 PE findings of someone with dementia:

A
  • Slow reactive pupils (small)
  • Decreased vibratory sense
  • Muscle atrophy
  • Increased tone (spasticity)
  • Primitive reflexes return
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3
Q

CT scan findings of a dementia brain:

A

Atrophied with large sulk

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4
Q

Definition of dementia:

A

Impairment of memory +, one or more cognitive domains AND a decline from the previous level of function (be enough to deal with daily function)

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5
Q

What is apraxia?

A

Inability to perform purposeful actions

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6
Q

What is agnosia?

A

Inability to recognize familiar objects

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7
Q

Dementia is NOT a part:

A

of normal aging

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8
Q

Most potent risk factor for dementia

A

Age

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9
Q

All of the dementia risk factors (7):

A 
Age
Anticholinergic
Vit D deficient
E4 - cholesterol transport protein
Family history
SES
Sleep
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10
Q

What is Apoliopoprotein E4?

A

Cholesterol transport protein that promotes the degradation of AB plaques

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11
Q

Common causes and break down of dementia causes:

A

70% AD - Neurosyphilis used to be the most common
Vascular 15%
Other 15%

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12
Q

What percent of dementia is reversible?

A

10%

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13
Q

The two proteinpathy dementias:

A
  • AD: Beta-amyloid, tau

- Dementia with lewy: Alpha-synuclein

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14
Q

Neuroinflammation has resulted from:

A

Excess cytokines

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15
Q

If someone is delirious what are two symptoms they have that dementia does NOT:

A
  • LOC is impaired

- Autonomic hyperactivity is present

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16
Q

What is in the Mini-cog test:

A

3 item and clock - 0-2 = Dementia; 3-5 = Probably ok

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17
Q

Test to run for neurosyphilis:

A

RPR

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18
Q

What should you use to image someone with dementia?

A

MRI with contrast

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19
Q

Who needs a LP for dementia (6): 2C, I, P, 2R

A

Patients with:

  • Cancer
  • CNS infection - vasculitis or CT disorders
  • Immunosuppression
  • Patient under 55
  • RPR +
  • Rapid dementia
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20
Q

If min-cog., general assessment were positive for dementia, what are the next two steps?

A
  1. Mini-mental state exam, Montreal or Saint Louis screening

2. Labs and MRI

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21
Q

If someone has cognitive impaired, do we screen for the apoliopoprotein E4 allele?

A

Not recommended for the patient but their kids may want it

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22
Q

Amnesic transitional stage has the ____ chance:

A

Highest; chance of progressive to AD (10%)

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23
Q

Eating how many calories a day can double your risk for AD if 70+?

A

2,100 - 6,000

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24
Q

Median survival after a diagnosis of Alzheimer’s

A

4.5 years

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25
Q

What do Alzheimer patients die from?

A

Pneumonia and CVD

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26
Q

What type of Alzhiemers is most common?

A

Sporadic - failure in AB clearance mechanisms

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27
Q

What is the mechanism behind familial AD?

A

1 of 3 genes encoding the amyloid precursor protein, presenilin 1 or 2 is mutated = increase build up of AB in the body

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28
Q

Global pathophysiology of AD (2):

A
  • Abnormal cleavage of APP AND

- Abnormal accumulation of AB that gets deposited into plaques

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29
Q

Neurofibrillary tangles contain what (2)?

A
  • Tau (phosphorylated)

- Ubiqutin

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30
Q

Neurofibrillary tangles are located:

A

Intracellularly

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31
Q

What proteins are in the neuritic plaques?

A

Beta-Amyloid and presenilin 1/2 (generated by APP cleavage)

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32
Q

When APP is cleaved it forms (2)

A

Beta-amyloid and presenilin 1/2

33
Q

The APOE3 Alzheimer genes are located on what chromosome? Allele significance?

A
  • CH. 19
  • APOE4: BAD (45-60% pts. have)
  • APOE3: Most common
  • APOE2: GOOD, protective
34
Q

Progression of dementia (5):

A
  1. Forget
  2. Disorient
  3. Aphasia
  4. Apraxia
  5. Gait disorder
35
Q

Treatment for AD (supplement):

A

Vitamin E (2000 IU) qd

36
Q

Four therapies for AD (non-medicinal):

A
  • Exercise
  • OT
  • Puzzles
  • Mental stimulation
37
Q

Meds for AD treatment:

A
  • Cholinesterase inhibitor (3)
  • Memantine
  • Aducanumab
38
Q

Three cholinesterase inhibitors: (DGV)

A

Donepezil
Galantamine
Vivastigmine
(Done, Gal, Viv)

39
Q

What is aducanumab directed against?

A

Beta-amyloid

40
Q

What is memantine?

A

Partial NMDA receptor antagonist

41
Q

Chemical change in the demented brain

A

There is cholinergic deficiency (decreased ACh)

42
Q

Three nerulogical signs and symptoms fo vascular dementia:

A
  • Emotional ability
  • Focal motor/sensory deficit
  • Abnormal gait
43
Q

Treatment for vascular dementia (3):

A
  • Manage HTN
  • Antiplatelet
  • Memantine
44
Q

Frontotemporal Dementia is seen in what age patients?

A

(50 - 65) - atrophy in the front/temporal areas

45
Q

What is the most common indication of Frontotemporal dementia?

A

Personality or behavioral changes *Memory may not be the first thing to go

46
Q

What is Primary Progressive aphasia?

A

Anomia –> Speech simplification –> Mutism

47
Q

Semantic Dementia definition:

A

Loss of words and then behavior changes

48
Q

Frontotemporal dementia treatment (3 A’s)

A

Atypical antipsychotics, Antidepressants, anxiolytics

49
Q

What is Normal-Pressure Hydrocephalus?

A

Ventricles enlarge at the expense of the parenchyma - PSI of CSF is the same

50
Q

Normal-Pressure Hydrocephalus also has what two names?

A
  • Non obstructive

- Communicating

51
Q

What two illnesses can cause Normal-Pressure hydrocephalus?

A
  • Meningitis

- Subarachnoid hemorrhage

52
Q

Two steps of Normal-Pressue Hydrocephalus presentation:

A
  1. Gait apraxia
  2. Urinary incontinence
  3. Dementia (maybe reversible)
53
Q

What is: Incontinence sans gene

A

NPH; person does not care that they are peeing themselves

54
Q

To diagnose NPH, a CF sample will be:

A

Normal with normal pressure

55
Q

What does a CT/MRI show when someone has NPH?

A

Enlarged ventricles WITHOUT the larger sulk

56
Q

Treatment for NPH

A

Centriculoperitoneal shunting

57
Q

Dementia with Lewy bodies - What do Lewy bodies look like? Where are they located?

A

Round, eosinophilic, intracytoplasmic neuronal inclusion in the CORTEX and CERBELLUM

58
Q

A Lewy body is made up of what two proteins?

A

Alpha-syn. and tau

59
Q

Dementia with Lewy bodies is like AD and Parkinsons in that…

A

They have dementia like AD and rigidity (and tremors) like PD

60
Q

What may be one of the first signs of Dementia with Lewy bodies?

A

Well formed hallucinations

61
Q

Do not use ___ in patients with Dementia with Lewy bodies:

A

Antipsychotics - if must use, only a low dose of quetiapine

62
Q

Corticobasal Syndrome two characteristics (is there a resting tremor?):

A
  • Dementia
  • Progressive asymmetrical and EPS
    NO RESTING TREMOR
63
Q

What four things atrophy with Corticobasal syndrome?

A
  • Parietal
  • Basal ganglia
  • Insula
  • Frontal
64
Q

What lab finding is hallmark for corticobasal?

A

Tau positive and glial inclusions

65
Q

People with Corticobasal syndrome can get what with their extremities?

A

Limb apraxia - ALIEN HANDS

66
Q

Can you treat the Parkinson like rigidity in Corticobasal syndrome with Levodopa?

A

Nope

67
Q

What are the two cardinal clinical symptoms of Creutz-feldt Jacob disease? (DOUBLE M)

A
  • Mental deterioration

- Myoclonus

68
Q

What is the gold standard for dx of CJD?

A

Brain biopsy

69
Q

How fast do people die with CJD?

A

1 year - no treamtent

70
Q

What are three other things that can cause dementia?

A
  • Vitamin B12 def.
  • Wilson disease
  • Alcoholism
71
Q

Repetitive TBI can develop what:

A

Neurofibrillary tangles

72
Q

What is Dementia Pugillstica?

*No pathology listed

A

Delayed, progressive, post TBI dementia (boxers)

73
Q

What are the features of Dementia Pugillstica?

A
  • Happy
  • Mentally slow
  • Tremor, rigidity, Brady kinesis
74
Q

What is Chronic Traumatic Encephalopathy? Who gets it?

A

Neurodegeneration related to football and wrestling

75
Q

What is CTE related to?

A

Concussions and sub-concussions

76
Q

What is a chronic subdural hematoma?

A

After mild head trauma - HA initially with dementia , hemiparesis and papilledema later

77
Q

Age of chronic subdural hematoma?

A

50 - 70

78
Q

Treatment for chronic subdural hematoma?

A

Evacuate with surgery

Neuro. CM3 (11 decks)

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