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Neuro. CM3 > Leftovers 2 > Flashcards

Leftovers 2 Flashcards

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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
What do Alzheimer patients die from?
Pneumonia and CVD
26
What type of Alzhiemers is most common?
Sporadic - failure in AB clearance mechanisms
27
What is the mechanism behind familial AD?
1 of 3 genes encoding the amyloid precursor protein, presenilin 1 or 2 is mutated = increase build up of AB in the body
28
Global pathophysiology of AD (2):
- Abnormal cleavage of APP AND | - Abnormal accumulation of AB that gets deposited into plaques
29
Neurofibrillary tangles contain what (2)?
- Tau (phosphorylated) | - Ubiqutin
30
Neurofibrillary tangles are located:
Intracellularly
31
What proteins are in the neuritic plaques?
Beta-Amyloid and presenilin 1/2 (generated by APP cleavage)
32
When APP is cleaved it forms (2)
Beta-amyloid and presenilin 1/2
33
The APOE3 Alzheimer genes are located on what chromosome? Allele significance?
- CH. 19 - APOE4: BAD (45-60% pts. have) - APOE3: Most common - APOE2: GOOD, protective
34
Progression of dementia (5):
1. Forget 2. Disorient 3. Aphasia 4. Apraxia 5. Gait disorder
35
Treatment for AD (supplement):
Vitamin E (2000 IU) qd
36
Four therapies for AD (non-medicinal):
- Exercise - OT - Puzzles - Mental stimulation
37
Meds for AD treatment:
- Cholinesterase inhibitor (3) - Memantine - Aducanumab
38
Three cholinesterase inhibitors: (DGV)
Donepezil Galantamine Vivastigmine (Done, Gal, Viv)
39
What is aducanumab directed against?
Beta-amyloid
40
What is memantine?
Partial NMDA receptor antagonist
41
Chemical change in the demented brain
There is cholinergic deficiency (decreased ACh)
42
Three nerulogical signs and symptoms fo vascular dementia:
- Emotional ability - Focal motor/sensory deficit - Abnormal gait
43
Treatment for vascular dementia (3):
- Manage HTN - Antiplatelet - Memantine
44
Frontotemporal Dementia is seen in what age patients?
(50 - 65) - atrophy in the front/temporal areas
45
What is the most common indication of Frontotemporal dementia?
Personality or behavioral changes *Memory may not be the first thing to go
46
What is Primary Progressive aphasia?
Anomia --> Speech simplification --> Mutism
47
Semantic Dementia definition:
Loss of words and then behavior changes
48
Frontotemporal dementia treatment (3 A's)
Atypical antipsychotics, Antidepressants, anxiolytics
49
What is Normal-Pressure Hydrocephalus?
Ventricles enlarge at the expense of the parenchyma - PSI of CSF is the same
50
Normal-Pressure Hydrocephalus also has what two names?
- Non obstructive | - Communicating
51
What two illnesses can cause Normal-Pressure hydrocephalus?
- Meningitis | - Subarachnoid hemorrhage
52
Two steps of Normal-Pressue Hydrocephalus presentation:
1. Gait apraxia 2. Urinary incontinence 3. Dementia (maybe reversible)
53
What is: Incontinence sans gene
NPH; person does not care that they are peeing themselves
54
To diagnose NPH, a CF sample will be:
Normal with normal pressure
55
What does a CT/MRI show when someone has NPH?
Enlarged ventricles WITHOUT the larger sulk
56
Treatment for NPH
Centriculoperitoneal shunting
57
Dementia with Lewy bodies - What do Lewy bodies look like? Where are they located?
Round, eosinophilic, intracytoplasmic neuronal inclusion in the CORTEX and CERBELLUM
58
A Lewy body is made up of what two proteins?
Alpha-syn. and tau
59
Dementia with Lewy bodies is like AD and Parkinsons in that...
They have dementia like AD and rigidity (and tremors) like PD
60
What may be one of the first signs of Dementia with Lewy bodies?
Well formed hallucinations
61
Do not use ___ in patients with Dementia with Lewy bodies:
Antipsychotics - if must use, only a low dose of quetiapine
62
Corticobasal Syndrome two characteristics (is there a resting tremor?):
- Dementia - Progressive asymmetrical and EPS NO RESTING TREMOR
63
What four things atrophy with Corticobasal syndrome?
- Parietal - Basal ganglia - Insula - Frontal
64
What lab finding is hallmark for corticobasal?
Tau positive and glial inclusions
65
People with Corticobasal syndrome can get what with their extremities?
Limb apraxia - ALIEN HANDS
66
Can you treat the Parkinson like rigidity in Corticobasal syndrome with Levodopa?
Nope
67
What are the two cardinal clinical symptoms of Creutz-feldt Jacob disease? (DOUBLE M)
- Mental deterioration | - Myoclonus
68
What is the gold standard for dx of CJD?
Brain biopsy
69
How fast do people die with CJD?
1 year - no treamtent
70
What are three other things that can cause dementia?
- Vitamin B12 def. - Wilson disease - Alcoholism
71
Repetitive TBI can develop what:
Neurofibrillary tangles
72
What is Dementia Pugillstica? | *No pathology listed
Delayed, progressive, post TBI dementia (boxers)
73
What are the features of Dementia Pugillstica?
- Happy - Mentally slow - Tremor, rigidity, Brady kinesis
74
What is Chronic Traumatic Encephalopathy? Who gets it?
Neurodegeneration related to football and wrestling
75
What is CTE related to?
Concussions and sub-concussions
76
What is a chronic subdural hematoma?
After mild head trauma - HA initially with dementia , hemiparesis and papilledema later
77
Age of chronic subdural hematoma?
50 - 70
78
Treatment for chronic subdural hematoma?
Evacuate with surgery

Neuro. CM3 (11 decks)

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