Major Neurocognitive Disorders- Dementia specific

Question 1

what is the most common type of dementia (Major Neurocognitive Disorder)

Answer 1

Alzheimer’s disease. Alzheimer’s accounts for 60-80% of dementia cases

Question 2

Alzheimer’s onset and course is generally:
A) sudden onset with progressive decline
B) gradual onset with progressive decline
C) sudden onset, progressive improvement until remission is reached
D) the trajectory depends on the person, it could be any of the above.

Answer 2

B

Question 3

what age group is most commonly affected by Alzheimers

Answer 3

people age 65+, it is also more common in women

Question 4

Alzheimers is characterized by a build up of what in the brain

Answer 4

Amyloid Plaques and tangles (Tau).

The presence of these leads to cell death in the brain which causes brain shrinkage

Question 5

true or false: the first symptom of alzheimers is usually changes in motor function

Answer 5

False. The first symptom is memory loss, though in later stages changes, motor function and sensory processing are usually effected.

Other common symptoms that appear early in the course of the disease are: changes in thinking, reasoning, behaviour, planning, language, etc.

Question 6

what is vascular dementia caused by?

Answer 6

brain cell death due to hypoxia (could be due to hemorrhage, stroke, narrowing of blood vessels, etc)

Question 7

the onset and course of disease progression for vascular dementia is most commonly:
A) sudden onset with progressive stepwise decline
B) gradual onset with progressive stepwise decline
C) sudden onset, progressive improvement until remission is reached
D) the trajectory depends on the person, it could be any of the above.

Answer 7

A

but it can also at times be gradual onset with progressive stepwise decline

Question 8

what is the typical age of onset of vascular dementia?

Answer 8

approximately 60-75 years of age

Question 9

list 5 lifestyles risk factors for vascular dementia

Answer 9

1. poor cardiovascular health
2. high cholesterol
3. high BP
4. diabetes
5. smoking

Question 10

True or false: vascular dementia is characterized by FOCAL neurological deficits.

Answer 10

True. the area of the brain affected by the hypoxic brain injury will result in specific symptom presentation.

Question 11

describe the most common clinical features of vascular dementia

Answer 11

• *1. focal neurological deficits
• *2. slowed thinking and difficulty problem solving
  3. poor concentration, disorganization, impulsiveness.
  4. confusion
  5. gait disturbance, unsteadiness
  6. sudden/frequent urge to urinate, incontenence
  7. depression, apathy, emotional liability, personality changes

Question 12

Dementia with Lewy Bodies commonly co-occurs with which other type of dementia?

Answer 12

Alzheimers

Question 13

What are the most common clinical symptoms of Lewy Body Dementia?

Answer 13

1. hallucinations and delusions
2. fluctuating confusion, and alertness
3. movement disorders (parkonsonian like)
4. malfunctions in autonomic nervous system
5. dizziness
6. impaired thinking and reasoning
7. significant sleep disturbances

Question 14

Dementia with Lewy Bodies overlaps and can progress to what disease

Answer 14

Parkinson’s disease and parkinson’s dementia

Question 15

What is the difference in cause in Lewy Body dementia and Alzheimers dementia?

Answer 15

Both are characterized by a buildup of proteins. Lewy Body dementia is caused by a buildup of Lewy Bodies (an abnormal protein) whereas Alzheimers is caused by a build up of amyloid plaque and Tau proteins. Alzheimers and LBD often occur simultaneously, they can also be misdiagnosed as each other.

Question 16

what is the typical age of onset for LBD?

Answer 16

50+ years

Question 17

LBD’s disease trajectory is best described as which of the following:

a) gradual onset, progressive and degenerative
b) very rapid onset, progressive and degenerative
c) it depends on the person, it can be extremely rapid or gradual

Answer 17

A

Question 18

List 3 characteristics of Fronto-temporal dementia

Answer 18

1. extreme behaviour and personality changes
2. speech and language problems
3. movement disorders

the location of the degeneration in the brain will determine what characteristic(s) a patient presents with

Question 19

Fronto-temporal dementia is best described as:

a) one specific type of dementia that is localized to the frontal and temporal lobes
b) a group of disorders that cause shrinking of the frontal or temporal lobes of the brain
c) progressive and degenerative
d) a and c
e) b and c

Answer 19

E

Question 20

fronto-temporal dementia is often misdiagnosed as what?

Answer 20

a pyschiatric condition. This is due to the characteristic behaviour and personality changes it causes.

Question 21

What is the cause of Wernicke Korsakoff Syndrome

Answer 21

Thiamine (B1) deficiency

Question 22

In Wernicke Korsakoff syndrome, Wernicke syndrome refers to what?

Answer 22

the acute phase of the disease which, while a medical emergency, can be reversed. It usually manifests as: confusion, ataxia, and involuntary eye movements.

Question 23

In Wernicke Korsakoff Syndrome, Korsakoff syndrome refers to what?

Answer 23

the chronic phase of the disease. It is non reversible (permanent) and is characterized by short term memory impairment and ataxia

Question 24

Wernicke Korsakoff Syndrome is more likely to affect people experiencing one of which two conditions?

Answer 24

1. Alcoholism
2. eating disorders

it also has a higher prevalence in people who have AIDS

Question 25

Name 2 broad populations who are at a higher risk of experiencing chronic traumatic encephalopathy

Answer 25

1. athletes (especially athletes in high contact sports)

2. veterans

Question 26

symptom presentation of chronic traumatic encephalopathy (CTE) often occurs:

a) immediately following a head trauma
b) approximately 72 hours after an traumatic brain injury has occurred
c) years to decades after a single traumatic brain injury has occurred
d) years to decades after a person has experienced repetitive head traumas.

Answer 26

D

Question 27

What is Chronic Traumatic Encephalopathy?

Answer 27

it is a degenerative brain disease found in people who have experienced repetitive head traumas, which leads to degeneration of brain tissue and build up of Tau protein.

Question 28

Describe the first, second, third and fourth stages of CTE

Answer 28

stage 1: ADHD, headaches, confusion, mild memory loss
stage 2: memory loss, impulse control, impaired executive funcitoning
stage 3 & 4: progressive dementia, movement disorders, language disorders, psychotic symptoms.

Question 29

general OT tips for working with dementia:

1. most effective interventions are person centered and environment based
2. look at sensory interventions
3. identify unmet needs (often show up as behaviours) and find creative ways to address them.
4. avoid use of antipsychotic medications as there is limited evidence for efficacy in adults with dementia