Mehl. Dementia types (incl. Alzheimer) + benign senility Flashcards
M. - Gradual-onset idiopathic cognitive decline. Dx?
Alzheimer
M. Alzheimer. Definition?
Gradual-onset idiopathic cognitive decline.
M. Alzheimer. MMSE score?
MMSE score will be low (i.e., low-20s out of 30) on USMLE.
If the diagnosis is instead benign senility, USMLE will give MMSE usually 28+.
M. Alzheimer. what neurology?
Patient must have normal neurologic exam (i.e., no motor or sensory abnormalities).
Beta-amyloid plaques and neurofibrillary tangles (hyperphosphorylated tau protein) seen on brain biopsy. What disease?
M. Alzheimer.
M. Alzheimer. what on biopsy? 2
Beta-amyloid plaques and neurofibrillary tangles (hyperphosphorylated tau protein) seen on brain biopsy.
M. Alzheimer. early onset in what disease?
Early-onset Alzheimer in Down syndrome (amyloid precursor protein gene is located on chromosome 21).
M. Alzheimer. what gene mutation?
Presenilin gene mutations can cause Alzheimer (on NBME exam). Presenilin is a protein involved in the cleavage of amyloid.
M. Alzheimer. Tx?
Tx = cholinesterase inhibitors (donepezil, galantamine, rivastigmine); memantine (NMDA glutamate receptor antagonist) can also be used.
buvo step 1 lentelej medikamentai prie SNS/PNS temos
M. Alzheimer. Sundowning is worsening of dementia at night that can resemble delirium.
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M. Alzheimer. 1st-line Tx for sundowning on NBME??
“decrease ambient noise and distractions.”
“Bright illumination of the room at all times” is wrong answer.
M. Frontotemporal dementia aka Pick disease. CP?
Triad: 1) personality change, 2) apathy, and 3) disinhibition.
M. 1) personality change, 2) apathy, and 3) disinhibition. Dx?
Frontotemporal dementia aka Pick disease.
M. Frontotemporal dementia aka Pick disease. Biopsy shows what?
Accumulation of hyperphosphorylated tau protein (similar to Alzheimer), except rather than accumulating as neurofibrillary tangles, it accumulates as round, silver- staining inclusions knowns as Pick bodies.
M. Lewy body dementia. Cp? 3
Dementia + visual hallucinations + Parkinsonism.
M. Dementia + visual hallucinations + Parkinsonism. Dx?
M. Lewy body dementia.
M. Lewy body dementia. Biopsy?
Lewy bodies are collections of alpha-synuclein. This protein is deposited throughout the brain in Lewy-body dementia. In Parkinson disease, in contrast, it is deposited primarily in the substantia nigra pars compacta of the midbrain.
M. Vascular dementia. aka?
Aka multi-infarct dementia.
M. Aka multi-infarct dementia?
Vascular dementia.
M. Vascular dementia. CP?
The answer for dementia + motor/sensory abnormalities.
M. The answer for dementia + motor/sensory abnormalities.
Vascular dementia.
M. Vascular dementia.
Seen in patients who have repeated mini-strokes (cerebral infracts) due to hypertension.
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M. Vascular dementia.
Resources tend to focus on this notion of “step-wise decline” (i.e., concrete timepoints at which deficits started), but it’s to my observation on NBME exams that this is rarely a salient aspect of Qs.
What USMLE likes is giving motor and/or sensory deficits – i.e., you’ll get a big paragraph with dementia, and you’ll notice somewhere in the stem that the patient has, e.g., 3/5 strength in the right upper extremity. This indicates Hx of stroke.
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M. AIDS.
Just be aware AIDS can cause dementia, known as AIDS complex dementia.
What CP would be?
Can present as “wet, wobbly, wacky,” similar to normal pressure hydrocephalus.
M. Pseudodementia. CP?
Not actual dementia. This is depression that presents as cognitive decline.
M. Pseudodementia. MMSE?
Patients with depression who have apathy will perform poorly on the MMSE.
M. Pseudodementia.
The Q might say the patient is unable to draw a clockface, but when prompted, is able to finish it quickly. They might also say patient remembers 0 out of 3 objects after 5 minutes.
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M. Subacute combined degeneration. what vitamin?
The fancy name for neurologic degeneration seen in B12 deficiency.
M. Pseudodementia. Look for obvious signs of depression, such as short, quiet answers, and low mood.
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M. The fancy name for neurologic degeneration seen in B12 deficiency. Dx?
Subacute combined degeneration.
M. Subacute combined degeneration.
Can present sometimes as a reversible cause of dementia. In elderly patients on tea and toast diets, or those in high-risk groups (i.e., vegans, pernicious anemia), B12 must be considered as cause of cognitive decline.
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M. Subacute combined degeneration.
The patient can have peripheral neuropathy as a result of deficits to the ….?3
1) corticospinal tracts, 2) dorsal columns, and 3) spinocerebellar tracts.
M. Subacute combined degeneration.
The easy way to remember those three is to start by saying, “The spinothalamic tract is not involved.” Then you say, “Well what are other ones I can think of?”
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M. Neurosyphilis.
Just be aware that neurosyphilis is a reversible cause of dementia and should be Neurosyphilis considered. There’s an NBME Q floating around for 2CK where they give (+) VDRL in 82-year-old woman with cognitive decline, and the treatment is penicillin.
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M. Alzheimer drugs. 2 drugs?
Donepezil
Memantine
M. Alzheimer drugs.
Donepezil - group?
As mentioned earlier, this is a cholinesterase inhibitor used in Alzheimer.
Rivastigmine and galantamine you can be aware of and have same MOA, but are LY.
M. Alzheimer drugs. memantine Moa?
NMDA glutamate receptor antagonist.
M. Alzheimer drugs.
Memantine = - NMDA glutamate receptor antagonist.
Glutamate receptor activation normally causes Ca2+ to flow into the neuron, leading to depolarization and neuroexcitation.
In other words, USMLE wants you to know glutamate receptor is a ligand-gated calcium channel (where glutamate is the ligand that activates the channel). Antagonism causes neuroinhibition.
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M. Benign senility. MMSE?
If the diagnosis is benign senility, MMSE will usually be 28+ on USMLE.
M. Benign senility. in contrast to true dementia MMSE?
This contrasts with true dementia, where USMLE will give MMSE low-20s.
M. Benign senility. highest yield point?
One of the highest yield points is you knowing that if the patient complains, it’s not dementia. In real life, this is probably not a 100% rule, but on USMLE, it’s HY way to distinguish.
M. Benign senility.
Patients with true dementia either won’t complain about it or just simply won’t be aware of their cognitive decline. If the Q tells you the patient is concerned because she walked into a room and doesn’t know why she went in there, it’s benign senility, not dementia.
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M. Benign senility.
For true dementia, the vignette might say the adult daughter reports her mother left the stove burner on the other day and is unconcerned about it, or that she went for a walk the other day and she got lost and it took her hours to come home, or that the police brought her home.
