NCD Dx Assess- 15B

Question 1

What are the two steps in the Dementia diagnosis process

Answer 1

• diagnose the clinical presentation (phenomenon)

- establish the etiology

Question 2

Name a scale that can be used to assess adaptive function across the age spectrum.

Answer 2

-Vineland Adaptive Function Scale

Question 3

What is a problem with the MMSE?

Answer 3

-poor at recognizing executive dysfunction

Question 4

What are the components of the Mini-Cog

Answer 4

• 3 word registration
• Clock drawing test
• 3 word recall

Question 5

Name two available neuropsychological batteries.

Answer 5

• Luria-Nebraska

- Halstead-Reitan

Question 6

Identify the NCD with the following physical exam findings:

• Parkinsonian motor symptoms
• Focal motor and sensory deficits
• Urinary incontinence and magnetic gait
• Wide based gait

Answer 6

• NCD with Lewy Body or Parkinson’s Dz
• Vascular NCD
• Biswanger’s disease and NPH (due to dysfunction of periventricular white matter tracts)
• Alcohol induced NCA, Wernicke’s encephalopathy (due to damage to cerebellum)

Question 7

Laboratory testing for syphilis is part of routine work-up for NCD. True or False

Answer 7

FALSE

Question 8

What are the choices for structural neuroimaging in NCD work-up

Answer 8

• MRI

- CT if hemorrhage is suspected

Question 9

What are the indications for functional neuroimaging in work-up of NCD?

Answer 9

• PET to differential Alz Dz from FT lobar in pts with features of both
• SPECT in pts with HIV/AIDS to differentiate toxoplasmosis (decreased perfusion in lesion) from lymphoma (increased perfusion in lesion)
• PET or SPECT scan to reveal abnormal metabolism in the basal ganglia in pts with Lewy Body disease

Question 10

Indications for EEG in NCD workup

Answer 10

• seizures
• Creutzfeld-Jacob Dz (fast polyphasic waves)
• Toxic metabolic encephalopathy (triphasic waves)

Question 11

Indications for lumbar puncture in NCD work-up

Answer 11

• Metastatic cancer
• CNS infection, reactive syphilis serology
• Hydrocephalus
• Age less than 55y
• Rapidly progressive or unusual dementia
• Immunosuppression
• CNS vasculitis

Question 12

When is brain biopsy indicated?\

Answer 12

• RARELY

- only when etiology remains unclear with a complete work-up, especially with early onset cognitive decline

Question 13

Describe a logical approach to work-up of NCD

Answer 13

• history and physical exam
• do Mini-Cog
• decide if it is cortical or subcortical
• imaging