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Neurobehavior 2 Flashcards

1
Q

What is the general process of dementia?

A

Accumulation of proteins in the neurons leads to dysfunction, and eventual death

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2
Q

What is the abnormal protein that accumulates in Alzheimer’s disease?

A

Beta-amyloid

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3
Q

What is generally the first area to be affected with Alzheimer’s?

A

Temporal lobe (hippocampus) and some parietal

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4
Q

What is the most common neurodegenerative dementia? Second?

A 
1= Alzheimers
2 = Lewy body disease
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5
Q

What is the protein that accumulates in Lewy body dementia? Where does this accumulate?

A
  • Alpha-synuclein

- BG, frontal, brainstem

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6
Q

What are the three proteins that accumulate in frontotemporal dementia (Pick’s disease)? Where does this accumulate? What are the symptoms of this?

A

Tau/TDP43/FUS

Frontal-temporal areas

Loss of inhibition

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7
Q

True or false: dementia is a symptom, not a diagnosis

A

True

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8
Q

What are the four defining features for diagnosing dementia?

A
  • Symptoms interfere with function
  • Represent a decline from baseline
  • Not explained by psych disorder
  • Measureable impairment
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9
Q

How many cognitive/behavioral domains have to be affected to diagnose dementia?

A

2

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10
Q

What is vascular dementia?

A

dementia caused by problems in the supply of blood to the brain, typically a series of minor strokes, leading to stepwise cognitive decline

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11
Q

What is the first step in diagnosing dementia?

A

Ask the patient about s/sx

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12
Q

Why is it so important to assess mood when assessing for dementia?

A

Mood will impair cognition

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13
Q

What vitamin deficiency in particular can lead to dementia?

A

B12

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14
Q

What endocrine organ dysfunction in particular can lead to dementia?

A

Thyroid

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15
Q

What is the classic medication that interferes with B12 absorption?

A

PPIs

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16
Q

Why are MRIs so crucial in the workup for dementia?

A

Space occupying lesions or other etiologies can lead to similar s/sx

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17
Q

What is normal pressure hydrocephalus? S/sx?

A

Decreased absorption of CSF, causes a slow increase in pressure that is somewhat offset by enlargement of the ventricles (pressures reach a high normal range)

-Gait disturbance, urinary incontinence, dementia

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18
Q

What causes primary and secondary normal pressure hydrocephalus?

A 
Primary = idiopathic
Secondary = Subarachnoid hemorrhage or infx
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19
Q

True or false: LPs are useful in the diagnosis of dementia through the use of biomarkers

A

True

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20
Q

What is the usual primary complaint of Alzheimer’s disease?

A

inability to form new memories

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21
Q

What particular aspects of memory go first with Alzheimer’s?

A
  • Visuospatial abilities

- Naming and semantic memory

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22
Q

What is semantic and episodic memory?

A 
Semantic = facts
Episodic = experiences
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23
Q

True or false: orientation is usually preserved with Alzheimer’s

A

False

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24
Q

What, generally, is atypical Alzheimer’s disease?

A

Disease starts in an area other than the hippocampus

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25
What are the three variants of atypical AD?
- Language - Visuospatial - Frontal
26
What is the classic MRI finding of AD?
Hole in the hippocampus
27
What is the PIB PET scan?
PET scan that localizes beta amyloid deposition
28
What is the criteria for AD?
Dementia plus: - Insidious onset - H/o worsening - Cognitive deficits on H and P
29
What is mild cognitive impairment?
Decline in mental function, without full AD
30
What are the criteria for mild cognitive impairment?
Decline in cognition in comparison to the patient's previous level
31
What type of memory is lost in the progression of MCI to AD?
Episodic memory
32
What is the main difference between MCI and dementia?
Significant interference in the ability to function at work or in usual daily activities
33
How do you communicate the diagnosis of a decline in mental function?
Level of impairment + cause | e.g Dementia 2/2 AD
34
What is the most underdiagnosed forms of dementia?
Frontotemporal dementia
35
What are the primary complaints with frontotemporal dementia?
Behavioral changes, impaired speech and dysexecutive syndromes
36
What age range generally develops FTD? AD?
``` FTD = 50s AD = 70s ```
37
What are the three subtypes of frontotemporal dementia?
- Frontotemporal dementia - Primary progressive aphasia (Broca's like) - Semantic dementia (Wernicke's like)
38
What are the three proteins that cause FTD?
- TDP-43 - Tau - FUS
39
What is the presentation of subcortical dementia?
- Slowed psychomotor speed - Memory loss - BG disease
40
What are the diseases that can cause a subcortical dementia? (4)
- MS - Parkinson's - Wilson's disease - huntington's
41
What are the classic s/sx of Lewy body dementia?
- *Early*, *vivid* visual hallucinations - Fluctuating cognition - Parkinsonism
42
How many characteristics are needed from the core and suggestive features?
2+
43
What is REM sleep behavior disorder? What can it be seen in?
Loss of motor inhibition during the REM stage of sleep Lewy body dementia
44
What causes the autonomic problems with Lewy body dementia?
Brainstem issues
45
What are the two key characteristics of the visual hallucinations with Lewy body dementia?
Benign, but Vivid and occur early in the course of the disease
46
What is the difference between Dementia brought about by parkinson's, and Lewy body dementia?
Name only--same pathophysiologic process
47
What is the classic history of dementia in patients with vascular dementia?
Stepwise loss of function
48
What is Binswanger's disease (subcortical leukoencephalopathy)?
a form of small vessel vascular dementia caused by damage to the white brain matter.[1] White matter atrophy can be caused by many circumstances including chronic hypertension as well as old age.[2] This disease is characterized by loss of memory and intellectual function and by changes in mood.
49
What are the classic s/sx with Binswanger's disease (subcortical leukoencephalopathy)? (2)
- Attention and concentration deficits | - psychomotor slowing
50
What are the three main differences between delirium and dementia?
Delirium has: - acute onset - Impaired attention - Paranoid Hallucinations
51
Does AD have impaired attention?
No--does not affect frontal cortex
52
What is the general class of medication used to treat dementia?
Acetylcholinesterse inhibitors
53
What are the three major Acetylcholinesterse inhibitors used to treat dementia?
- Donepezil - Rivastigmine - Galantamine
54
What is the role of Acetylcholinesterse inhibitors in the treatment of dementia?
Slow, or stabilize progression, but do not cure or prolong life
55
What happens to a sudden stop of treatment with Acetylcholinesterse inhibitors in the treatment of dementia?
Cognitive function will plunge, and is not reversible
56
What are the three major side effects of the Acetylcholinesterse inhibitors used to treat dementia?
- GI disturbance - Vivid dreams - Increased agitation
57
Why should Acetylcholinesterse inhibitors agents be avoided in FTD?
Increase agitation
58
What happens to choline levels in Lewy body disease? What happens with treatment with Acetylcholinesterse inhibitors?
Drops--thus will markedly improve patients
59
What is the MOA of memantine? Use?
Partial antagonist of NMDA receptor Dementia treatment
60
What are the vitamins that have been shown to benefit dementia patients?
E and C
61
What is the role of Gingko biloba in the treatment of dementia?
Does not prevent, but has a modest benefit
62
What drugs should be stopped in patients with dementia?
Anticholinergics and sedatives
63
What are the antidepressants that are preferred for treating depression in dementia?
SSRIs or SSNRIs
64
What are the two mood stabilizers used for dementia?
Valproate | Lamotrigine
65
What is the MOA and use of Lamotrigine?
Na channel blocker Anticonvulsant and mood stabilizer
66
What is the MOA and use of Valproate?
Na channel blocker Anticonvulsant and mood stabilizer
67
What is the role of atypical antipsychotics in the treatment of dementia?
Treats agitation and paranoia
68
What is the atypical antipsychotic of choice for dementia?
Quetiapine
69
What is the MOA and use of Quetiapine?
Atypical antipsychotic D1 receptor antagonist
70
What drugs are contraindicated in Lewy body dementia?
Atypical antipsychotics--loss of dopamine already an issue
71
What is the best prevention/treatment for dementia?
Exercise

Neurology (23 decks)

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