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Neurology > Neurobehavior 2 > Flashcards

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
Q

What are the three variants of atypical AD?

A
  • Language
  • Visuospatial
  • Frontal
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26
Q

What is the classic MRI finding of AD?

A

Hole in the hippocampus

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27
Q

What is the PIB PET scan?

A

PET scan that localizes beta amyloid deposition

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28
Q

What is the criteria for AD?

A

Dementia plus:

  • Insidious onset
  • H/o worsening
  • Cognitive deficits on H and P
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29
Q

What is mild cognitive impairment?

A

Decline in mental function, without full AD

30
Q

What are the criteria for mild cognitive impairment?

A

Decline in cognition in comparison to the patient’s previous level

31
Q

What type of memory is lost in the progression of MCI to AD?

A

Episodic memory

32
Q

What is the main difference between MCI and dementia?

A

Significant interference in the ability to function at work or in usual daily activities

33
Q

How do you communicate the diagnosis of a decline in mental function?

A

Level of impairment + cause

e.g Dementia 2/2 AD

34
Q

What is the most underdiagnosed forms of dementia?

A

Frontotemporal dementia

35
Q

What are the primary complaints with frontotemporal dementia?

A

Behavioral changes, impaired speech and dysexecutive syndromes

36
Q

What age range generally develops FTD? AD?

A 
FTD = 50s
AD = 70s
37
Q

What are the three subtypes of frontotemporal dementia?

A
  • Frontotemporal dementia
  • Primary progressive aphasia (Broca’s like)
  • Semantic dementia (Wernicke’s like)
38
Q

What are the three proteins that cause FTD?

A
  • TDP-43
  • Tau
  • FUS
39
Q

What is the presentation of subcortical dementia?

A
  • Slowed psychomotor speed
  • Memory loss
  • BG disease
40
Q

What are the diseases that can cause a subcortical dementia? (4)

A
  • MS
  • Parkinson’s
  • Wilson’s disease
  • huntington’s
41
Q

What are the classic s/sx of Lewy body dementia?

A
  • Early, vivid visual hallucinations
  • Fluctuating cognition
  • Parkinsonism
42
Q

How many characteristics are needed from the core and suggestive features?

A

2+

43
Q

What is REM sleep behavior disorder? What can it be seen in?

A

Loss of motor inhibition during the REM stage of sleep

Lewy body dementia

44
Q

What causes the autonomic problems with Lewy body dementia?

A

Brainstem issues

45
Q

What are the two key characteristics of the visual hallucinations with Lewy body dementia?

A

Benign, but Vivid and occur early in the course of the disease

46
Q

What is the difference between Dementia brought about by parkinson’s, and Lewy body dementia?

A

Name only–same pathophysiologic process

47
Q

What is the classic history of dementia in patients with vascular dementia?

A

Stepwise loss of function

48
Q

What is Binswanger’s disease (subcortical leukoencephalopathy)?

A

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
Q

What are the classic s/sx with Binswanger’s disease (subcortical leukoencephalopathy)? (2)

A
  • Attention and concentration deficits

- psychomotor slowing

50
Q

What are the three main differences between delirium and dementia?

A

Delirium has:

  • acute onset
  • Impaired attention
  • Paranoid Hallucinations
51
Q

Does AD have impaired attention?

A

No–does not affect frontal cortex

52
Q

What is the general class of medication used to treat dementia?

A

Acetylcholinesterse inhibitors

53
Q

What are the three major Acetylcholinesterse inhibitors used to treat dementia?

A
  • Donepezil
  • Rivastigmine
  • Galantamine
54
Q

What is the role of Acetylcholinesterse inhibitors in the treatment of dementia?

A

Slow, or stabilize progression, but do not cure or prolong life

55
Q

What happens to a sudden stop of treatment with Acetylcholinesterse inhibitors in the treatment of dementia?

A

Cognitive function will plunge, and is not reversible

56
Q

What are the three major side effects of the Acetylcholinesterse inhibitors used to treat dementia?

A
  • GI disturbance
  • Vivid dreams
  • Increased agitation
57
Q

Why should Acetylcholinesterse inhibitors agents be avoided in FTD?

A

Increase agitation

58
Q

What happens to choline levels in Lewy body disease? What happens with treatment with Acetylcholinesterse inhibitors?

A

Drops–thus will markedly improve patients

59
Q

What is the MOA of memantine? Use?

A

Partial antagonist of NMDA receptor

Dementia treatment

60
Q

What are the vitamins that have been shown to benefit dementia patients?

A

E and C

61
Q

What is the role of Gingko biloba in the treatment of dementia?

A

Does not prevent, but has a modest benefit

62
Q

What drugs should be stopped in patients with dementia?

A

Anticholinergics and sedatives

63
Q

What are the antidepressants that are preferred for treating depression in dementia?

A

SSRIs or SSNRIs

64
Q

What are the two mood stabilizers used for dementia?

A

Valproate

Lamotrigine

65
Q

What is the MOA and use of Lamotrigine?

A

Na channel blocker

Anticonvulsant and mood stabilizer

66
Q

What is the MOA and use of Valproate?

A

Na channel blocker

Anticonvulsant and mood stabilizer

67
Q

What is the role of atypical antipsychotics in the treatment of dementia?

A

Treats agitation and paranoia

68
Q

What is the atypical antipsychotic of choice for dementia?

A

Quetiapine

69
Q

What is the MOA and use of Quetiapine?

A

Atypical antipsychotic

D1 receptor antagonist

70
Q

What drugs are contraindicated in Lewy body dementia?

A

Atypical antipsychotics–loss of dopamine already an issue

71
Q

What is the best prevention/treatment for dementia?

A

Exercise

Neurology (23 decks)

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