Neurocognitive disorders

Question 1

What are the three broad categories of Amnestic Disorders?

Answer 1

1. Amnestic disorder due to a general medical condition
2. Susbtance-induced persisting amnestic disorder
3. Amnestic disorder not otherwise specified (NOS)

Question 2

What drug is used to treat psychosis in delirium? What is the effective total daily dose?

Answer 2

Haloperidol; Effective total daily dose is 5-40 mg

Question 3

These are masses of cytoskeletal elements seen in some post-mortem specimens but are not necessary for diagnosis?

Answer 3

Pick bodies

Question 4

Differentiate the memory characteristics in subcortical vs cortical dementia?

Answer 4

Subcortical: Impaired recall (retrieval), Not Recognition Encoding
Cortical: Recall and Recognition Impaired

Question 5

The hallmark of delirium

Answer 5

impairment in consciousness,

occurring with global impairments of cognitive function

Question 6

What is bradyphenia?

Answer 6

slow movements of persons with PD are parallel in the slow thinking of some affected patients

Question 7

This reversible CNS disorder is characterized by an acute decline in the level of consciousness and cognition with particular impairment in attention

Answer 7

Delirium

Question 8

What is S100B? What is its expected finding in delirium?

Answer 8

Calcium-binding protein involved in the regulation of a number of cellular processes, such as cell cycle progression and differentiation
• elevation in CSF

Question 9

This type of dementia is also called Punch-Drunk Syndrome (Dementia Pugilistica) which occurs in boxers after repeated head trauma over many years; Enumerate its clinical features

Answer 9

Head Trauma-Related Dementia; (1) emotional lability, (2) dysarthria, and (3) impulsivity

Question 10

Enumerate the impairments in dementia.

Answer 10

Visuospatial impairments

Memory impairments

Question 11

What are the main abilities affected by dementia?

Answer 11

1. Judgment
2. Orientation
3. Emotions
4. Memory
5. Thinking

Question 12

Enumerate the neurotransmitter involvement in Alzheimer’s Disease.

Answer 12

Decreased concentration of Acetylcholine and Norepinephrine
• Cholinergic System degeneration with the significant loss of neurons in the certain areas (such as Nucleus Basalis of Meynert)
• Decreased concentration of neuroactive peptides somastatin and corticotrophin

Question 13

Enumerate the psychiatric and neurologic changes in patients with dementia

Answer 13

Personality
Hallucinations and delusions
Mood (depression, anxiety)
Catastrophic reaction
Sundowner syndrome

Question 14

T or F: divalproex is given in low doses for the elderly

Answer 14

T

Question 15

How is the course of amnestic disorder different from that of Alzheimer’s dementia?

Answer 15

Alzheimer’s Disease – progressive deterioration

Amnestic Disorder – stasis or improvement

Question 16

What comprises complex attention?

Answer 16

Sustained attention
• Divided attention
• Selective attention
• Processing speed

Question 17

This is the second most common etiology of dementia?

Answer 17

Vascular Dementia

Question 18

Differentiate transient and chronic amnestic disorder according to DSM-IV

Answer 18

Transient: memory impairment lasts for 1 month or less
Chronic: memory impairment lasts for >1month

Question 19

What is the second diagnostic criterion for delirium in DSM-5?

Answer 19

The disturbance develops over a short period (usually hours to days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of the day.

Question 20

The Alzheimer’s type of dementia has shown linkage to which chromosomes?

Answer 20

chromosomes 1, 14 and 21

Question 21

This is the essential feature in patients with amnestic disorder

Answer 21

Impaired ability to learn and recall new information coupled with inability to recall past events

Question 22

T or F: In treatment of delirium, psychiatric symptoms must be addressed before starting treatment of the underlying symptom.

Answer 22

F

Question 23

How is the dementia in Huntington Disease different from Alzheimer’s Disease?

Answer 23

High incidence of depression and psychosis in addition to the classic choreoathetoid disorder

Question 24

T or F: Visual hallucinations are more common in schizophrenia and depression than in delirium

Answer 24

F

Question 25

What are the atypical antidepressants prescribed to depressed demented patients

Answer 25

Citalopram, fluoxetine, sertraline, trazodone

Question 26

Describe Sundowner Syndrome

Answer 26

Characterized by drowsiness, confusion, ataxia and accidental falls; Occur in demented patients when external stimuli, such as light and interpersonal orienting clues, are diminished

Question 27

This behavior approach in demented patients is used to recount pleasurable experiences

Answer 27

Reminiscence Therapy

Question 28

Major neurotransmitter involved in delirium

Answer 28

Acetylcholine

Question 29

Major anatomical area involved in delirium

Answer 29

Reticular Formation

Question 30

Major pathway involved in delirium

Answer 30

Dorsal Tegmental Pathway

Question 31

Which impairment in dementia is the first impairment noticed in highly educated/intelligent patients?

Answer 31

Executive Function

Question 32

How is dementia distinguished from normal aging?

Answer 32

Normal aging not affect activities of daily living

Question 33

Acetylcholinesterase Inhibitors are used for which type of symptoms in Mild to Moderate Alzheimer’s and dementia?

Answer 33

Cognitive Symptoms

Question 34

What is Biswanger’s Disease?

Answer 34

Subcortical Arteriosclerotic Encephalopathy; characterized by the presence of many small infarctions of the white matter that spare the cortical regions

Question 35

T or F: In pseudodementia, history of previous psychiatric dysfunction is unusual, whereas it is common in dementia.

Answer 35

F

Question 36

When will lithium-induced delirium be resolved once lithium has been stopped?

Answer 36

Up to 2 weeks