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(2) MS: Neurological Conditions 🩺 > S2_L3: Dementia > Flashcards

S2_L3: Dementia Flashcards

1
Q

Most common neurodegenerative disease

A

Alzheimer’s disease

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2
Q

Country with the highest population of adults older than 65 years old

A

Sweden

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3
Q

In the Philippines, how many years of age is considered as elderly?

A

60 years old

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4
Q

TRUE OR FALSE: The majority of demeted elders live in less developed regions such as South-East Asia. Asia is the most populous continent in the world.

A

True

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5
Q

The person who discovered Alzheimer’s & treated Auguste D

A

Dr. Alois Alzheimer

Additional: Alzheimer found the characteristic plaques throughout the cerebral cortex, but also found clumping and distortion of fibrils in the neuronal cytoplasm

Source: Adams & Victor

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6
Q

51 y/o female from Frankfurt, Germany, who is the first Alzheimer’s disease patient. She had progressive cognitive impairment, focal symptoms, hallucinations, and delusions. She died within 5 years.

A

Auguste D

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7
Q

Order of Forgetting in pts with dementia

A
  1. Grandchildren
  2. Youngest children
  3. Oldest children
  4. Wife
  5. Mother or Father
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8
Q

Determine whether the s/sx is present in which stage

  1. Difficulty following simple commands
  2. Difficulty learning new things
  3. Emotional deterioration
  4. Difficulty recalling familiar words
  5. Social skills decline

A. Early stage
B. Intermediate stage
C. Advanced stage

A
  1. C
  2. A
  3. C
  4. A
  5. B
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9
Q

Determine whether the s/sx is present in which stage

  1. Paranoia
  2. Loss of insight
  3. Physical / verbal aggression
  4. Bladder / bowel control declines
  5. Fatigue

A. Early stage
B. Intermediate stage
C. Advanced stage

A
  1. B
  2. C
  3. B
  4. C
  5. A
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10
Q

Determine whether the s/sx is present in which stage

  1. Deterioration in judgment and social behavior
  2. Loss of logic, memory, motor ability; Restlessness
  3. Impatience
  4. Hallucinations
  5. Forgetful and absent-minded

A. Early stage
B. Intermediate stage
C. Advanced stage

A
  1. A
  2. B
  3. B
  4. C
  5. A
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11
Q

It is a syndrome of cognitive decline with variable non-cognitive features of behavioral and psychiatric symptoms and disturbances in ADLs. The sustained acquired decline in intellect which interferes with an individual’s daily activities.

A

Dementia

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12
Q

Determine if the clinical feature corresponds to normal aging or dementia.

  1. Poor memory
  2. Intact ADLs
  3. Decline in other cognitive domains
  4. Minimal forgetfulness
  5. Abnormal n/p test result

A. Normal aging
B. Dementia

A
  1. B
  2. A
  3. B
  4. A
  5. B
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13
Q

TRUE OR FALSE: Alzheimer’s disease is the most common cause of dementia, followed by CVD, then AD with infarcts, then chronic, subdural hematoma, and slow-growing tumor.

A

True

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14
Q

Most common and important degenerative disease and dementia of the brain, having an immense societal impact. It is the underlying cause of memory loss in most cases of dementia.

A

Alzheimer’s Disease

Sources: Adams & Victor; Merritt

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15
Q

Average duration of Alzheimer’s Disease

A

8-11 years

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16
Q

Enumerate the 8 risk factors for Alzheimer’s disease.

A
  1. Age
  2. Gender
  3. Ethnicity
  4. Education
  5. Occupation
  6. Head trauma
  7. Comorbid conditions
  8. Life events
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17
Q

Country that has an association with life events for development of dementia, especially bereavement. The culture of this country has the longest time for mourning.

A

China

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18
Q

Most important risk factor for dementia

A

Age

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19
Q

TRUE OR FALSE: Prevalence of Alzheimer’s disease is higher in women than men.

A

True

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20
Q

Type of vascular dementia that leads to significant parenchymal volume loss not necessarily in critical locations

A

Multiple Large-Vessel Infarctions / Multiple ischemic infarcts affecting large vessels

Source: Merritt

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21
Q

Type of vascular dementia that is critically located. The ACA, PCA & MCA may be occluded.

A

Strategic (Single) Infarctions

Additional: If ACA, (B) frontal infarction; if MCA, frontal / parietal infarcts; if PCA, (B) thalamic infarction. Inferior medial temporal lobe infarcts can also occur.

Source: Merritt

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22
Q

TRUE OR FALSE: The brain-battering hypothesis states that lower education leads to a higher dementia prevalence

A

True

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23
Q

TRUE OR FALSE: Early-life stimulation can contribute to cognitive reserve and may decrease risk for AD. Adult education enhances cognitive reserve.

A

True

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24
Q

In DSM-IV for dementia - Alzheimer’s type: Gradual, progressive decline in memory plus one or more of the ff:
1-4.

A
  1. Aphasia
  2. Apraxia
  3. Agnosia
  4. Executive function disturbance
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25
Q

Warning signs: Normal or possibly dementia

  1. Trouble balancing a checkbook
  2. Rapid mood shifts
  3. Forgetting for a moment where you are going
  4. Forgetting that a meal was ever prepared
  5. Unable to find the right word, but using a substitute

A. Normal
B. Possibly dementia

A
  1. A
  2. B
  3. A
  4. B
  5. A
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26
Q

Warning signs: Normal or possibly dementia

  1. Getting lost on your own street
  2. Temporarily forgetting a colleague’s name
  3. Talking on the phone and temporarily forgetting to watch a child
  4. Drastic changes in personality, all of a sudden
  5. Putting a wristwatch in the sugar bowl
  6. Tired of housework but getting back to it

A. Normal
B. Possibly dementia

A
  1. B
  2. A
  3. A
  4. B
  5. B
  6. A
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27
Q

Enumerate 4 risk factors for vascular dementia

A
  1. Demographic factors
  2. Stroke features
  3. Vascular risk factors
  4. Psychological factors
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28
Q

TRUE OR FALSE: Mild cognitive impairment (MCI) is a cognitive state that falls between normal aging and dementia. This includes amnesia, dysnomia, visuospatial disorientation, paranoia and personality changes, and executive dysfunction.

A

True

Sources: Adams & Victor; Merritt

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29
Q

TRUE OR FALSE: Individuals with MCI, particularly amnestic MCI, are at increased risk for progressing to dementia, most often Alzheimer’s disease.

A

True

Source: Merritt

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30
Q

Match the treatments for AD & their corresponding presumed mechanism

  1. Donepezil hydrochloride
  2. Memantine hydrochloride
  3. Rivastigmine tartrate
  4. Galantamine hydrobromide

A. Cholinesterase inhibition
B. NMDA receptor inhibition

A
  1. A
  2. B
  3. A
  4. A
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31
Q

TRUE OR FALSE: If there is hemiplegia, homonymous hemianopia, and the like, either the diagnosis of Alzheimer disease is incorrect or the disease has been complicated by a stroke, tumor, or subdural hematoma.

A

True

Source: Adams & Victor

32
Q

It is characterized by cognitive dysfunction with accompanying functional decline caused by either ischemic or hemorrhagic cerebrovascular disease, or sequelae of hypoperfusion, hypotension, or hypoxia. It is regarded as the 2nd or 3rd most frequent cause of dementia.

A

Vascular dementia (VaD)

33
Q

Match the pathologic hallmark of AD with its corresponding clinical implication

  1. Parietotemporal atrophy
  2. Nucleus basalis cell loss
  3. Hippocampal atrophy

A. Attentional impairment
B. Dysnomia/ visuospatial impairment
C. Memory impairment

34
Q

A common complaint in the elderly with regards to details of recent events or a recent conversation, an important appointment or telephone number, and personal items misplaced.

A

Forgetfulness

35
Q

What indicates a (+) abnormal face-hand test?

A

Patient reports only the face is touched by the light touch stimulus.

36
Q

How to perform abnormal face-hand test?

A

Apply a light touch stimulus simultaneously to the cheek and hand.

37
Q

Determine the common side effects of each ACh inhibitor

  1. Nausea, vomiting, diarrhea, anorexia
  2. Transaminase elevations, nausea, agitation
  3. Nausea, diarrhea, insomnia, vomiting
  4. Dyspepsia, asthenia, fatigue, headache

A. Donepezil
B. Rivastigmine
C. Galantamine
D. Tacrine

38
Q

It is one of the pharmacotherapies for AD and an NMDA channel antagonist

39
Q

Name the 2 pharmacotherapies for AD that are cholinesterase inhibitors

A

Donepezil, Rivastigmine

40
Q

Name the 4 approved cholinesterase inhibitors

A

Donepezil, Rivastigmine, Galantamine, and Tacrine

41
Q

In Cholinergic Synaptic Transmission, cholinesterase (ChE) inhibitors reduce (1)___ hydrolysis in remaining neurons and help to normalize (2)___ function

A
  1. acetylcholine
  2. cholinergic
42
Q

Name the 2 important histological markers of Alzheimer’s disease

A

Intracellular Neurofibrillary Tangles & Extracellular Amyloid Plaques

43
Q

It is a collection of paired helical filaments that is derived from Tau protein, a normal component of the microtubule.

A

Neurofibrillary tangles

44
Q

It is the most important predictor of cognitive impairment in Alzheimer’s disease

A

Hippocampal atrophy

45
Q

Imaging used to detect hippocampal atrophy

A

Volumetric MRI

46
Q

A clock drawing that contains 2 of the following: circular face, numbers 1-12, and symmetric number placement is given what score?

A

3/4 - Good (2)

47
Q

A clock drawing that contains approximately circular face or the numbers 1-12 is given what score?

A

2/4 - Fair (1)

48
Q

What are the 2 screening tests in the evaluation of patients with dementia?

A

Mini-Mental State Examination (MMSE) & Clock Drawing Test (CDT)

49
Q

TRUE OR FALSE: The key locations for strategic infarcts that cause dementia are the head of caudate, genus of internal capsule, angular gyrus, thalamus, corpus callosum, hippocampus, and basal forebrain.

50
Q

Neuritic plaques are found (1)___, while neurofibrillary tangles are present (2)___.

A
  1. outside neurons / extracellularly
  2. inside neurons / intracellularly
51
Q

Alzheimer’s disease corresponds to cholinergic (1)___, while vascular dementia corresponds to cholinergic (2)___.

A
  1. hypothesis
  2. deficit
52
Q

TRUE OR FALSE: Estrogen should not be used to treat AD

53
Q

What MMSE score corresponds to mental decline?

54
Q

What MMSE score corresponds to dementia?

A

17 and below

55
Q

What time is set in a Clock Drawing Test?

56
Q

Name the 3 common types of Vascular dementia

A
  1. Multiple Large-Vessel Infarctions
  2. Strategic Infarctions
  3. Subcortical VaD
57
Q

It is characterized by a thalamic lesion. As the thalamus is important for relaying information / memory, the individual may experience sudden memory loss

A

Strategic infarctions

58
Q

It is described as an extensive white matter pathology. It is seen in the elderly. It may occur without any symptoms but suddenly developing neurological deficits (memory impairment).

A

Subcortical vascular dementia

59
Q

A syndrome of acquired intellectual impairment due to cerebrovascular injury

A

vascular dementia

60
Q

TRUE OR FALSE: In some cases of Alzheimer’s, symptoms may start with behavioral changes rather than memory affectation

61
Q

TRUE OR FALSE: In diagnosis of VaD, multiple expert consensus diagnostic criteria modeled after AD require dementia linked to stroke or CVD

62
Q

Determine which description corresponds to the stage of AD

  1. No s/sx, positive biomarker status
  2. Definite functional impairment, multiple domains of cognitive s/sx
  3. No s/sx nor functional impairment
  4. Single or multidomain s/sx

A. No disease
B. Presymptomatic disease (Preclinical AD)
C. Symptomatic predementia (Mild cognitive impairment)
D. Symptomatic dementia (AD)

63
Q

Determine whether the following are true for atypical features suggesting non-alzheimer disease or not.
A if true, B if false

  1. Kluver-Bucy syndrome
  2. Insidious onset
  3. Onset before age 60
  4. Visual hallucinations
  5. Late gait disturbance
64
Q

TRUE OR FALSE: The basis for symptomatic treatment of Alzheimer disease are drugs that increase cholinergic tone

A

True

Source: Merritt

65
Q

Determine the classification of the following non-alzheimer dementias

  1. Chronic meningitis
  2. Gerstman Straussler
  3. Huntington’s Disease
  4. Subdural hematoma
  5. Hypothyroidism

A. Neurodegenerative disorders
B. Prion diseases
C. Metabolic-toxic
D. Infections
E. Other

66
Q

Determine the classification of the following non-alzheimer dementias

  1. AIDS dementia
  2. B12 deficiency
  3. Cortical Basal Ganglionic Degeneration
  4. Hydrocephalus
  5. Creutzfeldt-Jakob disease
  6. Neurosyphilis

A. Neurodegenerative disorders
B. Prion diseases
C. Metabolic-toxic
D. Infections
E. Other

A
  1. D
  2. C
  3. A
  4. E
  5. B
  6. D
67
Q

TRUE OR FALSE: The cerebrospinal fluid can reveal the total tau, ptau total AB42, and isoprostanes

68
Q

TRUE OR FALSE: The plasma can show the Amyloid Precursor Protein, inflammatory biomarkers (i.e. C-reactive protein/interleukins), oxidative markers of DNA damage, and lipoproteins and homocysteine.

69
Q

TRUE OR FALSE: Anti-AD drugs can prevent fast degradation of Ach. Vitamin E can also be used in attempt to slow progression of AD.

70
Q

Determine whether the test is routinely done for evaluation of patients with dementia or only done when indicated.

  1. Electroencephalogram
  2. Complete blood count
  3. Syphilis serology
  4. Thyroid function tests
  5. Urinalysis

A. Routine
B. When indicated

71
Q

Determine whether the test is routinely done for evaluation of patients with dementia or only done when indicated.

  1. Vitamin B12 level
  2. CSF examination
  3. Cranial CT scan/MRI
  4. PET/SPECT Scan
  5. Erythrocyte sedimentation rate

A. Routine
B. When Indicated

72
Q

TRUE OR FALSE: Obstructive sleep apnea is a risk factor for VaD

73
Q

TRUE OR FALSE: The Neuropsychological testing / neurocognitive assessment is indicated for patients with abnormal findings on MSE with normal ADLs, a high index of suspicion but normal screening test/s, determining competency for legal purposes, and for determining depression vs dementia.

74
Q

TRUE OR FALSE: The most common early sign and present symptom of Alzheimer’s is subjectively and objectively impaired memory. Alzheimer’s is a slow progressive cognitive impairment, eventually affecting many cognitive domains.

A

True

Source: Merritt

75
Q

TRUE OR FALSE: Mutations in the Amyloid precursor protein (APP) gene, Presenilin 1 (PSEN1) gene, and Presenilin 2 (PSEN2) gene are correlated with Alzheimer’s disease

A

True

Source: Merritt

(2) MS: Neurological Conditions 🩺 (12 decks)

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