Section 7: Dementia

Question 1

Minimum investigations for all patients with memory loss

Answer 1

• Head CT
• B12 level
• Thyroid function testing (T4/ TSH)
• RPR or VDRL

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7025-7029). . Kindle Edition.

Question 1

Rx for Alzheimer’s disease

Answer 1

• Donepezil
• Rivastigmine
• Galantamine

These are anticholinesterases

• Memantine

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7033-7034). . Kindle Edition.

Question 2

The 3 Ws of Normal Pressure Hydrocephalus

Answer 2

• Wet: Urinary incontinence
• Weird: Dementia
• Wobbly: Wide-based gait/ ataxia

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7056-7057). . Kindle Edition.

Question 3

Diagnostic tests and Rx of NPH

Answer 3

Diagnostic tests:

• Head CT
• LP

Rx:

• Shunt placement

Question 4

Parkinson’s Disease + Dementia

Answer 4

Lewy Body Dementia

Question 5

Diagnosis:

• Personality and behavior become abnormal first.
• Then memory is lost afterward
• There is no movement disorder
• Head CT or MRI shows focal atrophy of the frontal and temporal lobes

Rx of above condition

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7037-7048). . Kindle Edition.

Answer 5

Pick Disease (Frontotemporal dementia)

Treat the same as Alzheimer’s with less response.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7037-7048). . Kindle Edition.

Question 6

Creutzfeldt-Jakob Disease (CJD) CJD is caused by prions, transmissible protein particles. It manifests as rapidly progressive dementia and the presence of myoclonus. The patient is younger than in Alzheimer’s. The EEG is abnormal.

What is the most accurate diagnostic test?

What is the finding in CSF and what is the benefit?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7037-7048). . Kindle Edition.

Answer 6

The most accurate diagnostic test is a brain biopsy

CSF shows a 14-3-3 protein. The presence of the 14-3-3 protein spares the patient the need for brain biopsy.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7037-7048). . Kindle Edition.

Question 7

Diagnosis:

• Dementia
• Psychiatric disturbance with personality changes
• Chorea/ movement disorder

Diagnostic testing

Rx for above condition

Mode of inheritance

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7064-7066). . Kindle Edition.

Answer 7

Huntington Disease (HD)

Genetic testing

No Rx available to reverse HD

• Tetrabenazine for dyskinesia
• Haloperidol, quetiapine or a traid of different antipsychotics for psychosis

Autosomal dominance

Question 8

Describe the dementia syndromes

Answer 8

All patients have memory loss and should have a head CT/ MRI, VDRL, B12, and T4

Conditions vary as follows:

• Alzheimer’s: No focal deficits. Treatment is with anticholinesterases and memantine
• Pick’s/ frontotemporal: Personality and behavior are affected first
• Lewy body: Parkinsonian symptoms accompany dementia
• Huntington’s: Presents with movement (chorea) and personality disorders
• Normal pressure hydrocephalus: Remember WWW: Wet, weird, wobbly.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7072-7082). . Kindle Edition.

Question 9

True or False

• Avoid tyramine-containing (TC) foods with MAO inhibitors
• Give an example of such food
• Why should TC foods be avoided

Answer 9

• True
• Cheese
• They precipitate HTN

Question 10

Medications likely to slow the progression of Parkinson’s Disease

Answer 10

MAO inhibitors

• Rasagiline
• Selegiline

Question 11

Internuclear ophthalmoplegia (INO) is the inability to adduct one eye with nystagmus in the other eye.

INI is characteristic of what diseas?

Answer 11

Multiple Sclerosis

Question 12

Rx for spasticity

Answer 12

• Baclofen
• Dantrolene
• Tizanadine (centrally acting alpha agonist)