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Medical Neuropsychology > Topic 2: Cardiovascular Disease > Flashcards

Topic 2: Cardiovascular Disease Flashcards

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USMLE® Step 1 flashcards
1
Q

Traditional biomedical CV risk factors

A
  • Hypertension
  • dyslipidemia
  • obesity
  • insulin resistance
  • glucose intolerance
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2
Q

Which two genotypes are known to be common to both CV and dementia

A
  • APOE e4 is associated with AD. Also a risk factor for dyslipidemia, atherosclerosis, cardiac disease and stroke
  • MEOX2, a known cerebrovascular gene
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3
Q

Hypertensives perform poorly on tests of ….

A

Executive function, learning, memory and attention

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4
Q

What shape has the relation of BP and cognitive function?

A

The relation is nonlinear and may be J-shaped such that both high and low levels of BP are associated with lower levels of cognitive performance and cognitive decline

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5
Q

Vulnerability to the potential cognitive consequences of hypertension is most pronounced:

A
  • at younger ages
  • among those with lower levels of education
  • in women
  • among those with APOE e4 alleles
  • in hyperinsulinemic diabetic
  • in obese persons
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6
Q

Various neurobiological mechanisms may underlie hypertension-cognition relations, name these mechanisms

A
  • reduced regional or global cerebral blood flow or metabolism
  • disruption of the blood-brain barrier
  • endothelial dysfunction
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7
Q

Neuroanatomical findings in hypertension include:

A
  • increased cerebral white matter disease
  • silent brain infarction
  • brain atrophy
  • macro vascular disease
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8
Q

What is the effect of antihypertensive agents on cognition?

A

Select measures of verbal memory appear to benefit from antihypertensive agents.
Measures of learning and perceptuo-motor speed may show decrement

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9
Q

What is dyslipidemia?

A

Dyslipidemia encompasses a range of disorders of lipoprotein lipid metabolism that include both abnormally high and low lipoprotein concentrations and abnormalities in the composition of these lipoprotein particles

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10
Q

Total cholesterol consists of:

A
  • low-density lipoprotein cholesterol (LDL-C)
  • high-density lipoprotein cholesterol (HDL-C)
  • triglycerides (TG)
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11
Q

Higher levels of Low density lipoprotein cholesterol promotes …

A

Atherosclerosis

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12
Q

High levels of high density lipoprotein cholesterol are …

A

In part protective against atherosclerosis

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13
Q

High levels of triglycerides are associated with …

A

Increased risk of atherosclerosis

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14
Q

Lower levels of total cholesterol are associated with …

A

Higher scores on various indexes of IQ

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15
Q

What are proposed mechanisms linking lipid levels with dementia include …

A
  • Atherosclerosis
  • APOE genotype
  • modulation of beta-amyloid protein
  • oxidative stress
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16
Q

What is the function of cholesterol?

A
  • it is an important constituent of neuronal and glial membranes and of myelin sheaths
  • it provides structural integrity, modulates membrane fluidity, and is important for synaptic function, neurotransmission, and the transport of nutrients to the brain
  • cholesterol is also a precursor of steroid hormones involved in brain function
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17
Q

What are the proposed mechanisms for the relation between obesity and dementia?

A
  • endocrine dysregulation (hyperinsulinemia, abnormal leptin levels)
  • inflammation
  • enhancement of other CV risks
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18
Q

The metabolic syndrome is characterized by ….

A
  • Glucose intolerance
  • insulin resistance
  • central adiposity
  • dyslipidemia
  • hypertension
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19
Q

People with the metabolic syndrome are at increased risk of developing ..

A

Diabetes mellitus

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20
Q

Diabetes is characterized by …

A

High levels of glucose in the blood

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21
Q

Diabetes can be caused by …

A

Too little insulin, resistance to insulin, or both

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22
Q

What are the two main forms of diabetes?

A
  • type 1: is characterized by loss of the insulin-producing beta cells of the islets of langerhans of the pancreas leading to a deficiency in insulin secretion
  • type 2: is characterized by variable degrees of insulin deficiency and resistance
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23
Q

What are the therapeutic goals in diabetes?

A

The alleviations of symptoms of hyperglycemia and aggressive CV risk factor intervention to reduce end-organ damage

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24
Q

What mediates the relation between diabetes and dementia?

A

Diabetes-associated cerebrovascular disease may mediate the relation

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25
Q

Type 1 diabetes has been associated with:

A

Difficulties in attention, learning and memory, visuospatial abilities and perceptuo-motor and motor speed

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26
Q

Cardiovascular disease classification

A
  • coronary heart disease (coronary death, myocardial infarction, coronary insufficiency and angina)
  • cerebrovascular disease (ischemic stroke, hemorrhagic stroke and transient ischemic attack)
  • peripheral artery disease
  • heart failure
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27
Q

Which biomarkers could add substantial prognostic information of CV disease

A
  • Inflammation
  • Oxidative stress
  • Chronic Kidney Disease
  • Homocysteine
28
Q

What are the behavioral risk factors for CV disease?

A
  • Smoking
  • Alcohol
  • Diet/Antioxidants
  • Physical activity
29
Q

What are the psychophysiological risk factors of CV?

A
  • ANS dysregulation

- HPA axis dysfunction

30
Q

What are the three most common and clinically important

cardiac arrhythmias?

A
  • Artrial fibrillation (AF)
  • Ventricular tachycardia (VT)
  • Ventricular fibrillation (VF)
31
Q

What is artrial fibrillation?

A

During AF, the two upper chambers beat chaotically and irregularly, and their contractions are not coordinated with the contractions of the ventricles.

32
Q

What is Ventricular Tachycardia?

A

VT is defined as three or more successive beats of ventricular origin at a rate greater than 100 bpm.

33
Q

What is ventricular fibrillation?

A

VF is the uncoordinated, often very rapid ineffective contractions of the ventricles caused by chaotic electrical impulses. In VF, nu blood is pumped from the heart.

34
Q

AF is associated with decreased performance on tests of …

A

memory, attention, cognitive composites and MMSE.

35
Q

What are the cognitive effects of VF?

A

severe effects, not only isolated to memory but rather extend to motor and executive functions.

36
Q

What are the two common markers of arterial stiffness?

A

Pulse pressure and pulse wave velocity

37
Q

PWV is linked with …

A

diminished cognitive function

38
Q

Increasing levels of PP relate significantly to prospective decline on …

A

tests of verbal learning, nonverbal memory, working memory

39
Q

The cognitive deficits most frequently self reported after CABG are …

A

Memory and concentration problems

40
Q

CV risk factors and diseases confer substantial increase in risk for …

A

ischemic and hemorrhagic stroke

41
Q

Most dementia is mixed, with involvement of …

A

both vascular and neurodegenerative pathology

42
Q

CV disease is part of the broadly defined diseases of the …. (ICD classification)

A

circulatory system

43
Q

The APOE e 4 allele is a risk factor for …

A
  • dyslipidemia
  • atherosclerosis
  • cardiac disease
  • stroke
44
Q

Increased BMI and WHR have been associated with …

A
  • temporal lobe or hippocampal atrophy
  • greater overall brain atrophy
  • greater white matter disease
  • Also, the frontal lobes may be severely impaired
45
Q

Case studies of type 2 diabetes report the most impact on tests of ….

A

Learning and memory

However: also affected are measures of attention, psychomotor speed, and problem solving

46
Q

aerobic fitness training is associated with improvements in ..

A
  • coordination
  • planning
  • inhibition
  • scheduling
  • working memory
47
Q

Depression and cognitive dysfunction and depression may be linked by …

A

inflammatory mechanisms

48
Q

Cumulative exposure to high and increasing levels of cortisol is associated with …

A

decreased hippocampal volumes and decline in attention, memory and executive function.

49
Q

What is thought to be particularly important to the ultimate development of dementia?

A

Cerebral hypoperfusion

50
Q

AF is an important risk factor for ..

A

AF inscreases risk of developing blood clots that may lead to stroke.

51
Q

Which four subclinical cardiovascular disease states have been linked with decrements in concurrent cognitive function and/or prospective cognitive decline?

A
  • atherosclerosis
  • arterial stiffness
  • endothelial dysfunction
  • left ventricular hypertrophy
52
Q

Why is atherosclerosis a contributor to the development of VaD?

A

Because of its involvement in cerebral ischemia and stroke

53
Q

What are the proposed mechanisms whereby atherosclerosis contributes to AD?

A

oxidative stress, inflammation, and immune responses

54
Q

What are the most frequently studied indices of subclinical atherosclerosis?

A
  • carotid intima-media thickness (IMT)

- plaque

55
Q

Significant associations between increased carotid IMT and diminished cognitive function have been found across a number of cognitive domains, including …

A
  • global cognitive function
  • attention
  • psychomotor speed
  • verbal memory
  • non verbal memory
  • language
  • verbal fluency
  • inductive reasoning
  • mental flexibility
56
Q

What are manifestations of Coronary Heart Disease?

A
  • stable angina
  • acute coronary syndromes
  • myocardial infarction
  • heart failure
  • sudden death
  • silent ischemia
57
Q

Non-demented cardiac patients have been described as exhibiting dysfunction on tests of …

A

memory, fine motor control, and orientation

58
Q

Peripheral artery disease is a subtype of

A

peripheral vascular disease

59
Q

PAD results from..

A

atherosclerosis of the arteries that supply the lower extremities

60
Q

PVD patients performed more poorly than healthy controls on tests of …

A

attention, psychomotor speed, executive functions, visual memory, and visuospatial ability.

61
Q

What is Heart Failure?

A

HF is a syndrome where there are structural or functional cardiac disorders that impair the ability of the left ventricle to fill with or eject blood.

62
Q

HF is characterized by …

A

dyspnea and fatigue, and signs on physical examination, such as fluid retention.
(kortademigheid, vermoeidheid en vocht vasthouden)

63
Q

Which domains are affected by HF?

A
  • attention
  • concentration
  • memory
  • language
  • psychomotor speed
  • executive function
64
Q

What is a commonly used marker of endothelial dysfunction?

A

Brachial artery flow-mediated dilatation

65
Q

Increased brachial artery FMD is related to …

A

Decreased performance on measures of attention, EF and psychomotor speed

Medical Neuropsychology (9 decks)

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