Trans 044: Dementia and Neurobehavioral

Question 1

a syndrome – usually of a chronic or progressive
nature – in which there is deterioration in cognitive function
(i.e., the ability to process thought) beyond what might be
expected from normal ageing.

Answer 1

Dementia

Question 2

T/F?

Dementia results from a variety of diseases and injuries that
affect the brain, such as Alzheimer disease or stroke.

Answer 2

TRUE

Question 3

T/F? Dementia is not a normal part of aging

Answer 3

T

Question 4

Diagnostic criteria for dementia?

Answer 4

the presence of an acquired impairment in memory, associated with impairment in one or more cognitive domains:

executive functioin
language
praxis
gnosis

impairments in cognition mus be severe enough to interfere c daily function

Question 5

The diagnostic process in dementia has 3 major conceptual components:

Answer 5

conceptual components:
1) the clinical diagnosis,
2) a logical search for the cause,
 logical search for the cause is important because some of the causes of dementia may be irreversible
3) the identification of treatable comorbid conditions and other contributing factors, such as the degree of cerebrovascular disease.`

Question 6

The diagnostic process should involve 6 main steps:

Answer 6

o taking the patient’s history,
o interviewing a caregiver or family member,
o physical examination,
o brief cognitive tests,
o basic laboratory tests,
o structural imaging for patients meeting certain criteria.

Question 7

It is important to interview not only the patient but also the family, all close members and caregiver. T or F?

Answer 7

T

Question 8

what laboratory tests would we request for dementia?

Answer 8

In laboratory tests test for iron deficiency & thyroid disease

Question 9

remains the most widely used instrument, with high sensitivity and specificity for separating moderate dementia from normal cognition.

Answer 9

MMSE

 Kapag mild lang, hindi ganun kasensitive ang test”

Question 10

mild dementia? moderate? severe? SCORES IN MMSE

Answer 10

A rough rule of thumb is that patients with mild dementia usually have a score of 18–26 out of 30, those with moderate dementia a score of 10–18, and those with severe dementia a score of 10 or less than

Question 11

is a more expanded version that also includes assessment of delayed recall.

Answer 11

Modified Mini-Mental State Examination

Question 12

test that focuses on memory, attention, construction and orientation domains.

Answer 12

MMSE

Question 13

3 tests for cognitive function

Answer 13

• Mini-Mental State Examination Test (MMSE)
• Clock Drawing Test
• Montreal Cognitive Assessment Test

Question 14

evaluates general executive functioning of the frontal lobe, as well as visuospatial abilities.
• It requires 5–10 minutes to administer and has achieved widespread clinical use.
may lack sensitivity for the diagnosis of early or mild dementia.

Answer 14

CLOCK DRAWING TEST

Question 15

causes of dementia?

Answer 15

is caused by damage to or loss of nerve cells and their connections in the brain.

Question 16

If the patient is suffering from the dementia and you want to know, the better imaging test is MRI for dementia” T OR F?

Answer 16

T

Question 17

a condition that is a transient, usually reversible, acute confusional state. : clinical hallmarks are impaired attention and fluctuations in levels of consciousness.

Answer 17

Delirium

Question 18

In considering diagnosis of a degenerative dementia, it is important to exclude delirium. T or F?

Answer 18

T

Question 19

is a medical emergency with an increased risk for morbidity and death. It calls for immediate investigation and management of treatable medical conditions.

Answer 19

delirium

Question 20

T or F? Individuals with dementia are at risk for delirium; however, the initial diagnosis of dementia should not be made while the patient is in a delirious state.

Answer 20

T

Question 21

characterized principally by an alteration of consciousness and by prominent disorders of attention and perception, which interfere with the speed, clarity, and coherence of thinking, the formation of memories, and the capacity for performance of self-directed and commanded activities.

Answer 21

Acute confusional and delirious states:

Question 22

(new mental confusion) is a sudden change in mental status, or sudden confusion, which develops over hours to days.
 In the history, it is always important to ask the relatives when did this state started

Answer 22

Delirium

Question 23

2 types of delirium

Answer 23

1) hyperactive delirium and hypoactive delirium. Hyperactive means overactive (agitation, restlessness)
2) Hypoactive means underactive (sleepy and hard to respond). Sometimes both types can occur together.

Question 24

identify if delirium vs dementia? abrupt

Answer 24

delirium (dementia is insidious)

Question 25

identify if delirium vs dementia? course is slow decline?

Answer 25

dementia. fluctuation in delirium

Question 26

identify if delirium vs dementia? duration? hours to weeks

Answer 26

Delirium. Dementia is months to years

Question 27

identify if delirium vs dementia? Alertness is impaired

Answer 27

Delirium

Question 28

identify if delirium vs dementia? word finding problems?

Answer 28

Dementia

Question 29

decreased level of consciousness, but rapid arousal to verbal or noxious stimuli

Answer 29

Drowsiness

Question 30

impaired arousal to noxious stimuli, but preserved purposeful movements

Answer 30

Stupor

Question 31

sleep-like state of unresponsiveness, with no purposeful response to stimuli

Answer 31

Coma

Question 32

risk factor gender for delirium?

Answer 32

Male

Question 33

(Binswanger’s Disease aka

Answer 33

Subcortical Vascular Disease

Question 34

Neurodegenerative conditions that could lead to dementia

Answer 34

• Pick’s Disease
• Huntington’s Chorea
• Parkinson’s Disease

Question 35

Infections that can cause dementia? (4)

Answer 35

• Creutzfeldt Jackob’s Disease
• HIV (AIDS Dementia Complex)
• Viral Encephalitis
• Progressive Multifocal Leukoencephalopathy

Question 36

nutritional causes that can lead to dementia

Answer 36

• Wernicke Korsakoff (Thiamine Deficiency)

- B12 Deficiency (Folate Deficiency)

Question 37

metabolic causes that could lead to dementia? (4)

Answer 37

• Hepatic Disease
• Thyroid Disease
• Parathyroid Disease
• Cushing’s Syndrome

Question 38

how many percent of dementia are reversible?

Answer 38

10-15%

Question 39

While several different genes are probably involved in Alzheimer’s disease, one important gene that increases risk is

Answer 39

apolipoprotein E4 (APOE).

Question 40

alzheimer’s is Due to alteration on what chromosome (3)

Answer 40

1, 14 and 21

Question 41

Mutation on chromosome 14 – produces a protein

Answer 41

PRESENLIN 1 (PSEN1)

Question 42

Mutation on chromosome 1 – produces a protein

Answer 42

PRESENLIN 2 (PSEN2)

Question 43

PRESENLIN 1 & 2 encode for membrane protein involved for

Answer 43

AMYLOID PRECURSOR PROTEIN (APP).

Question 44

mutations on the chromosomes affected in AD will lead to decreased activity of?

Answer 44

Mutations lead to decreased activity of γ-secretase, an enzyme important in Β-amyloid peptide (ΒAP) formation.

Question 45

APP is encoded on what chromosome?

Answer 45

chromosome 21

Question 46

amyloid cascade hypothesis?

Answer 46

altered APP procesesing > overproduction of BAP > plaque formation > neurodegeneration > neuronal loss > dementia

Question 47

ΒAP aggregation & deposition – leads to

Answer 47

plaque formation

Question 48

Hyperphosphorylation of Tau protein – leads to

Answer 48

NFT development

Question 49

Gene responsible for production of apoE gene – chromosome ?

Answer 49

chromosome 19

Question 50

provides structural support to microtubules, cell’s transportation and skeletal system support.

Answer 50

Tau protein

When Tau filaments undergo abnormal phosphorylation at specific site, they can’t bind to microtubules thereby collapses.

Question 51

act as potential neurotoxins for AD.

Answer 51

Glutamine & other excitatory amino acid NTs; If glutamate remains in synapse for a long period of time : destroys nerve cells

Question 52

Blocking of NMDA receptors decreases/increases the glutamate activity in synapse

Answer 52

decreases

This is the reason why in the management of patients with AD, usually the target is the different neurotransmitters.

Question 53

ApoE4 is associated with increased/decreased deposition of ΒAP

Answer 53

increases

Question 54

AD risk factors

Answer 54

• Age!!
• Mild cognitive impairment (MCI)
• ApoE-e4 positivity
• Family hx in first degree relative (especially if younger onset)
• Vascular risk (diabetes, heart disease, etc.)
• Low education and physical/social activity
• Female sex

Question 55

This second most common type of dementia is caused by damage to the vessels that supply blood to the brain

Answer 55

vascular dementia

Question 56

The most common symptoms of vascular dementia include

Answer 56

difficulties with problem-solving, slowed thinking, focus and organization. These tend to be more noticeable than memory loss.

Question 57

For Vascular Dementia, the risk factors are correctable except for

Answer 57

age.

Question 58

suspect vascular dementia when?

Answer 58

• Suspect when
o Abrupt onset and/or stepwise decline
o Fluctuating course
o H/o stroke
o Focal neurologic symptoms or signs

Question 59

are abnormal balloon like clumps of protein that have been found in the brains of people with Lewy body dementia, Alzheimer’s disease and Parkinson’s disease.

Answer 59

Lewy body

Question 60

Common s/sx of lewy body dementia?

Answer 60

Common signs and symptoms include acting out one’s dreams in sleep, seeing things that aren’t there (visual hallucinations), and problems with focus and attention. Other signs include uncoordinated or slow movement, tremors, and rigidity (parkinsonism).

Question 61

Core features of lewy body dementia?

Answer 61

Core features
o Parkinsonism
o Recurrent early visual hallucinations
o Fluctuations (clue: recurrent delirium evaluations)

Question 62

Suggestive features of lewy body dementia?

Answer 62

Suggestive features include REM sleep disorder (dream enactment) & neuroleptic sensitivity

Question 63

what part of the brain has early degeneration in lewy body dementia

Answer 63

Relatively earlier occipital and basal ganglia degeneration

Question 64

this dementia has this clinical feature

Progressive non-fluent aphasia

Answer 64

Frontotemporal dementia

Question 65

identify what type of dementia is this based on the affected area: earliest changes in medial portion of the parietal cortex, parietal and superior/posterior temporal abnormalities; bilateral temporoparietal hypoperfusion

Answer 65

AD

Question 66

identify what type of dementia is this based on the affected area: temporoparietal associated with occipital hypoperfusion

Answer 66

Diffuse Lewy Body Disease

Question 67

identify what type of dementia is this based on the affected area: motor/premotor frontal cortex, anterior cingulate gyrus, hippocampus, basal ganglia and thalamus

Answer 67

progressive supranuclear palsy

Question 68

identify what type of dementia is this based on the affected area: frontal, anterior cingulate gyrus, anterior temporal lobe, hippocampus, basal ganglia, and thalamus

Answer 68

frontal dementia

Question 69

what dementia is this pathology?

Pick cells and pick bodies in cortex

Answer 69

Frontotemporal

Question 70

For slowly progressive “typical” dementia in adults >65, most essential tests:

Answer 70

B12, TSH, brain image (CT is ok)

Question 71

approved to differentiate AD from FTD

Answer 71

FDG (Functional Digital Imaging) PET

Question 72

The most widely used CSF biomarkers for Alzheimer’s disease measure certain proteins:

Answer 72

o beta-amyloid 42 (the major component of amyloid plaques in the brain),
o tau, and
o phospho-tau (major components of tau tangles in the brain).

Question 73

`ADHD is closely related with poor regulation of some neurotransmitter which are?

Answer 73

Dopamine and norepinephrine