VASCULAR DEMENTIA Flashcards
What is the primary underlying cause of vascular dementia?
A) Abnormal tau protein aggregation
B) Accumulation of beta-amyloid plaques
C) Cerebrovascular disease leading to ischemic or hemorrhagic injury
D) Dysfunction of dopamine-producing neurons
Answer: C) Cerebrovascular disease leading to ischemic or hemorrhagic injury
Rationale: Vascular dementia results from cerebrovascular disease, including symptomatic strokes and asymptomatic vascular lesions, leading to cognitive impairment. Unlike Alzheimer’s disease, which is driven by beta-amyloid accumulation, vascular dementia is primarily due to disruptions in cerebral blood flow.
What is the significance of the term “vascular contributions to cognitive impairment and dementia (VCID)”?
A) It emphasizes that only large strokes cause dementia
B) It highlights that cerebrovascular pathology contributes to cognitive decline alone or in combination with other neurodegenerative diseases
C) It replaces the term “Alzheimer’s disease” as the most common dementia
D) It suggests that all dementias are caused by vascular disease
Answer: B) It highlights that cerebrovascular pathology contributes to cognitive decline alone or in combination with other neurodegenerative diseases
Rationale: VCID reflects a broader understanding that cerebrovascular changes frequently coexist with other neurodegenerative diseases, such as Alzheimer’s, contributing to cognitive impairment.
Which imaging modality is most useful in detecting vascular contributions to dementia?
A) X-ray
B) Electroencephalogram (EEG)
C) Magnetic resonance imaging (MRI)
D) Positron emission tomography (PET)
Answer: C) Magnetic resonance imaging (MRI)
Rationale: MRI is the best tool for detecting cerebrovascular lesions, including infarcts, microbleeds, and white matter changes, which are critical in diagnosing vascular dementia and assessing its contributions to cognitive decline.
What is a key clinical feature that differentiates vascular dementia from Alzheimer’s disease?
A) Gradual onset with memory loss as the first symptom
B) Early-onset hallucinations
C) Stepwise cognitive decline with a history of strokes
D) Presence of Lewy bodies on autopsy
Answer: C) Stepwise cognitive decline with a history of strokes
Rationale: Unlike Alzheimer’s disease, which has an insidious onset with early memory loss, vascular dementia often presents with a stepwise decline due to recurrent strokes or cerebrovascular events.
In the longitudinal Reasons for Geographic and Racial Differences in Stroke study, what was observed about the cognitive trajectory of stroke patients?
A) Constant cognitive improvement
B) A shift from cognitive gain to cognitive loss after the stroke
C) No change in cognitive trajectory post-stroke
D) Patients showed an immediate cognitive decline after the stroke, followed by steady recovery
Answer: B) A shift from cognitive gain to cognitive loss after the stroke
Rationale: The study found that patients who previously showed a cognitive gain began to experience cognitive loss following their stroke, indicating a shift in cognitive trajectory due to the stroke.
What is believed to be a contributing mechanism to poststroke cognitive decline?
A) Increased neurogenesis after stroke
B) Ongoing effects of the cerebrovascular disease and loss of cognitive reserve
C) Inflammation only in the frontal lobe
D) Sudden restoration of cortical function following ischemia
Answer: B) Ongoing effects of the cerebrovascular disease and loss of cognitive reserve
Rationale: Poststroke cognitive decline is thought to be driven by the continuing effects of cerebrovascular disease as well as the loss of cognitive reserve, which makes the brain less resilient to subsequent age-related cognitive decline.
Which MRI sequence is particularly useful for detecting small, chronic infarcts, microbleeds, and white matter changes in patients with suspected VCID?
A) T1-weighted imaging
B) FLAIR, diffusion-weighted, and T2*-weighted sequences
C) Post-contrast imaging
D) PET scan
Answer: B) FLAIR, diffusion-weighted, and T2-weighted sequences
Rationale: FLAIR, diffusion-weighted, and T2-weighted MRI sequences are key for detecting small chronic infarcts, microbleeds, and white matter hyperintensities, which are indicative of cerebrovascular disease in patients with VCID. These sequences are critical in identifying the full spectrum of cerebrovascular pathology.
What is the suggested treatment approach for cognitive impairment due to vascular contributions to cognitive impairment and dementia (VCID)?
A) Immediate use of high-dose steroids
B) Consideration of cholinesterase inhibitors or memantine
C) Initiation of antipsychotic medications
D) Antidepressants and mood stabilizers
Answer: B) Consideration of cholinesterase inhibitors or memantine
Rationale: For mild to moderate cognitive impairment in VCID, cholinesterase inhibitors (donepezil, rivastigmine, galantamine) can be considered, while for moderate to severe impairment, high-dose donepezil or memantine (an NMDA receptor antagonist) may be used. These medications have shown modest cognitive benefits similar to those observed in Alzheimer’s disease patients.
