Clinical Approach to Dementia (Hon)

Question 1

What is the definition of dementia?

Answer 1

A decline in memory and at least one other cognitive function or a decline in an executive function

Question 2

What are some infectious causes of dementia?

Answer 2

1) Fungal meningitis
2) Syphilis
3) AIDS
4) CJD
5) Post-herpes simplex encephalitis

Question 3

What are some toxic/metabolic causes of dementia?

Answer 3

1) Vitamin B12 deficiency
2) Thyroid deficiency
3) Heavy metals

Question 4

What is the criteria for clinical diagnosis of Alzheimer’s disease?

Answer 4

1) Deficits in 2 or more areas of cognition
2) Progressive worsening of memory and other cognitive function
3) No disturbance of consciousness
4) Onset most often after 65

Question 5

What is found on CT or MRI of the brain with Alzheimer’s?

Answer 5

Progressive atrophy

Question 6

What is the main goal of the treatment of Alzheimer’s?

Answer 6

To slow the progression of the disease

Question 7

What class of drugs are used in the treatment of Alzheimer’s?

Answer 7

1) Acetylcholinesterase inhibitors

2) NMDA receptor antagonist

Question 8

Donepezil, rivastigmine, and galantamine are from what drug class?

Memantine is from what drug class?

Answer 8

1) Acetylcholinesterase inhibitors

2) NMDA receptor antagonist

Question 9

What is a probably precursor to Alzheimer’s disease?

Answer 9

Mild Cognitive Impairment

Question 10

What is Mild Cognitive Impairment?

Answer 10

Memory complaint abnormal for age

Question 11

What should be given to a patient with mild cognitive impairment in order to slow progression to Alzheimer’s?

Answer 11

AChE inhibitor

Question 12

What is the criteria for probable vascular dementia?

Answer 12

1) Presence of focal signs such as hemiparesis, lower facial weakness, Babinski sign, etc.
2) Evidence of relevant cerebrovascular disease on brain imaging including infarcts, multiple basal ganglia and white matter lesions

Question 13

A diagnosis of vascular dementia can be when there is a relation between cognitive problems and vascular events manifested or inferred by the presence of one or more of the following:

Answer 13

1) Onset of dementia within 3 months after a recognized stroke
2) Deterioration in cognitive functions (either abrupt or progressive)

Question 14

What are some vascular causes of dementia?

Answer 14

1) Multiple infarction
2) Stroke
3) Binswanger’s disease
4) Vasculitis
5) Subarachnoid hemorrhage

Question 15

What symptoms seen with Diffuse Lewy Body disease?

Answer 15

1) Dementia
2) Parkinsonian symptoms (bradykinesia and rigidity)
3) Prominent psychotic symptoms (generally visual hallucinations)

Question 16

Lewy Body Disease patients can experience severe, potentially life-threatening adverse reactions if treated with?

Answer 16

Antipsychotic agents

Question 17

Up to 81% of Lewy Body Disease patients have unexplained periods of?

Answer 17

Increased confusion that last days to weeks and closely mimic delirium

Question 18

What often presents early in Lewy Body Disease patients?

Answer 18

Bradykinesia, rigidity and falls

Question 19

How do Lewy Body Disease patients respond to levodopa?

Answer 19

Poor

Question 20

When do psychotic symptoms commonly present in Lewy Body Disease patients?

In Alzheimer’s disease patients?

Answer 20

1) Earlier in disease course

2) Later in disease course

Question 21

What is the most common psychotic symptom of Lew Body Disease?

Answer 21

Visual hallucinations generally of animals of children

Question 22

Where are the Lewy bodies found with Parkinson’s disease?

In Lewy Body disease?

Answer 22

1) Midbrain

2) Diffuse

Question 23

Executive dementia sometimes occurs when with Parkinson’s disease?

Cortical dementia always occurs when in Lewy Body disease?

Answer 23

1) Late in illness

2) Early

Question 24

What symptom is usually only present with Parkinson’s disease and mostly absent in Lewy Body disease?

Answer 24

Resting tremor

Question 25

Is autonomic dysfunction prominent in Parkinson’s or Lewy Body Disease?

Answer 25

Lewy Body Disease

Question 26

While hallucinations are a hallmark of Lewy Body disease, when may they occur in Parkinson’s?

Answer 26

Only in response to antiparkinsonian drugs

Question 27

Frontotemporal degeneration includes several forms of dementia characterized by?

Answer 27

1) Loss of social skills
2) Personality changes
3) Impairment of intellect, memory, and language

Question 28

Frontotemporal degeneration usually affects individuals between what ages?

Answer 28

40 and 60

Question 29

What is the triad of symptoms seen with normal pressure hydrocephalus?

Answer 29

Wet, Wacky, Wobbly:

1) Dementia
2) Gait disturbance
3) Urinary incontinences

Question 30

Normal Pressure Hydrocephalus is potentially reversible with?

What symptom is most likely to be reversed?

Answer 30

1) Ventriculoperitoneal shunting

2) Gait disturbance

Question 31

The definite diagnosis of degenerative causes of dementia can only be made by?

Answer 31

Autopsy