Dementia

Question 1

65 yo M with 6 month hx of confusion, disorientation, visual hallucinations of children playing. Wife says he is normal between episodes. Exam: normal language, memory, mod dif with trails test, mild diff with serial substractions, mild symmetric rigidity and bradykinesia. Brain MRI unremarkable. CSF, routine labs and UDS normal. Dx?

Answer 1

Lewy body dementia.

Question 2

When combined with functional neuroimaging, which of the following biomarkers is most likely to ID those geriatric its with mild cognitive impairment most at risk for developing Alz disease?

Answer 2

E-4 apolipoprotein E allele

Question 3

80 yo with visual hallucinations and worsening gait, episodic confusion, fighting in sleep, bilateral rigidity, masked facies. Levodopa/carbidopa improved movement temporarily. Dx?

Answer 3

Dementia with Lewy bodies

Question 4

80 yo pt with Alz is brought in for increasingly combative behavior. Daughter would like to keep him at home if possible. What interventions would be most helpful in this situation?

Answer 4

Assessing for caregiver burnout.

Question 5

91 yo hospice pt with cachexia, end stage dementia, and renal impairment has stopped eating and drinking. What comfort measure would be most appropriate

Answer 5

Refrequent small sips of water

Question 6

Which of the following is the most specific factor for distinguishing delirium from dementia of the Alz type

Answer 6

Fluctuating arousal

Question 7

Neurocognitive fx most likely to show decline in people over 65 years of age?

Answer 7

Information in processing speed

Question 8

Over the course of several months, a 46 yo pt with no past psych hx becomes emotionally labile/irritable. Pt undergoes personality changes, is observed to laugh inappropriately when neighbor kids taunt stray cat. Within 2 yrs is convinced all food has germs. Memory is preserved. Pt is no longer able to work/live independently. Neurpsych testing shows impaired language/attention

Answer 8

Frontotemporal dementia

Question 9

Most accurate genetic testing for Alz?

Answer 9

The testing has limited predictive value for alz disease in sx free individuals

Question 10

What sx is most commonly associated with aggressive behavior in Alz pts?

Answer 10

Concurrent psychosis

Question 11

Hippocampal tissue, tau stained, pt with progressive dementia, what is the dx?

Answer 11

Alz disease

Question 12

What is the initial diagnostic study for an elderly male endorsing memory difficulty, loss of energy, and difficulty concentrating?

Answer 12

Neuropsychological testing

Question 13

MRI of the brain shows ventriculomegaly of 65 yo with progressive cognitive decline. Normal OP in LP. Likely to found on exam?

Answer 13

Gait apraxia

Question 14

Subcortical dementia is suggested by which of the following in regards to a pt with early stage cognitive impairment

Answer 14

Preserved calculation skills

Question 15

Which neurocognitive disorder has more severe EPS Session from antipsychotics

Answer 15

Lewy body disease

Question 16

Excess activation of which R contributes to cell death in Alz dx

Answer 16

NMDA

Question 17

Loss of nicotinic R sites and potentiation of remaining R sites are involved in the pathophysiology of what

Answer 17

Alz

Question 18

Test that differentiates Alz from frontal temporal dementia

Answer 18

Single photo emission CT

Question 19

Neurocognitive disorder with fluctuating rate of progression, visual spatial impairment and early unilateral resting tremor and increased muscle tone

Answer 19

Dementia with body Lewy

Question 20

67 yo male with visual hallucinations, behavioral disturbances, confusion, staring episodes, kicking in sleep, memory loss, dishinbition, and smaller steps.

Answer 20

Lewy body dementia

Question 21

Confabulation is

Answer 21

Unconscious filling in of memory gaps

Question 22

What test is most helpful to distinguish dementia vs delirium

Answer 22

EEG

Question 23

Suggests delirium rather than dementia

Answer 23

Clouding of consciousness

Question 24

85 yo patient with hx of dementia admitted for agitation becomes more confused and angry. What lab should you get

Answer 24

UA

Question 25

Picture of tau staining for pt with progressive dementia. Dx?

Answer 25

Alz

Question 26

80 yo patient with forgetfulness f/b progressive language impairment. 2 yr later with difficulty using common tools/appliances. Dx

Answer 26

Alz

Question 27

Which cancer treatment may be followed by a subcortical dementia due to a leukoencephalopathy with onset after 6 months post-treatment?

Answer 27

Whole brain radiation

Question 28

A pt who has been receiving dialysis tx for years has become more disoriented, has memory loss. PE normal, nursing staff report that the pt has begun to have seizures. Labs normal. What accounts for this ppt?

Answer 28

Dialysis dementia

Question 29

FTD with mutation in chromosome 17 is associated with abnormal intraneuronal deposition of which protein

Answer 29

TAU

Question 30

A doctor meets with a pt and family to discuss tx of pmts mild Alz disease. There are no other neurological sx. The most appropriate course of action would be to

Answer 30

Begin cholinesterase inhibitor tx

Question 31

74 y/o, R handed patient presents with significant memory loss, expressive aphasia, and left plantar extensor response. The most likely dx

Answer 31

Vascular dementia

Question 32

Earliest evidence of cell loss in its with Alz typically occurs in which of the following areas of the brain

Answer 32

Entorhinal cortex

Question 33

74 y/o F suspicious, poor ADLs, personality changes, most likely dx

Answer 33

Pick's disease

Question 34

Protein mutation associated with Alz disease in people younger than 60 yo

Answer 34

Amyloid precursor

Question 35

80 y/o pt with no prior psych hx, more forgetful, having difficulty with ADLs. However, pt is able to conduct routine social activities so that casual acquaintances don't notice. Dx?

Answer 35

Alz

Question 36

Neurofibrillary tangles in Alz are composed of

Answer 36

Hyperphophorylated Tau proteins

Question 37

80 yo Alz patient with increasingly combative behavior. Family wants to keep at home. Give what med?

Answer 37

Haldol

Question 38

Dementia characterized by personality change, attention deficit, impulsivity, affect lability, indifference, perseveration, and loss of executive fx. Ass with dysfunction in what area of the brain?

Answer 38

Frontal lobe

Question 39

Early stage HIV type 1 ass dementia as compared to early onset dementia has which of the following deficits?

Answer 39

Decreased processing speed

Question 40

Which meds have best results for treating agitation in dementia

Answer 40

Antipsychotics

Question 41

Amyloid precursor protein in what cognitive disorder?

Answer 41

Alz

Question 42

MCC of dementia in its >65

Answer 42

Alz

Question 43

Characteristic MRI scan finding in Alz

Answer 43

Reduce hippocampal volumes

Question 44

Known risk factors for dementia

Answer 44

Age, fam hx, female, down's

Question 45

Pt with vascular dementia typically has neuropathological changes associated with

Answer 45

Basal ganglia

Question 46

An 82 yo pt has falls, ophthalmoplegia, Parkinsonism, and progressive dementia. Autopsy shows

Answer 46

Tau positive neurofibrillary tangles

Question 47

65 yo is brought to the ED with disorientation and mild agitation and experiencing vivid VH of children. Two similar episodes in the past, normal between episodes. mild symmetric rigidity and bradykinesia.

Answer 47

Dementia with Lewy bodies

Question 48

A medicine most likely to slow the progression of vascular dementia

Answer 48

ASA

Question 49

Best rationale for using cholinesterase I in pts with Alz

Answer 49

To reduce neuropsychiatric sx

Question 50

The most important tool for evaluation of early and moderate dementia

Answer 50

MMSE

Question 51

Dementia rather than depression in regards to memory has

Answer 51

Naming deficits (rather than impaired nonverbal intelligence)

Question 52

Which of the following brain regions is affected earliest in the course of Alz

Answer 52

Hippocampus

Question 53

Bilateral loss of neurons in the CA1 segment of the hippocampus is the MC histologic finding in its with

Answer 53

Alz

Question 54

Patient with Alz dementia. Daughter is frutated and is considering leaving church group

Answer 54

Tell her to continue going to her church group

Question 55

PET scan shows bitemporoparietal hypo perfusion in early stages of which dementia

Answer 55

Alz

Question 56

What deficit includes significant word-finding difficulties when attempting to label pictured objects but can describe how to use objects?

Answer 56

Anomia

Question 57

65 yo pt brought in by family for gradual onset and very slow progression of mental confusion with respect to orientation, anomia, slowness of comprehension, neglect of personal hygiene and grooming, apathy, and alterations of personality and behavior, impairment of gait and upright stance, and prominent grasp and suck reflexes. Dx? The clock drawing test administered and sensitive screen for

Answer 57

Frontotemporal dementia or Alz

Question 58

65 yo high school grad has MMSE score of 23, this score would suggest

Answer 58

Dementia, mild cognitive impairment

Question 59

Individuals over 40 with Downs frequently develop

Answer 59

Alz

Question 60

HIV patient with memory loss, inattention, lack of motivation, and poor coordination. Normal LP. CT shows atrophy. MRI shows diffuse and confluent white matter changes in T2, w/o any mass effect or gadolinium enhancement. Dx?

Answer 60

HIV ass dementia

Question 61

Binswanger disease has pseudo bulbar state, gait disorder, and..

Answer 61

Dementia

Question 62

Clock drawing test is quickly administered and sensitive screen for which d/o

Answer 62

Alz

Question 63

Brain of football player who died by suicide has finings typical of chronic traumatic encephalopathy, what is the most typical pathology for this behavior?

Answer 63

Tauopathy

Question 64

54 y/o pt dies from rapidly progressing dementia ass with myoclonus, what is most likely finding at autopsy?

Answer 64

Microvacuolation of glia and neuronal dendrites

Question 65

Psych eval of 82 yo F with memory loss (mostly working memory): she frequently calls for help with the bathroom but will urinate on herself. Pt frustrated with staff bc she feels the sudden need to void without much warning and wishes the staff would arrive sooner bc she is embarrassed about it. MSE significant for memory loss. What to do?

Answer 65

Schedule regular voiding, independent of pt requests, and sufficiently frequent to eliminate accidents

Question 66

Which is important when working with family members who are caregivers to pts with dementia?

Answer 66

Work with family should enhance effectiveness of care to pt

Question 67

What characterizes executive abilities in healthy individuals > 65?

Answer 67

Show no significant change

Question 68

Fluent speech with preserved comprehension, inability to repeat statements is consistent with what type of aphasia?

Answer 68

Conduction

Question 69

In normal aging, last cognitive abilities to decline

Answer 69

Work knowledge

Question 70

Medicare pays for hospice care when a physician declares that a patient has a maximum life expectancy of

Answer 70

6 months

Question 71

Two days after bowel surgery, 53 yo is delirious. Correctly draws a square when asked, but then continues to draw squares when asked to draw other shapes. MSE would reveal

Answer 71

Perseveration

Question 72

Cancer patient on chemo is disoriented and agitated. Afebrile. Poor attention, cognitive impairment. Held for observation. EEG= diffuse slowing

Answer 72

Haldol

Question 73

78 yo pt with Alz living with spouse and daughter, starting to accuse the spouse of infidelity. He is on donepezil. Next?

Answer 73

Arrange for regular evaluations of the pt and reassure the fam

Question 74

Family of a 75 yo pt is concerned about his safety b/c he has been forgetting to turn off the stove. What is most likely to be the earliest impairment to occur in the pt?

Answer 74

Inability to recall 3 words after a 3 min delay

Question 75

85 yo nursing home pt with hx of dementia being more confused and screaming fire whenever the light next to bed is turned on. next step?

Answer 75

Urinalysis

Question 76

Epigenetic drift has been postulated to contribute to what disorder?

Answer 76

Late onset alz disease

Question 77

Which cognitive enhancer circulates unbound to serum proteins and has limited drug interactions?

Answer 77

Rivastigmine