Geri One Pagers (Harrison/Bennett)

Question 1

there is a big spike in dx alzheimer’s disease after what ageq

Answer 1

after age 75

Question 2

what is the prevalence of alzheimer’s after 60s

Answer 2

above 25%

Question 3

what two brain areas are most affected in early alzheimer’s

Answer 3

hippocampus

parietal lobe

Question 4

what is the usual function of tau? how is tis changed in alzheimer’s

Answer 4

normal tau–> supports microtubules for function, transport within neuron

abnormal tau–> tau separates from microtubules, tau fragments form tangles and therefor transport within the neuron ceases

Question 5

how much is your risk increased if you have a first degree relative with alzheimer’s

Answer 5

4x increased risk

Question 6

why do people with down syndrome develop alzheimer’s

Answer 6

have extra chromosome 21, which means they have an extra copy of the amyloid precursor protein and thus high risk of developing alzheimer’s if survive to midlife

Question 7

alzheimer’s is “early onset” if occurs before what age

Answer 7

55

Question 8

what is the strongest risk factor for alzheimer’s

Answer 8

age

Question 9

list 6 risk factors for alzheimer’s

Answer 9

age

sex (female higher risk)

vascular

hx depression

low education

TBI

Question 10

what are two areas of life which are often the first to be affected in alzheimer’s

Answer 10

ability to drive

ability to handle finances

*good to screen for these

Question 11

what two areas of functioning are classically affected in alzheimer’s

Answer 11

1. amnestic memory loss/learning–> hippocampus
2. perceptual/motor dysfunction–> parietal
   (i.e do you get lost?)

Question 12

what area of functioning is often preserved until late in course in alzheimer’s

Answer 12

social cognition

Question 13

what 3 areas are often first affected when undergoing neuropsych testing in alzheimer’s

Answer 13

memory

language/fluency

executive function

Question 14

what two things would you look for in CT head if suspecting alzheimer’s

Answer 14

cortical atrophy

medial temporal lobe atrophy

Question 15

what two things would you look for on MRI is suspecting alzheimer’s

Answer 15

parietal atrophy

hippocampal atrophy

Question 16

what would you look for on PET/SPECT if suspecting alzheimer’s

Answer 16

bilateral tempoparietal hypometabolism

Question 17

what are the 3 hallmarks of alzheimer’s on postmortem exam of the brain

Answer 17

cortical atrophy

amyloid-predominant neuritic plaques

tau-predominant neurofibrillary tangles

Question 18

what are two ways to look for amyloid early in pathophysiological cascade for alzheimer’s

Answer 18

PET amyloid imaging

CSF amyloid beta-42 (low levels)

Question 19

what is the gene with the greatest known effect on the risk of developing late onset alzheimers

Answer 19

APOE (chromosome 19)

Question 20

what are the two genes associated with EOAD

Answer 20

PSEN 1 or 2–> PSEN 1 causes up to 80% of all familial alzheimer’s cases

APP gene

Question 21

what medication can be used for apathy in alzheimer’s

Answer 21

methylphenidate was only agent with benefit, according to cochrane review (small benefit only)

Question 22

what is a mnemonic for the symptoms of the behavioural variant of frontotemporal dementia

Answer 22

HADES

Hyperorality and dietary changes

Apathy or inertia

Disinhibition of behaviour

Empathy or sympathy loss

Stereotyped, perseverative or compulsive/ritualistic behaviour

needs 3/5

Question 23

what area of functioning is most prominently affected in behavioural variant of frontotemporal dementia

Answer 23

prominent decline in SOCIAL COGNITION or EXECUTIVE ABILITIES

Question 24

what is relatively spared in FTD

Answer 24

learning and memory

perceptual-motor function

*relevant because these are the areas most affected in alzheimers

Question 25

what is required for "probable" (instead of possible) FTD

Answer 25

evidence of a causative genetic mutation from either fam hx or GENETIC TESTING OR evidence of disproportionate frontal and/or temporal lobe involvement from NEUROIMAGING

Question 26

what % of people with FTD have family hx of early onset NCD

Answer 26

about 40% --10% show autosomal dominant inheritance pattern

Question 27

list 3 genes that may be associated with FTD

Answer 27

MAPT GRN C9ORF72

Question 28

why dont you treat FTD with cholinesterase inhibitors

Answer 28

because the cholinergic system is INTACT in these patients treating with cholinesterase inhibitors can make behaviours WORSE (serotonin is mostly affected, maybe some dopamine)

Question 29

what % of those with FTD are diagnosed before age 65

Answer 29

75%

Question 30

what is the classic presentation for FTD

Answer 30

progressive development of behavioural and personality change, language impairment

Question 31

describe symptoms of behavioural variant of FTD

Answer 31

impaired insight apathy, disinhibition decreased socialization, self care, personal responsibilities, social appropriateness changes in social style, religious/political beliefs, hyperorality COGNITIVE DECLINE IS LESS PROMINENT

Question 32

how do language variants of FTD typically present

Answer 32

primary progressive aphasia with gradual onset

Question 33

list the 3 subtypes of FTD language variant

Answer 33

logopenic semantic nonfluent (agrammatic)

Question 34

what is the earliest sign of FTD semantic variant

Answer 34

word finding

Question 35

what is the most prominent symptom in FTD semantic variant

Answer 35

impaired single word comprehension and object naming (preserved fluency, repetition, grammar)

Question 36

what is the most prominent symptom in nonfluent/agrammatic FTD variant

Answer 36

motor speech deficit, articulatory difficulty (can understand simple words)

Question 37

what is the most prominent symptom in logopenic FTD

Answer 37

impaired single word retrieval, repetition, naming (vague) *spared grammar *more linked to alzheimers

Question 38

what would you expect to see on CT/MRI in the behavioural variant of FTD

Answer 38

atrophy in frontal lobe (especially medial) atrophy in anterior temporal lobe

Question 39

what would you expect to see on CT/MRI in the semantic variant of FTD

Answer 39

atrophy in middle, inferior and anterior temporal lobe --> bilateral but more left sided

Question 40

what would you expect to see on CT/MRI in the nonfluent variant of FTD

Answer 40

atrophy in left posterior frontal-insular

Question 41

what would you expect to see on CT/MRI in the logopenic variant of FTD

Answer 41

left posterior perisylvian or parietal atrophy

Question 42

what medications are used for FTD

Answer 42

SSRIs, trazodone, AAPs as alternatives

Question 43

in what areas are the most effects noted in vascular dementia

Answer 43

complex attention (including processing speed) and frontal-executive function

Question 44

what is CADASIL

Answer 44

cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy genetic condition

Question 45

in vascular dementia, if there is more of a picture of worsening executive function, where is the stroke more likely to have occurred

Answer 45

subcortical

Question 46

in vascular dementia, if there is more of a picture of worsening complex attention, where is the stroke more likely to have occurred

Answer 46

cortical

Question 47

describe 4 features of "vascular depression"

Answer 47

late onset depressive symptoms psychomotor slowing executive dysfunction progressive small vessel ischemic disease

Question 48

what gene anomaly causes CADASIL

Answer 48

NOTCH3 mutation

Question 49

what should you do in patients with a stroke history in order to reduce the risk of post stroke depression

Answer 49

lower BP

Question 50

does LBD have more or less of a cholinergic defecit than alzheimers

Answer 50

LBD has a MORE PROFOUND cholinergic deficit than in alzheimers thus they RESPOND BETTER to cholinesterase inhibitors

Question 51

how is the hippocampus affected in LBD compared to AD

Answer 51

hippocampus relatively preserved in LBD vs AD

Question 52

what is a major risk factor for LBD

Answer 52

presence of REM sleep behaviour disorder

Question 53

at what age do most LBDs present

Answer 53

mid 70s

Question 54

what often occurs before diagnosis of LBD

Answer 54

prodromal delirium precipitated by illness or surgery

Question 55

what are the 4 cardinal symptoms of LBD

Answer 55

1. fluctuating cognition with variations in attention and alertness 2. recurrent well formed visual hallucinations (or in other modalities; "feeling of presence" in up to 15%) 3. REM sleep behaviour disorder (acting out dreams) 4. parkinsons symptoms like bradykinesia, tremor, rigidity

Question 56

what might you see on EEG in LBD

Answer 56

prominent slow wave activity temporal lobe transient waves

Question 57

what might you see on SPECT/CT perfusion scan in LBD

Answer 57

reduced occipital activity generalized low uptake low dopamine transporter uptake

Question 58

which NCD population sees the MOST benefit from use of cholinesterase inhibitors

Answer 58

LBD--have even more cholinergic deficit than AZ

Question 59

what is the preferred agent for treating hallucinations in LBD

Answer 59

quetiapine but often doesnt work (clozapine is best results)

Question 60

what to use in REM sleep behaviour disorder

Answer 60

melatonin up to 12mg trazodone is a good place to start gabapentin or pregabalin clonazepam later option with caution in LBD pop

Question 61

list the 4 types of NONfluent aphasias

Answer 61

global aphasia mixed transcortical aphasia broca's aphasia transcortical motor aphasia

Question 62

list the 4 types of FLUENT aphasias

Answer 62

wernicke's aphasia transcortical sensory aphasia conduction aphasia anomic aphasia

Question 63

list the 4 types of aphasia where people CAN repeat words or phrases

Answer 63

mixed transcortical aphasia transcortical motor aphasia transcortical sensory aphasia anomic aphasia

Question 64

list the 4 types of aphasia where people CANNOT repeat words or phrases

Answer 64

global aphasia broca's aphasia wernicke's aphasia conduction aphasia

Question 65

list the 4 types of aphasia where someone CAN understand spoken messages

Answer 65

brocas aphasia transcortical motor aphasia conduction aphasia anomic aphasia

Question 66

if someone presents with the following pattern of speech production/comprehension, what type of aphasia do they have? fluent + comprehends spoken messages + can repeat words or phrases

Answer 66

anomic aphasia

Question 67

if someone presents with the following pattern of speech production/comprehension, what type of aphasia do they have? non fluent + cannot comprehend spoken messages + cannot repeat words or phrases

Answer 67

global aphasia

Question 68

if someone presents with the following pattern of speech production/comprehension, what type of aphasia do they have? fluent + cannot comprehend spoken messages + can repeat words

Answer 68

transcortical sensory aphasia

Question 69

if someone presents with the following pattern of speech production/comprehension, what type of aphasia do they have? fluent + cannot comprehend spoken messages + cannot repeat words

Answer 69

wernicke's aphasia

Question 70

if someone presents with the following pattern of speech production/comprehension, what type of aphasia do they have? non fluent + can comprehend spoken messages + cannot repeat words

Answer 70

broca's aphasia

Question 71

if someone presents with the following pattern of speech production/comprehension, what type of aphasia do they have? fluent + can comprehend spoken messages + cannot repeat

Answer 71

conduction aphasia

Question 72

if someone presents with the following pattern of speech production/comprehension, what type of aphasia do they have? non fluent + can comprehend + can repeat

Answer 72

transcortical motor aphasia

Question 73

if someone presents with the following pattern of speech production/comprehension, what type of aphasia do they have? non fluent + cannot comprehend + can repeat

Answer 73

mixed transcortical aphasia

Question 74

what is the most severe form of aphasia

Answer 74

global aphasia

Question 75

can someone with global aphasia read or write

Answer 75

no

Question 76

can someone with broca's aphasia read or write

Answer 76

may be able to read limited in writing

Question 77

can someone with wernicke's aphasia read or write

Answer 77

often reading and writing is severly impaired "inability to grasp meaning of spoken words"

Question 78

can someone with anomic aphasia read or write

Answer 78

read well same trouble finding words in writing as in speaking

Question 79

what is the clinical picture of anomic aphasia

Answer 79

people who are left wiht a persistent inability to supply the words for the very things they want to talk about (esp. significant nouns and verbs) speech is full of vague circumlocutions and expressions of frustration understand speech well

Question 80

what is primary progressive aphasia

Answer 80

neurological syndrome in which language capabilities become slowly and progressively impaired caused by neurodegenerative diseases (unlike other forms of aphasia which are susually caused by stroke or TBI) results from deterioration of brain tissue responsible for speech and language

Question 81

why does pseudobulbar affect occur

Answer 81

due to disconnect between the frontal lobe (which regulated emotions) and the cerebellum and brainstem (which is where basic reflexes are mediated) LOSS OF INHIBITION from limbic motor neurons in the brain may also be involved