MCI & AD

Question 1

What is the single largest risk factor for AD?

Answer 1

Age (over 60)

Question 2

Early onset familial AD is associated with mutations in identified genes on which three chromosomes?

Answer 2

Chromosome 1 (presenilin 2 gene)

Chromosome 14 (presenilin 1gene)

Chromosome 21 (APP gene)

** 21 is associated with down’s syndrome which is why ppl with Down’s are more vulnerable to AD later in life

Question 3

All of the following are subtypes of MCI except:

(A) amnestic
(B) executive
(C) non-amnestic
(D) mulitiple-domain

Answer 3

(B) executive

Question 4

All of the following are examples of common cognitive changes with aging EXCEPT:

(A) decreased sustained attention and divided attention
(B) basic arithmetic problem solving
(C) less efficient and slower rates of learning
(D) decreased cognitive flexibility
(E) reduced spontaneous recall of detailed information presented recently

Answer 4

(B) basic arithmetic problem solving

All the others are common with normal aging

Question 5

Early AD should be suspected if the family complains of significant changes in the patient’s _____.

(A) personality functioning
(B) emotional status and responsiveness
(C) ability to perform ADLs
(D) capacity to function in an unfamiliar setting

Answer 5

(D) capacity to function in an unfamiliar setting

individuals diagnosed with either MCI or in the early stage of AD demonstrate poor judgment in complicated and unfamiliar situations. Complicated situations can include complex tasks such as managing finances

Question 6

Patients in the early stages of AD will typically display all of the following memory characteristics except ______.

(A) little improvement with repeated learning trials
(B) a heightened recency effect
(C) errors during recall, such as intrusions
(D) preservative and echolalic behavior

Answer 6

(D) preservative and echolalic behavior

patients with early AD display a pattern of deficits characterized by reduced learning, rapid forgetting, increased recency recall, elevated intrusion errors, and poor recognition discriminability with increased false-positives. Perseverative behavior typically occurs later in the disease process.

Question 7

If a clinician only had time to administer three tests in the assessment of an individual with suspected dementia, he or she should include ______.

(A) figure learning, story memory, and simple attention measure
(B) word list generation, MMSE, and mental flexibility
(C) sensory motor tests, an executive function measure, and a visuospatial task
(D) verbal memory, word-list generation, and mental flexibility task

Answer 7

(D) verbal memory, word-list generation, and mental flexibility task

Question 8

Patients with AD are more likely to produce what type of errors on confrontation naming?

(A) semantic
(B) phonemic
(C) echolalic
(D) preseverative

Answer 8

(A) semantic

in addition they are less likely to benefit from semantic cues

Question 9

Many believe that _____, AD can be clinically differential from LBD.

(A) in the early stages
(B) in all stages
(C) in the middle to late stages
(D) only in the late stages

Answer 9

(A) in the early stages

In addition, often LBD presents with greater impairments in attention, letter/word-list generation, and prominent visuospatial impairment (e.g., deficits in visuoperceptual organization and visuoconstructional skills), as well as extrapyramidal symptoms and visual hallucinations

Question 10

A 50-year-old woman comes to you with concerns that she might develop AD after age 65. What combination of risk factors would carry the greatest risk for AD later in life?

(A) prior moderate brain injury and exposure to toxic chemicals
(B) vascular disease and depression
(C) family history and prior severe brain injury
(D) exposure to toxic chemicals and family history

Answer 10

(C) family history and prior severe brain injury

Additional risk factors include

• elevated blood cholesterol
• diabetes mellitus
• concurrent small vessel disease
• history of chronic major depression

Question 11

Which regions of the brain show the most atrophy in AD?

(A) temporoparietal
(B) orbitofrontal and primary motor
(C) occipitoparietal
(D) thalamus and basal ganglia

Answer 11

(A) temporoparietal

Question 12

Early-onset dementia is typically associated with _____.

(A) a prolonged course
(B) more rapid decline
(C) hallucinations
(D) tremor

Answer 12

(B) more rapid decline

Patients with early-onset AD demonstrated a faster decline on cognitive screening tests administered 1 year apart, suggesting a more aggressive course

Question 13

The average age of onset of AD is approximately ___ years old.

(A) 60
(B) 65
(C) 70
(D) 75

Answer 13

(D) 75

Most patients are dx’d between the ages of 70 and 79, with 74.7 years as the mean based on recent NIH figures

Question 14

Chromosome 21 ____.

(A) has been rule out as related to AD
(B) has been marginally implicated in AD
(C) appears to be related to the development of neurofibrillary tangles
(D) appears to be related to the development of amyloid plaques

Answer 14

(D) appears to be related to the development of amyloid plaques

Chromosome 21 is also associated with Down’s syndrome. These individuals are vulnerable to developing plaques

Question 15

A patient who has all the neurocognitive features of AD on formal neuropsychological assessment but also displays parkinsonian symptoms most likely ____________.

(A) has FTD
(B) has a Lewy body variant of AD
(C) is in the late stages of AD
(D) does not have AD

Answer 15

(C) is in the late stages of AD

Changes such as rigidity, gait disturbance, and bradykinesia are parkinsonian signs that occur with later progression of AD. Additionally, ideational and ideomotor apraxia typically occur in the middle to late stages of the disease.

LBD is an unlikely choice as visuospatial impairment is more significant than memory dysfunction, the latter of which is the cardinal symptom of AD, and patients with LBD also experience early extrapyramidal symptoms and visual hallucinations, whereas patients with AD do not.

Question 16

The ApoE4 allele is carried on chromosome _____.

(A) 18
(B) 19
(C) 20
(D) 21

Answer 16

(B) 19

There is a reported 29% lifetime risk of developing AD in patients with the ApoE4 allele, relative to 9% in patients without this allele

Question 17

In AD, the progression of atrophy affects the following systems in which order?

(A) hippocampus and entorhinal cortex in the late stages, preceded by changes in the frontal, temporal, and parietal association areas
(B) basal ganglia in the middle stages, and temporal, frontal, and parietal association areas as the disease progresses
(C) hippocampus and entorhinal cortex in the earliest stages, and temporal, frontal, and parietal association areas as the disease progresses
(D) hippocampus and entorhinal cortex in the earliest stages, followed by frontal, parietal, and occipital association areas

Answer 17

(C) hippocampus and entorhinal cortex in the earliest stages, and temporal, frontal, and parietal association areas as the disease progresses

Disease progression follows a temporal-to-frontal spread, but eventually involves multiple brain systems, with the primary sensory cortices and aspects of subcortical structures relatively unaffected until quite late in the disease process

Question 18

All of the following memory functions are typically impaired in mild AD except _____.

(A) episodic memory
(B) semantic memory
(C) visual memory
(D) procedural memory

Answer 18

(D) procedural memory

Question 19

A patient with AD who has been treated with acetylcholine (ACh) inhibitors ____.

(A) will most likely show memory improvement initially, but then decline
(B) may improve behaviorally initially and decline at a slower pace
(C) may improve initially, but will most likely decline at the same pace
(D) may or may not improve initially, but will decline at a similar if not more rapid rate

Answer 19

(B) may improve behaviorally initially and decline at a slower pace

“while 50% of the untreated AD patients had been in some form of supportive housing after 36 months, we never reached a 50% survival point for the treated patients within the follow-up period. The relative risk was 0.33. So, while the effects of cholinesterase inhibitors (CEIs) are not dramatic on formal testing, clearly something of importance is happening. Some PET data indicate that 8 weeks on Aricept alters brain blood flow during memory tasks.”

Question 20

Which statement is true with regard to neurofibrillary tangles in AD?

(A) The tangles are almost exclusively found in the temporal lobe
(B) the tangles are primarily found in the frontal and parietal lobes
(C) the tangles are found in clusters throughout most brain areas
(D) the tangles are limited to subcortical as opposed to cortical areas

Answer 20

(C) the tangles are found in clusters throughout most brain areas

Neurofibrillary tangles are often found in hippocampal and amygdaloid areas, and in specific brainstem nuclei-nucleus basalis of Meynert in the forebrain, nucleus raphe nucleus in the midbrain, and the locus coeruleus at the anterior pontine level

Question 21

In patients with AD, cholinesterase inhibitors given in the early stages of illness ____.

(A) may delay nursing home placement
(B) may delay onset of incontinence
(C) may delay onset of motor or sensory impairments
(D) rarely if ever delay functional or cognitive changes

Answer 21

(A) may delay nursing home placement

“for each year of tx with galantamine or other AChEI, the risk of being admitted to a nursing home within a given period was reduced by 31% (galantamine) and 29% (other AChEI).”

Question 22

Alzheimer’s disease has been described as a disease of ____.

(A) subcortical and limbic systems
(B) the association cortices
(C) the primary cortices
(D) the heteromodal cortices

Answer 22

(B) the association cortices

Neuronal degeneration has been found to be greatest in the medial temporal lobe and heteromodal association areas, with sparing of the primary sensory and motor cortices until later in the disease process.

Most vulnerable are the cortico-cortical projections, disruption of which can contribute to degradation of the hippocampal formation and subsequent memory impairment.

Question 23

DEFINITION:

Amyloid

Answer 23

Protein fragments that the body produces normally.

Healthy Brains –> broken down and eliminated

AD Brains–> accumulate to form, hard, insoluble Plaques

Question 24

DEFINITION:

Amyloid Hypothesis

Answer 24

accumulation of Aβ in the brain is the primary influence driving AD pathogenesis. The rest of the disease process, including formation of neurofibrillary tangles containing tau protein, is proposed to result from an imbalance between Aβ production and Aβ clearance.

Unclear if amyloid leads to dementia or dementia processes lead to amyloid

Question 25

DEFINITION:

Anosodiaphoria

Answer 25

Disorder in which a patient experiences inability to fully appreciate a significant medical or neurological condition, although the patient is aware of the condition.

Question 26

DEFINITION:

Anterograde Amnesia

Answer 26

Disorder in which an individual loses the abiliity to transfer new information to long-term memory, whereas long-term memories already created remain intact.

Anterograde amnesia –> can be caused by AD, as well as other dementias, alcohol/substances, TBI, neoplasms, and other dz states