Neurocognitive Disorder

Question 1

Mild Cognitive Impairment MCI

Answer 1

Objective evidence of memory impairment (complaint is only restricted to memory) – episodic memory loss

Question 2

Alzheimer’s Disease

Answer 2

Memory impairment + one of the following… Aphasia, Apraxia, Agnosia, Executive dysfunction, (gradual and insidious)

Question 3

Definitive diagnosis of Alzheimer’s?

Answer 3

Autopsy

Question 4

Genetic association with Alzheimer’s?

Answer 4

APOE-E4 – 5-30% of population (15x risk of AD)

Question 5

pathological findings of Alzheimer’s?

Answer 5

Amyloid β plaques & Neurofibrillary tau tangles

Question 6

Plaques & tangles primarily located in

Answer 6

hippocampus

Question 7

Neuro findings in Alzheimer’s?

Answer 7

flat cortical sulci, atrophy, enlarged ventricles, loss of ACh neurons (from basal forebrain)

Question 8

Physiologic causes of Alzheimers

Answer 8

Stress –> high glucocorticoid levels –> low neurotrophins (nerve growth factors)

Question 9

Vascular Dementia Dx

Answer 9

Memory + 2 other cognitive domains, onset: <3mo after stroke, abruptly, incremental

Question 10

Distinguishing features of vascular dementia

Answer 10

HA, nausea, fatigue, sleep disturbance, pseudo bulbar palsy, focal neuro findings, dysarthria, dysphagia

Question 11

ACA stroke Findings

Answer 11

c/l hemiparesis of LE, personality changes, decline in executive functioning (d/t involvement of frontal cortex)

Question 12

MCA stroke Findings

Answer 12

limbic system, Broca’s & Wernicke’s aphasia

Question 13

PCA stroke Findings

Answer 13

hemianopsia, hemineglect syndrome

Question 14

Lacunar stroke

Answer 14

white-matter hyperintensities, atherosclerosis, parenchymal lesions of glial cells

Question 15

TIA

Answer 15

no lesions left, no focal deficits, <1h

Question 16

MMSE Scoring

Answer 16

27-30: normal
24-26: psych consult for depression, geriatric
<24: consult for neuro, psych, geriatric

Question 17

Reversible causes of dementia

Answer 17

B12 def, folate def, thyroid, syphilis, HIV, depression

Question 18

Alzheimers Disease Tx

Answer 18

1. AChE Inhibitor

2. NMDA Antagonist

Question 19

AChE Inhibitors for Alzheimers

Answer 19

Rivastigmine, Galantmine, Donepezil

Question 20

NMDA Antagonist for Alzheimers

Answer 20

Memantine

Question 21

AChE Inhibitor S/E

Answer 21

GI problems

Question 22

Which AChE Inhibitor has the least S/E & needs the least monitoring?

Answer 22

Donepezil

Question 23

Which antidepressant should be avoided in Alzheimers pts?

Answer 23

Fluoxetine

Question 24

Which antidepressant should be used in Alzheimers pts w/ depression?

Answer 24

Trazadone, Citalopram

Question 25

Which Benzos should be used in Alzheimers pts w/ anxiety?

Answer 25

Zolpidem

Question 26

Vascular Dementia Tx

Answer 26

1. Antihypertensives (ACE-I, Diuretics) 2. Anticoagulants 3. Thrombolysis (w/in 3h) 4. Antiplatelet prevention

Question 27

Which Antihypertensive is avoided for pts w/ Vascular Dementia?

Answer 27

b-blockers

Question 28

Alzheimer’s dementia is due to…

Answer 28

Hypoactive ACh

Question 29

Occlusion of the ACA produces deficits in what cognitive domain?

Answer 29

Executive

Question 30

Early sign of dementia?

Answer 30

Short-term memory loss

Question 31

Male has loss of cognition, requires more help in basic living activites, most appropriate treatment?

Answer 31

Donepezil