Neurocognitive Disorder I: Dementia

Question 1

onset before age 65

Answer 1

early-onset

Question 2

neuropathologic hallmark of alzheimer’s disease

Answer 2

amyloid plaques, neurofibrillary tangles plus loss of connections between neurons

Question 3

cognitive decline from previous level of performance– it is acquired deficit not developmental

Answer 3

dementia

Question 4

is more than one cognitive domain affected in dementia?

Answer 4

yea

Question 5

dementia is a specific illness

Answer 5

nope; a syndrome

Question 6

not all patients with dementia have alzheimer’s dx. but al alzheimers pt. have dementia

Answer 6

true that

Question 7

alz is ___ leading cause of death after heart disease and cancer

Answer 7

3rd

Question 8

six cognitive domains

Answer 8

1. complex attention
2. executive function
3. learning and memory
4. language
5. perceptual- motor
6. social cognition

Question 9

sundowing

Answer 9

more confused at dusk

Question 10

Alz. requires evidence of insidious onset, gradual progression of impairment and significant cognitive decline from a previous level of performance in ___ or more of the six cognitive domains

Answer 10

2

Question 11

evidence of 1 or 2 for Alz.

Answer 11

1. genetic- rare

2. memory and learning steady decline with no evidence of mixed etiology

Question 12

MCD (mild neurocognitive disorder do to Alz.): The cognitive deficits do/does not interfere with capacity for independence in everyday activities.

Answer 12

Does not

Question 13

most common cause of psychosis in the lederly

Answer 13

MCD due to Alz.

Question 14

amyloid cascade hypothesis

Answer 14

amyloid precursor protein leading to beta amyloid aggregation and neurotoxicity

Question 15

most recent strategy for Alz.

Answer 15

use of monoclonal ab directed against beta amyloid very early in the course of the illness

Question 16

APOE allele increase or decrease risk?

Answer 16

increase especially if homozygous leading to possible early onset of the disease

Question 17

down’s increase or decrease?

Answer 17

highly increased risk for developing Alz

Question 18

are females at high risk?

Answer 18

disagreement

Question 19

modifiable risk factors

Answer 19

1. head trauma
2. low educational levels
3. vascular risk factors

Question 20

biomarkers for Alz.

Answer 20

1. beta-amyloid deposition
2. increased CSF tau
3. glucose uptake in parietal/temporal cortex
4. atrophy on MRI in parietal/frontal cortex
5. PET tau imaging

Question 21

use multiple biomarkers to improve

Answer 21

sensitivity and specificity

Question 22

FDA approved medications

Answer 22

1. cholinesterase inhibitos

2. NMDA partial receptor antagonists

Question 23

cholinesterase inhibitors

Answer 23

inhibits the enzyme that normally breaks down the ntt acetylcholine, thereby enhancing cholinergic ntt.

Question 24

NMDA antagonist

Answer 24

blocks the excessive ntt of the excitatory ntt glutamate

Question 25

Medications for Alz are disease modifying?

Answer 25

nope, wish it were but we are not there yet

Question 26

Anticholinergic burden reduction in elderly subjects with dementia reduces BPSD and caregiver burden

Answer 26

yep

Question 27

major frontotemporal neurocognitive disorder

Answer 27

dominated by personality change but decline often faster than Alz - onset is often before 65

Question 28

Lewy Body dementia

Answer 28

fluctuating cognition with pronounced variations in attention and alertness

Question 29

visual hallucinations are prominent in early course

Answer 29

Lewy body Dementia

Question 30

what do you find in lewy body dementia

Answer 30

alpha-synuclein throughout cerebral cortex

Question 31

differenrial dx. for parkinson dx.

Answer 31

motor symptom clearly pre-date the cognitive decline

Question 32

vascular dementia

Answer 32

cognitive deficit due to one or more cerebrovascular events

Question 33

vascular dementia can have some improvement

Answer 33

yes

Question 34

Which CSF biomarker pattern is most consistent with Major Neurocognitive Disorder due to Alzheimer’s Disease (Dementia, Alzheimer’s type)? 1. ↑ beta amyloid, ↑ tau 2. ↓ beta amyloid, ↓ tau 3. ↑ beta amyloid, ↓ tau 4. ↓ beta amyloid, ↑ tau

Answer 34

4. ↓ beta amyloid, ↑ tau

Question 35

Alzheimer’s disease is the most common cause or form of dementia.

Answer 35

true

Question 36

Patients with dementia-related apathy are also likely to be depressed and will respond nicely to antidepressants.

Answer 36

false

Question 37

Which dementia often initially presents with vivid visual hallucinations? 1. Alzheimer’s 2. Parkinson’s 3. Lewy Body 4. Frontotemporal

Answer 37

3. Lewy Body

Question 38

Which dementia often initially presents with personality change? 1. Alzheimer’s 2. Vascular 3. Lewy Body 4. Frontotemporal

Answer 38

4. Frontotemporal