Dementia

Question 1

Individuals with this sensory-related condition are frequently misdiagnosed as having dementia?

1. Cataracts
2. Sensorineural hearing loss
3. Anosmia (loss of sense of smell)
4. Loss of joint position sense

Answer 1

2. Sensorineural hearing loss

Question 2

______________ is the deterioration of cognition across multiple cognitive domains.

Answer 2

Dementia

Question 3

Dementia usually consists of decline in two or more cognitive domains. What are the cognitive domains?

Answer 3

• Memory
• Executive function (planning, behavior modulation, etc.)
• Complex attention
• Language (both receptive and productive language)
• Perceptual motor (learned motor tasks and mental mapping)
• Social cognition

Question 4

Dementias are often broadly categorized as _____________ or ____________.

Answer 4

Cortical or subcortical

Question 5

What are the characteristics of cortical dementia?

Answer 5

• Early aphasia and calculation difficulties
• Minimal neurologic primary motor findings until very late
• Usually effect higher-level structures first.

Question 6

What are two examples of cortical dementias?

Answer 6

• Alzheimer’s dementia
• Frontotemporal dementia

Question 7

Which lobe of the brain processes most forms of memory?

1. Frontal
2. Parietal
3. Temporal
4. Occipital

Answer 7

3. Temporal

Question 8

What lobe primarily deals with vision?

Answer 8

Occipital

Question 9

What lobe primarily deals with memory function?

Answer 9

Temporal

Question 10

What lobe primarily deals with personality and planning?

Answer 10

Frontal

Question 11

What lobe primarily deals with spatial orientation, math, and calculation abilities?

Answer 11

Parietal

Question 12

What lobes are effected in Alzheimer’s disease and what are the deficits that usually occur?

Answer 12

• Lobe:
  
  • Temporal
  • Parietal lobes
• Deficits:
  
  • Memory
  • Language,
  • Visuospatial ability

Question 13

What are the abnormalities on the following MRI image? What disease does the patient most likely have?

Answer 13

• Increased ventricular size is outlined in red.
• Widening of sulci is outlined in blue.

These findings are common in Alzheimer’s disease patients.

Question 14

What is the PET scan finding representative of Alzheimer’s dementia?

1. Bilateral temporal lobe hypometabolism
2. Bilateral frontal lobe hypometabolism
3. One or two small areas of hypometabolism
4. Unilateral parietal lobe hypometabolism

Answer 14

1. Bilateral temporal lobe hypometabolism

Question 15

The most common frontotemporal dementia is _______________.

Answer 15

Pick’s disease

Question 16

How do patients with frontotemporal dementia usually presnet? What type of histological findings are seen upon autopsy?

Answer 16

• Personality changes and disinhibition initially, as opposed to appearing later in the course of the disease which is common for the other dementia
• These dementias typically show tau inclusions upon autopsy

Question 17

What type of dementias are characterized by deficits in the basal ganglia, causing early motor and speech difficulties?

Answer 17

Subcortical

Question 18

What are four examples of subcortical dementias?

Answer 18

• Huntington’s disease
• Wilson’s disease
• Progressive Supranuclear Palsy
• Limbic encephalopathy: Paraneoplastic

Question 19

What subcortical dementia is commonly associated with Parkinson’s disease?

Answer 19

Lewy Body dementia (about 25% of dementia cases)

Question 20

What lobes are commonly affected in Lewy Body dementia and what are the deficits seen?

Answer 20

• Lobes:
  
  • Parietal
  • Temporal
  • Also subcortical brainstem lesions (protein aggregates the develop inside neurons)
• Deficits:
  
  • Early losses in memory and language
  • Visual hallucinations (most commonly of little men or people)
  • Extrapyramidal symptoms

Question 21

_______________ is the second most common type of dementia and is often confused with Alzheimer’s.

Answer 21

Vascular dementia

Question 22

What are the characteristics of Vascular Dementia?

Answer 22

• Rapid, stepwise declines in cognition and function
• Often associated with focal neurologic deficits
• Imaging findings often include old infarcts, lacunae, diffuse white matter changes, and subdural hematomas

Question 23

(T/F) Vascular dementia losses are irreversible, but treating vascular risk factors can slow progression.

Answer 23

True.

Question 24

Normal pressure hydrocephalus (NPH) may also be a cause of dementia. What is the classic triad of symptoms for NPH?

Answer 24

• Dementia
• Incontinence
• Gait apraxia (magnetic gait)

NPH = DIG

Question 25

While documenting the history of a patient that you suspect of having dementia, what should you pay special attention to that may point to dementia?

Answer 25

The patient's **Instrumental Activities** of **Daily Living** (**IADLs**). * Once they start to lose the ability to accomplish things such as bathing, dressing, paying the bills, grocery shopping, you may more strongly suspect a dementia.

Question 26

The primary goal in obtaining an MRI of the head in a dementia work-up is to: 1. Confirm dementia by demonstrating cortical atrophy 2. Confirm dementia by demonstrating enlarged ventricles 3. Confirm dementia by demonstrating temporal hypometabolism 4. Rule out a tumor or other mass lesion

Answer 26

4. Rule out a tumor or other mass lesion

Question 27

Dementia has a(n) (abrupt/gradual) **onset**.

Answer 27

Gradual

Question 28

Dementia has a (progressive/fluctuating) **course**.

Answer 28

Progressive

Question 29

Dementia patients present with (impaired/intact) **consciousness**.

Answer 29

Intact

Question 30

Dementia patients present with (impaired/intact) **attention abilities**.

Answer 30

Intact

Question 31

Dementia patients present with a (variable/normal) **circadian rhythm**.

Answer 31

Variable

Question 32

What condition results from **decreased** or **failed resorption** of **CSF** and how does it **present**? How is it **treated**?

Answer 32

**Normal Pressure Hydrocephalus** (**NPH**) * Presents with a classic triad of symptoms: (**DIG**) * **D**ementia * **I**ncontinence * **G**ait apraxia. * May be treated with a **shunt** to **drain excess CSF**.

Question 33

What vitamin is required for the synthesis of myelin? What is the result of a deficiency in this vitamin?

Answer 33

Vitamin **B₁₂** (Cobalamin) Deficiency may lead to: * **Dementia** * **Degerneration** of **lateral** and **posterior spinal columns** * **Megaloblastic** anemia (type of macrocytic anemia) * **Loss** of **vibritory** sensation * **Increased methylmalonic** acid

Question 34

What are three common **anticholinesterases** used in the **treatment** of **dementia**?

Answer 34

* Donepezil * Rivastigmine * Galantamine

Question 35

\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is a **glutamate receptor blocker** theorized to prevent glutamate-mediated cell death via excitotoxicity in dementia patients.

Answer 35

Memantine

Question 36

What is the genetic linkage that is associated with Alzheimer's? What is the method for definitive diagnosis?

Answer 36

* **ApoE4 allele** genetic linkage * Definitive diagnosis is by **autopsy** with detection of **neurofibrillary** plaques and tangles