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36 Cards in this Set
- Front
- Back
Dementia
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global deterioration of intellectual function in the face of unimpaired consciousness
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What are the six categories of the assessment of mental state (bedside tests: MMSE and MOCA)?
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-level of consciousness
-orientation (time, place, person) -memory (remote, recent, immediate) -attention and concentration -knowledge and insight -language |
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Pout reflex
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tap lips with tendon hammer--a pout response is observed
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Grasp reflex
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stroking palm of hand induces grasp
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Glabellar reflex
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patient cannot inhibit blinking in response to stimulation (tapping between eyes)
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Palmo-mental reflex
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quick scratch on palm of hand induces sudden contraction of mental is muscle in face
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Where does the anterior pathway of dementia take place, and what are four symptoms associated with it?
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-frontal pre-motor cortex
-behavioural changes/loss of inhibition, antisocial behaviour, facile, and irresponsible |
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Where does the posterior pathway of dementia take place, and what are the two symptoms associated with it?
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-parietal and temporal lobes
-disturbance of memory and language without marked changes in behaviour |
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The anterior pathway can lead to which two other dementias?
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frontotemporal dementia (Pick's) and huntington's disease
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The posterior pathway can lead to which disease?
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alzheimer's disease
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Causes of dementia (7)
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-degenerative
-cerebrovascular -structural -infections -toxic/metabolic -immune disorders and cancer -depression |
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What are three examples of degenerative causes of dementia?
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-lewy body dementia
-tauopathies (frontotemporal--Pick's disease, progressive supra nuclear palsy) -wilson's disease (hepatolenticular degeneration) |
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What are four examples of infectious causes of dementia?
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-creutzfeld-jacob disease
-neurosyphilis -HIV -sequelae of viral encephalitis |
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What are four examples of toxic/metabolic of dementia?
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-vitamin deficiencies (B12, thiamine, folate)
-hypothyroidism -uremia and dialysis related -hepatic encephalopathy |
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How many neurons, and synapses are in the human brain?
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100 billion neurons and 100 trillion synapses
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What three essential functions of neurons does alzheimer's disease disrupt?
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-communication
-metabolism -repair |
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Symptoms of alzheimer's disease (7)
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-impairment of memory and attention
-language and comprehension -abstract thinking -judgement -personality changes -depression -visuo-spatial disorientation |
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Signs of alzheimer's disease (4)
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-motor and gait disturbance
-extrapyramidal signs -sphincters -seizures |
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What are the four susceptibility genes involved in alzheimer's disease?
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-APP mutation
-apolipoprotein E -presenilin 1 and 2 mutations -SORL 1 |
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What are five indications of alzheimer's disease presented in neuropathology?
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-cortical atrophy
-synaptic and neuronal loss -NFTs with paired helical filaments (hyperphosphorylated forms of the microtubule-associated protein tau) -neuritic plaques with amyloid core -amyloid angography |
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Brains of people with AD have an abundance of which two abnormal structures?
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-beta-amyloid plaques: which are dense deposits of protein and cellular material that accumulate outside/around nerve cells
-neurofibrillary tangles: which are twisted fibres that build up inside the nerve cell |
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Amyloid precursor protein (APP)
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membrane protein sitting on membrane and extending outwards to assist in neuronal growth, survival and repair
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What is the most important enzyme for cutting the APP?
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beta-amyloid
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What chemical messenger is decreased in AD, and where (2)?
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acetylcholine in the cortex and hippocampus
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What are the three current drugs for alzheimer's disease and what is their mechanism?
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-aricept, exelon, reminyl
-inactivate the enzyme ACh-esterase |
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What are four cholinesterase inhibitors (symptomatic) drugs for AD?
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-donepezil
-rivastigmine -galantamine -tacrine |
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Memantine
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a non-cholinergic agent (glutamate receptor modular)
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What are three non-cholinergic agent possible treatments for AD?
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-amyloid vaccine
-secretase inhibitors -anti-amyloid agents |
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What are four non-cholinergic agent unproven treatments for AD?
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estrogens, NSAIDs, vasodialators, and propentofylline
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What are some laboratory investigations of AD? (13)
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CBC, ESR, thyroid function tests, B12, folate, serum electrolytes, glucose, BUN, creatinine, calcium, liver function tests, toxicity screen
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What are four symptoms of dementia with lewy bodies, and what are two treatments?
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-fluctuating cognition, variation in attention and alertness, recurrent visual hallucinations, and parkinsonian features
-cholinesterase inhibitors and atypical antipsychotics |
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What is a unique pathological effect of DLB that resembles PD?
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loss of pigmented neurons in the substantial nigra
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Symptoms of frontotemporal dementia (Pick's disease) (5)
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-disinhibition
-apathy -perseveration -mental rigidity -affective symptoms |
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What pathology was most frequently observed with FTD?
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tau
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The gene on what chromosome is associated with FTD?
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17
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Vascular dementia accounts for what percentage of dementias?
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10-15%
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