20 Dementia - Marks

Front 1

What % of all hospital patients have abnormal mental statuses?

Back 1

50%

Front 2

What are the 12 categories for mental status?

Back 2

1. normal and its variants
2. dementia
3. mental retardation
4. mild cognitive impairment (MCI)
5. coma
6. Stupor & delirium
7. focal brain syndromes
8. vegetative state
9. minimally conscious state
10. psychiatric disorders
11. locked in state
12. brain dead

Front 3

Does old age cause dementia?

Back 3

No!! However, old age is a risk factor for dementia

Front 4

T/F - to have dementia, there needs to be a period of normalcy before decline.

Back 4

True

Front 5

1. Define coma
2. Can someone technically stay in a coma forever?

Back 5

1. unarousable and unresponsive
2. No!! You either go into a vegetative state or die

Front 6

How is a vegetative state different than a coma?

Back 6

People have sleep-wake cycles, and their eyes are open
--> still no awareness of self or the environment

Front 7

How are stupor/delirium patients different than patients in a coma?

Back 7

Patients are arousable, otherwise like a coma

Front 8

What is a patient able to do while in minimally conscious state (aka akinetic mutism)?

Back 8

They're able to visually track something (e.g., the doctor's face)

Front 9

For locked-in state:
1. what is the mental status?
2. are they awake and alert?
3. in-tact vertical eye movements result from lesions where?

Back 9

1. normal mental status
2. yes, pts are awake and alert, just "de-efferented"
3. caudal pontine lesions

Front 10

What are the 4 prerequisites for performing the MMSE?

Back 10

1) Proper hearing?
2) Share a common language?
3) Normal level of consciousness?
4) Aphasic?

Front 11

Per Dr. Marks, does dementia always involve memory problems?

Back 11

No! Not always

Front 12

What are the brain function deficits in dementia?

Back 12

1. memory
2. behavior
3. motivation
4. language
5. visual-spatial

Front 13

1. Dementia has a _____ onset with a progression over _____.

2. Is there alteration of consciousness?

Back 13

1. insidious onset; months to years progression

2. Not initially, but possibly at end stages

Front 14

Why is brain imaging a MUST for evaluating dementia?

Back 14

The possibility of discovering treatable dementias (e.g., Normal-Pressure Hydrocephalus, frontal lobe tumor, subdural hematoma)

Front 15

What blood work is always necessary for a dementia work-up?

Back 15

1. full chemistry, cell count, thyroid, and B12
--> problems in these values are treatable

Front 16

What additional values are useful?

Back 16

1. ESR (erythrocyte sedimentation rate) - a sign of inflammation
2. HIV status - a common cause of dementia
3. heavy metals

Front 17

When is spinal tap done in dementia evaluation?

Back 17

Atypical cases --> young onset, immune compromised, normal-pressure hydrocephalus, syphilis suspects

Front 18

What are the top 3 causes of dementia?

Back 18

#1 - Alzheimer's
#2 - Vascular/stroke
#3 - Mixed

Front 19

What is pseudodementia? Is it treatable?

Back 19

When depression results in dementia symptoms
--> treatable with antidepressants

Front 20

What are common causes of iatrogenic dementia?

Back 20

1. medications - i.e., anything that is anti-cholinergic or anti-histaminergic

Front 21

What are other treatable dementias?

Back 21

normal pressure hydrocephalus
subdural hematomas
thyroid and B12 etiologies
paraneoplastic causes
vasculitis
sleep disorders
infections

Front 22

Are infections that cause dementia treatable and reversible?

Back 22

Infections are treatable, but MAY NOT be reversible (e.g., Lyme, syphilis)

Front 23

Dementias listed below fall into what category?
HIV-associated
Syphilis
Lyme disease
Whipple’s disease
Viral encephalitis
Bacterial & fungal meningitis
Prions – CJD, nvCJD

Back 23

infectious dementias

Front 24

Are vascular dementias treatable?

Back 24

Not really, but...
*future stroke risk can be lowered
*some VD patients respond to cholinesterase inhibitors

Front 25

1. What type of dementia is characterized by apathy and the "Butler Please" demeanor?

2. How common is this?

Back 25

1. Frontotemporal dementia (FTD)

2. 2nd most common degenerative dementia after Alzheimer's

Front 26

When does Parkinson's Disease with dementia occur?

Back 26

Late in Parkinson's progression

Front 27

What is Diffuse Lewy Body disease (DLB)? Is this rare?

Back 27

Lewy Bodies are present in the substantia nigra AND the hippocampus and cerebral cortex
--> leads to dementia and Parkinsonism

**This is not rare.**

Front 28

What type of dementia is characterized by a Parkinsonian look and impaired verical eye movements

Back 28

Progressive Supranuclear Palsy (PSP)

Front 29

What motor symptoms characterize corticobasal degeneration (CBD)?

Back 29

1. Hemi-motor/sensory problems
2. Apraxia of a limb (inability to do previously learned motor skills)
3. alien hand syndrome - where your hand does something you don’t want it to do, as if it’s operating on its own

Front 30

Does Huntington's disease result in dementia?

Back 30

yes

Front 31

What type of dementia is the #1 type of degenerative dementia and makes of 2/3 of dementia cases?

Back 31

Alzheimer's disease (AD)

Front 32

1. What is the progression of Alzheimer's disease and what type of memory loss usually occurs?

2. What type of memory usually stays in-tact?

Back 32

1. insidious onset that affects short-term memory

2. well rehearsed memories

Front 33

What are the intracellular and extracellular pathological hallmarks in Alzheimer's disease?

Back 33

intracellular - neurofibrillary tangles
extracellular - neuritic (beta-amyloid) plaques

Front 34

1. Via PET scans, what lobes of the brain are preferentially involved in late stages of Alzheimer's disease?

2. What increases the sensitivity of PET scans?

Back 34

1. temporal and parietal
2. presence of amyloid ligands

Front 35

What do CSF studies of Alzheimer's disease show? Is this a sensitive test?

Back 35

low Amyloid
high Tau protein
--> very sensitive

Front 36

1. What chromosome encodes non-deterministic or sporadic genes involved in AD?

2. What genes are on this chromosome?

Back 36

1. Chromosome 19
2. ApoE
--> ApoE2 - protective
--> ApoE3 - neutral
--> ApoE4 - increase risk for AD

Front 37

What chromosomes encode deterministic genes for AD (aka if you get the gene, you'll get the disease), and hat genes are on these chromosomes?

Back 37

*chromosome 14 - presenilin 1 gene
*chromosome 1 - presenilin 2 gene
*chromosome 21 - amyloid precursor protein

Front 38

What is early-onset familial dementia? What % of AD does this comprise?

Back 38

Dementia in people under the age of 65
--> comprises < 5% of AD

Front 39

1. What chromosome is duplicated in Down's Syndrome?

2. What type of dementia are these people at high risk of developing?

Back 39

1. chromosome 21
2. early-onset AD

Front 40

1. How is ACh affected in AD?

Back 40

1. cholinergic deficiency via early degeneration of the Basal Nucleus of Meynert

Front 41

1. What drugs can be given to increase ACh levels in AD?

2. How effective are these drugs?

Back 41

1. AChase inhibitors (e.g., long lasting Donepezil, galantamine, and rivastigmine)

2. Modest improvement (like going back 6 months in time)
--> 40% of pts will improve (60% do not)

Front 42

How are glutamate levels altered in AD?

Back 42

elevated to the point of glutamate excitotoxicity

Front 43

1. What drug is given to treat the glutamate aspect of AD and what is its mechanism?

2. Is it affected? For what stage of AD is it FDA approved?

Back 43

1. Memantine (Namenda) - a noncompetitive and mild inhibitor of the NMDA-R

2. mild, but insignificant memory benefits
--> can actually slow clinical deterioration
--> FDA approved for moderate and severe AD

Front 44

What other therapies have been suggested for AD?

Back 44

omega fatty acids
vitamin D
curcumin
statins
HRT
huperzine A

Front 45

What lifestyle modifications can decrease risk of AD?

Back 45

*Keep up your brain activity
--> memory challenges
*Don't smoke
*Don't drink alcohol when young and only moderately when an adult
*Avoid "diabesity"
*Avoid head trauma
*Exercise regularly