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60 Cards in this Set
- Front
- Back
What is shown? What can this cause?
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Hydrocephalus
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What is shown? What kind of dementia may this cause?
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Huge cerebellar infarct. May cause vascular dementia.
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What is shown?
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Metastatic breast cancer
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What is shown on the left?
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Alzheimers. Massive brain atrophy.
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What is shown? What symptoms could this cause? What is the most likely cause of this injury?
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Subdural hematoma. Can cause focal neuro symptoms. Most likely the result of tearing of bridging veins.
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Long acting ACh-esterase inhibitor, muscarinic modulator, nicotinic agonist, may also be a MAOI, ↓ GABA release, ↑ release of NE, DA, 5-HT. Used in the tx of Alzheimers.
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Tacrine
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What ACh-esterase inhibitor has poor bioavailability (extensive 1st pass metabolism) & many adverse effects including hepatotoxicity? Used in the tx of Alzheimers.
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Tacrine
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This drug reduces deterioration in cognitive performance in the 1st 3 mos of Tx but shows no evidence it delays the long-term course of AD.
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Tacrine
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ACh-esterase inhibitors approved for both mild to severe symptomatic management of Alzheimers.
Does not alter long term prognosis, but improves global fxn, cognition & behavior. Delays tims to institutionalization |
Donepezil
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What ACh-esterase inhibitor has 100% bioavailability, higher CNS affinity (fewer side effects) and is metabolized by cytochrome P450? Used in the tx of Alzheimers.
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Donepezil
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While metabolized by cytochrome p450 this ACh-esterase inhibitor is NOT hepatoxic. Used in the tx of Alzheimers.
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Donepezil
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This ACh-esterase inhibitor is a natural alkaloid dervied from daffodils and is approved for mild to moderate AD.
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Galantamine
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What ACh-esterase inhibitor may also be beneficial in Tx symptoms of vascular dementia & dementia w/ Lewy bodies?
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Galantamine
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What ACh-esterase inhibitor requires multiple daily dosages (a slow titration) to limit GI side-effx? It also has partial metabolism via CYP450 & renal excretion. Used in the tx of Alzheimers.
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Galantamine
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What ACh-esterase inhibitor is approved or both mild to moderate AD and Parkinson's disease?
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Rivastigmine
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What ACh-esterase inhibitor is NOT metabolized by CytP450 and therefore has fewer drug interactions? How is it metabolized? Used in the tx of Alzheimers.
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Rivastigmine
Metabolized by cholinesterase at CNS sites |
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What are the side efx associated w/ Rivastigmine? (Used in the tx of Alzheimers.)
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GI. Available as a patch with fewer side effx.
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What ACh-esterase inhibitor is in Phase III trials for Lewy Body dementia, vascular dementia, & mild cognitive impairment?
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Rivastigmine
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What class ofAlzheimer's drugs are used for mild to moderate AD, severe AD by delay/preventing symptoms from becoming worse? They may help control some behavioral symptoms, ↑effects of reamining NT afferents, and may reduce A-beta 1-42 by stimulating Ig production?
What are the drugs in this class? |
Acetylcholinesterase inhibitos
Tacrine, Donepezil, Galatamine, Rivastigmine |
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What drug used in the tx of Alzheimers is an NMDA-receptor antagonist?
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Memantine
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What NMDA-receptor antagonist is approved to modertae-severe AD (pending for mild AD)?
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Memantine
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What are the benefits of Memantine? What is its MOA?
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• Improved cognitive & psychomotor fxn
• Reduction of care dependence • Neuroprotective, slows disease progression • Very few side effx • Not metabolized by Cyt P450 • Extended release formulation is available |
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What drug used in the tx of Alzheimer's disease has very good tolerability (side effx similar to placebo) and few drug interaxns? Why is this?
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Memantine
• Not metabolized by CytP450 |
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What neurological disease presents with memory loss as the first symptom w/ a MMSE showing epsodic memory loss?
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Alzheimer's disease
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What neurological disease will show entorhinal cortex & hippocampal atrophy in imaging?
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Alzheimer's disease
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What will the MMSE, neuropsych & neuro exam show in Alzheimer's disease?
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MMSE will show episodic memory loss, but neuropsych & neurology exam will initially be normal
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What neurological disease first presents with apathy, poor judgment/insight/speech/language & hyperorality?
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Fronto-temporal dementia
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What will the MMSE and Neuropsych exam show for Fronto-temporal dementia?
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MMSE: shows deficits in frontal/executive fxn & language but spares drawing
Neuropsych exam show apath, disinhibition, hyperorality, euphoria, depression |
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What neurological disease may show vertical gaze palsy, axial rigidity, dystonia, alien hand, or motor neuron disease in the neurology exam?
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Fronto-temporal dementia
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What neurological disease will show frontal, insular and/or temporal atrophy w/ sparing of the posterior parietal lobe in imaging?
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Fronto-temporal dementia
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What neurological disease will first present w/ visual hallucinations, REM sleep disorder, delirium, Capgras' synrome, or Parkinsonism?
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Lewy-body dementia
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What will the MMSE and Neuropsych exam show for Lewy-body dementia?
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• MMSE will show deficits in drawing & frontal/executive fxn. May show delirium. Memory is spared.
• Neuropsych exam will show visual hallucinations, depression, sleep disorders, and delusions |
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What neurological disease may show Parkinsonism in the neurology exam?
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Lewy-body dementia (or Creutzfeld-Jakob)
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What neurological disease will show posterior parietal atrophy (and hippocampi larger than in AD) in imaging?
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Lewy-body dementia
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What neurological disease will present with dementia, mood ∆s, anxiety, & movement disorders?
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Creutzfeld-Jakob disease
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What will the MMSE and Neuropsych exam show for Creutzfeld-Jakob disease?
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• MMSE will show deficits in variable frontal/executive fxn, focal cortical, & memory
• Neuropsych will show depression & anxiety |
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What neurological disease may show myoclonus, rigidity, & parkinsonism in the neurology exam?
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Creutzfeld-Jakob disease
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What neurological disease will show non-covulsive seizure activity and/or periodic discharges on the EEG?
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Creutzfeld-Jakob disease
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What neurological disease will show cortical ribboning & basal ganglia/thalamus hyperintensity on diffusion/flair MRI?
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Creutzfeld-Jakob disease
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What neurological disease will often first present with sudden, variable; apathy, falls, & focal weakness with stepwise deterioration?
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Vascular dementia
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What will the MMSE and Neuropsych exam show for Vascular dementia?
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• MMSE will show deficits in frontal/executive fxn, cognitive slowing (sparing of memory)
• Neuropsych exam will show apathy, delusions, & anxiety |
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What neurological disease will show motor slowing or spasticity but can also be normal?
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Vascular dementia
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What neurological disease will show cortical and/or subcortical infarctions, confluent white matter disease in imaging?
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Vascular dementia
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What class of dementias will show stepwise, sudden deterioration in cognition; episodes of confusion, aphasia, slurred speech, & focal weakness?
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Cerebrovascular disease: Vascular dementia, multi-infarc dementia, Binswangers dementia
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To w/u for dementia in all patients you must do a:
• Brain MRI (including FLAIR & DWI, w/ & w/o gad), • Serum electrolytes • Liver, renals & Thyroid fxn tests • Vitamin B12 & homocysteine and what other test? |
Urinalysis, culture
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Definition: Reduced comprehension, coherence, ability to reason. Commonly encountered in clinical setting.
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Altered Mental Status
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Definition: Relatively acute decline in cognition (especially attention but all cognitive domains may be affected)
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Delirium
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Definition: Progressive decline in cognitive function (especially memory, but all domains may be affected)
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Dementia
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Definition: Cognitive deficits that interfere subtly with ADLs, possible precursor to dementia
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Mild Cognitive impairment
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What are the 4 DSM IV criteria for dementia?
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1. Memory impairment
2. At least one of: Aphasia, Apraxia, Agnosia, Disturbance in executive fxning 3. The disturbance in 1 or 2. significantly intereferes w/ work, social activities, or relationships 4. Disturbance does not occur exclusively during delirium |
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Definition: difficulty carrying out purposeful motor fxn b/c of planning, coordinating or executing action, not because of movement, senses or comprehension of command
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Apraxia
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Definition: Imparied ability to recognize of identify objects, even though sensory abilities are intact
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Agnosia
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What neurological disease will often first present with prominent deficits in executive fxn w/ memory initially intact?
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Vascular dementia
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In what dementia do behavioral symptoms predominate? What is another common presentation?
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• Frontotemporal dementia
• May also present w/ aphasias (fluent & nonfluent) |
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What clinical test/exam is most SPECIFIC for dementia? What clinical test/exam is most SENSITIVE for dementia?
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• Specific: Short Portable Mental Status Questionnaire: 94% (followed by MMSE & clinical judgement, 82%)
• Sensitive: NINCDS criteria 92% |
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What dementia progresses episodically? Which progresses rapidly?
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• Alzheimers (episodically)
• Rapidly with Creutzfeld-Jakob disease |
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What dementia may present w/ loss of position/vibratory sense?
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B-12 deficiency
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What is pictured? What are they caused by? What diseases can these be seen in ?
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Lewy body inclusions, caused by α-synnuclein protein deposits in neuronal nuclei
• Seen in Parkinson's (substantia nigra) and Lewy Body Dementia (cortex) |
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What is pictured on the L? on the R? What proteins are they derived from? Characteristic of what disease?
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L: Neurofibrillary tangle (from abnormal tau protein - used to assemble microtubules)
R: Senile plaque of β-amyloid • Alzheimer's disease |
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What is seen on the top? On the bottom? What proteins are involved? What disease are these characteristic of?
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TOP: Neurofibrillary tangle (from abnormal tau protein - used to assemble microtubules)
BOTTOM: Senile plaque of β-amyloid • Alzheimer's disease |
