Inpatient Psych Rotation - Dementia - Revised

Front 1

If a patient's Vitamin B12 level is borderline low, what should you consider?

Back 1

Check homocysteine/methylmalonic acid.

Front 2

True/False: Vitamin B12 deficiency can be treated with po vitamin B12.

Back 2

True.

Front 3

HIV- associated dementia: where does it affect the brain first?

Back 3

Basal ganglia and substantia nigra.

Front 4

HIV- associated dementia: Why does it matter what part of the brain gets affected?

Back 4

May explains why haldol/risperidal are not best first choices for rx – high rate of dystonia.

Front 5

HIV- associated dementia: What are risk factors?

Back 5

High viral load.

Front 6

HIV- associated dementia: When to screen for this?

Back 6

CD4<350.

Front 7

HIV- associated dementia: Diagnostic differential?

Back 7

Opportunistic CNS infections, delirium, depression.

Front 8

HIV- associated dementia: What are other risk factors?

Back 8

Low education, older age, IV drug use, anemia, female.

stinky mnemonic: Le Oaaf IV

Front 9

HIV- associated dementia: What are the symptoms?

Back 9

subcortical dementia (think APRIL AGE) – apathy, depression are prominent, Parkinsonism psychosis, mania

stinky mnemonic: SD MAD PP

Front 10

HIV- associated dementia: What is the course of the disease?

Back 10

Varies, can be slow, but on average: Rapid progression – death in 2 years.

Front 11

HIV- associated dementia: How do you diagnose it?

Back 11

MRI to r/o other causes.

Front 12

HIV- associated dementia: How do you treat it?

Back 12

antiretrovirals.

Front 13

Name 3 ways Hepatitis C or its treatment can affect behavior. Explain how the conditions affect brain function.

Back 13

1) Acute fulminant hepatitis (rare) / Cirrhosis (common)
- can damage liver function enough to increase NH3.
2) Inflammatory cytokines
- adversely affect brain function.
3) Interferon can precipitate depression
- Interferon is a pro-inflammatory cytokine.

Front 14

Name 3 conditions commonly comorbid with hepatitis C that affect behavior.

Back 14

1) HIV can be comorbid – Hep C does not affect brain directly, but HIV does.
2) EtoH use/drug use is common comorbidity
3) Alzheimer’s Disease

stinky mnemonic: HEDAD

Front 15

Alzheimer’s Disease: Pathophysiology of Cortical Dementia: where does cortical atrophy occur?

Back 15

ACh neurons in nucleus basalis; also association cortex of temperoparietal lobe and (to lesser degree) frontal lobes.
most severe: medial temporal, includes hippocampus.

Front 16

Alzheimer’s Disease: Yes/No: Are subcortical structures involved even though this is a “cortical dementia”?

Back 16

Yes.

Front 17

Alzheimer’s Disease: What are the classic microscopic findings?

Back 17

Senile plaques, neurofibrillary tangles, neuronal and synaptic loss, granulovascular degeneration of neurons, amyloid angiopathy.

Front 18

Alzheimer’s Disease: Which of the microscopic findings are unique to Alzheimer disease?

Back 18

Amyloid plaques.

Front 19

Alzheimer’s Disease: What are neurofibrillary tangles?

Back 19

Mostly phosphorylated tau protein: these are seen in other neurodegenerative diseases

Front 20

Alzheimer’s Disease: What are tau proteins?

Back 20

part of cytoskeleton

Front 21

Alzheimer’s Disease: What are the DSM IV-TR criteria for Dementia of the Alzheimer’s Type:

Back 21

Criterion A: multiple cognitive deficits:
Loss of memory +
At least one of: Agnosia, Apraxia, Aphasia
Criterion B: Impaired executive function
Criterion C: Gradual onset, continuing cognitive decline
Subtypes:
Early Onset: <age 65
Late Onset: > age 65

Front 22

Alzheimer’s Disease: Name two classes of meds, give one example each and the mechanism of action.

Back 22

Cholinesterase inhibitors (Donezepil)
decreased Ach from involvement of nucleus basalis of Meynert
Glutamate antagonist (Memantine)
protects neurons from glutamate which can be neurotoxic

Front 23

Alzheimer’s Disease: Name characteristics of subcortical dementia that are different from in cortical dementia and how they are different.

Back 23

stinky mnemonic: APRiL AGE
A pathy
P sychomotor Retardation
R ecall (unlike cortical dementia, recall better preserved, can be better with cues)
iL = L oss of Initiative
A ffective Syndrome
G ait
E xtrapyramidal Signs
All are earlier or more marked (except for recall)

Front 24

What kind of dementia(s) is/are probably responsive to anti-cholinesterase inhibitors?

Back 24

Alzheimer’s, Lewy Body/Parkinsons, Vascular, maybe dementia from TBI.

stinky mnemonic: VALP TBI

Front 25

What kind of dementia(s) is/are less likely to be responsive to anti-cholinesterase inhibitors?

Back 25

Huntington, Frontotemporal.

Front 26

Secondary Parkinson’s symptoms: Name 6.

Back 26

Bradykinesia, Extrapyramidal Rigidity, Rest Tremor; Festinating gait, Masked facies

stinky mnemonic: BERT FM

Front 27

Striatum:
Name a major component of the ventral striatum.

Back 27

Nucleus accumbens.

Front 28

Striatum:
Name two components of the dorsal striatum.

Back 28

Caudate and Putamen.

Front 29

In the striatum, the direct pathway is mediated by the ___ receptor, while the indirect pathway is mediated by agonism of the ___________receptor or antagonism of the ________receptor.

Back 29

the direct pathway is mediated by the __D1__ receptor.
the indirect pathway is mediated by agonism of the __serotonin/5HT__ receptor or antagonism of the __D2__ receptor.

Front 30

The direct pathway ________ action while the indirect pathway __________________ This may explain (list two clinical observations):

Back 30

The direct pathway __facilitates (Go)__ action while the indirect pathway __inhibits action (NoGo)__ This may explain:
1) Serotonin decreases impulsivity.
2) Dopamine increases impulsivity.

Front 31

Deep brain stimulation for Parkinsons disease inhibits ________ activity, thereby reducing the __________ pathway activity and the __________ Signal.

Back 31

Deep brain stimulation for Parkinsons disease inhibits __STN__ activity, thereby reducing the __hyperdirect and indirect__ pathway activity and the __Global NoGo__ Signal.

Front 32

Deep Brain Stimulation of this structure is associated with decreased ability to ___________when it is unclear what the reward/risk ratio is.

Back 32

Deep Brain Stimulation of this structure is associated with decreased ability to __wait for more information__ when it is unclear what the reward/risk ratio is.