Nsp Week 2: Dementias (Hershey)

Front 1

List 4 screening tools for dementia patients

Back 1

1. Clinical dementia rating (CDR)
2. Instrumental activities of daily living (IADL)
3. Neuropyschiatric inventory (NPI)
4. Mini-Mental State Examination (MMSE)

Front 2

According to DSM-III R, dementia is diagnosed based on what criteria?

Back 2

1. Change in cognitive abilities sufficient enough to compromise a person's daily function
2. Conscious and aware. No delerium
3. Memory impairment beyond that seen in normal aging
4. At least one other cognitive domain affected:
Visuospacial abilities
Language skills
Executive function

Front 3

Describe the Clinical Dementia Rating (scale) from 0.5 - 3.0

Back 3

0.5 = Questionable dementia (no impairment of IADL or BADL)
1.0 = Mild dementia (impaired IADL, but not BADL)
2.0 = Moderate dementia (pt is dependent on others for most IADLs and some BADLs)
3.0 = Severe dementia (pt is dependent on others for all IADLs and BADLs)

Front 4

Briefly describe Lawton's IADL scale

Back 4

Instrumental Activities of Daily Living
Scale of 0 - 2.
2 = no help required, 0 = unable

Activities include things like using the telephone, driving, grocery shopping, preparing meals, etc.

Front 5

Beta-amyloid plaques are commonly associated with which disease?

Back 5

Alzheimer's disease

Front 6

What would you expect to see on a CT scan of a patient with Alzheimer's disease?

Back 6

Bilateral hippocampal atrophy

Front 7

What kind of diet is recommended for patients with Alzheimer's?

Back 7

Meditteranean style

Front 8

What causes vascular dementia?

Back 8

1. Ateriosclerosis of subcortical small vessels
2. Hypoperfusion of subcortical white matter

Front 9

Risk of vascular dementia increases in a dose-dependent fashion in what type of patients?

Back 9

1. Patients who smoke
2. Have HTN, diabetes, and hyperlipidemia

Front 10

What is the clinical presentation of vascular dementia?

Back 10

Acute or subacute onset of gait disorders and/or memory loss

Front 11

50% of Dementia with Lewy Bodies patients have what type of disorder?

Back 11

REM sleep behavior disorder
(acting out dreams and kicking in their sleep)

Front 12

List some characteristics of Dementia with Lewy Bodies.

Back 12

1. REM sleep behavior disorder
2. Progressive memory loss
3. Parkinsonism
4. Fluctuations in alertness
5. Visual hallucinations/ altered visual perception

Front 13

Which dementia patients need to see a neurologist?

Back 13

1. Gait/balance disorder
2. Psychiatric issues
3. Involuntary movements

Front 14

What is the cholinergic hypothesis?

Back 14

Cholinergic cells in the nucleus basalis of Meynert die early in both AD and DLB

Front 15

What are the advantages of using Donepezil in patients with AD?

Back 15

1. Improves symptoms in severe AD
2. Delays nursing home placement

Front 16

Which medication improves the function in AD patients on Donepezil?

Back 16

Memantine

Front 17

Which medications are recommended for improving symptoms of AD and delaying nursing home replacement?

Back 17

1. Donepezil
2. Memantine

Front 18

Which medications improve the symptoms associated with DLB?

Back 18

1. Cholinesterase inhibitors
2. Memantine

Front 19

What are the most common clinical characteristics of AD?

Back 19

1. Insidious onset and gradual progression
2. Asking repeated orientation questions
3. Geographic disorientation

Front 20

What is the pathophysiology of AD?

Back 20

1. Extracellular accumulation of beta-amyloid
2. Atrophy of both hippocampi and medial temporal lobes

Front 21

List the 4 mot common clinical characteristics of DLB.

Back 21

1. Memory disorder
2. Parkinsonism
3. Visual hallucinations
4. Cognitive fluctuations (daytime sedation)

Front 22

What is the pathophysiology of DLB?

Back 22

1. Intracellular accumulation of alpha-synuclein
2. SPECT = hypoperfusion of parietal lobes

Front 23

List the 3 most common clinical characteristics of Vascular dementia

Back 23

1. Sudden onset of cognitive changes
2. Gait apraxia/ urinary incontinence
3. Pseudobulbar affect/ depression

Front 24

What is the pathophysiology of Vascular dementia?

Back 24

1. Arteriosclerosis of small subcortical vessels
2. Hypoperfusion of subcortical white matter
3. Demyelination of subcortical white matter

Front 25

Dementia patients with gait disorder and complex psychiatric issues are most likely to have which types of degenerative disorders?

Back 25

More likely to have DLB or VaD
(less likely to have AD)

Front 26

Intracellular accumulation of alpha-synuclein is associated with which degenerative disease?

Back 26

Dementia with Lewy Bodies

Front 27

Parkinsonism is associated with which degenerative disorder?

Back 27

Dementia with Lewy Bodies