Olol Pa Neurology Test

Front 1

What is the central feature of Dementia?

Back 1

Memory Loss

Front 2

What are the 2 divisions of dementia?

Back 2

1. Cortical
2. Sub Cortical

Front 3

This division of dementia causes problems with memory and language and patients typically show severe memory impairment and aphasia.

Back 3

Cortical Dementia (in cerebral cortex)

Front 4

This division of dementia causes changes in personality and attetion span with slowed thinking.

Back 4

Sub cortical dementia (brain beneath the cortex)

Front 5

What is the most common underlying cause of dementia? Give 3 examples of this type of dementia?

Back 5

-Neurodegenerative
-Alzheimer's dz, Frontotemporal dementia, diffuse lewy body dz

Front 6

T or F:
Most dementia is treatable?

Back 6

FALSE!
Potentially correctable causes are <10% of all cases

Front 7

In patients with evidence of dementia, what diseases must initially be ruled out?

Back 7

-Infection, Metabolic, and Nutrional diseases

Front 8

What imaging should be performed in all pts with focal neuro signs and in those <65 at onset of dementia?

Back 8

MRI

Front 9

List the causes of potentially reversible cognitive impairment.

Back 9

-Drugs
-Depression
-Thyroid Dz
-Vit B12 deficieny
-Hypercalcemia
-Subdural Hematoma
-HIV
-NORMAL PRESSURE HYDROCEPHALUS!!!

Front 10

What is the best bedside/office screening tool to ID dementia pts?

Back 10

MMS (mini-mental status exam)
*better for IDing cortical dementia b/c emphasizes memory and language!

Front 11

List 3 specific neuropsychological tests?

Back 11

Praxis (tests learned behavior), Visual spatial processing (draw clock), Executive fxn (connect numbers in order least to greatest)

Front 12

What dz is responsible for 70% of all cases of dementia in the elderly?

Back 12

ALZHEIMER'S DZ

Front 13

Incidence of Alzheimer's _____ with age and 30% of people over _____ have the dz.

Back 13

-increases
-85

Front 14

The pathology of AD begins with progressive loss of _____ neurons and the formation of _________ in the intraneuronal neurofibrillary tangles.

Back 14

-cortial
-amyloid plaques
NOTE: Neurfibrillary tangles are twisted masses of protein fibers within nerve cells of the cerebral cortex of AD pts.

Front 15

Where does the pathological process begin in AD?

Back 15

Hippocampus
(spreads to diffuse areas of the cortex in all lobes except the occipital)

Front 16

AD may be treated with centrally acting __________.

Back 16

-Achesterase inhibitors
(a deficiency in cortical Ach from the loss of neurons in the nucleus basalis is noted in AD)

Front 17

What are the two forms of AD?

Back 17

1. Young onset/Familial
2. Sporadic (>65yo)

Front 18

Because autosomal dominant AD is seen in the majority of with Down's Syndrome who are over 30 yo, it is though to be associated with chromosome ____.

Back 18

21

Front 19

The _______ gene was found to be a susceptibile locus for sporadic AD.

Back 19

Apolipoprotein E

Front 20

Despite advanced cognitive impairments in AD, _______ are retained.

Back 20

Social graces

Front 21

What are some personality changes and behavioral difficulties in pts with AD?

Back 21

-Wandering
-Inappropriate Sexual Behavior
-Agitation

Front 22

What is end stage AD characterized by?

Back 22

-Near Mutism
-Inability to sit-up, hold head up, or track objects
-Difficulty eating/swallowing
-Wt loss, bowel/bladder incontinence, recurrent UTI's and URI's

Front 23

Achesterase inhibitors are used to treat AD by producing a modest improvement in _________. What other 2 forms of dementia may they also help in treating?

Back 23

-cognitive functions
-Vascular Dementia & Lewy Body Dementia

Front 24

Pt's with _______ have clinical Parkinson's signs (slow gait, rigidity, and balance problems and prominent dementia.

Back 24

Diffuse Lewy-body disease

Front 25

Where are Lewy-bodies found?

Back 25

-Brainstem, Limbic System, & Cortex

Front 26

In PD, Lewy-bodies are restricted to the _____ only.

Back 26

Brainstem

Front 27

_______ hallucinations & ______ fluctuations are common clinical findings in Diffuse Lewy-body dz.

Back 27

-Visual
-Cognitive

Front 28

Attempts to treat hallucinations in Diffuse Lewy-body dz may worsen the _____ symps b/c these pts demonstrate a marked hypersensitivity to _____ therapy.

Back 28

-extrapyramidal
-neuroleptic

Front 29

What is the 2nd most common cause of dementia after AD?

Back 29

Diffuse Lew-body Dz

Front 30

What percentage of eldery dementia pts have findings of focal strokes on MRI/CT with focal signs on PE? What is this type of dementia called?

Back 30

-10-20%
-Vascular Dementia

Front 31

When dementia begins with a ____ and illness progression is stepwise, dx of vascular dementia is likely.

Back 31

STROKE!

Front 32

Early incontinence, flattening of affect, and gait disturbances are clinical signs of ____ dementia.

Back 32

Vascular

Front 33

How would you treat the risk factors for vascular dementia?

Back 33

-BP control
-Stop smoking
-Diet modification
-Anticoagulation (esp in A-fib)

Front 34

Unlike AD, _______ dementias begins with marked behavioral disturbances.

Back 34

FRONTOTEMPORAL

Front 35

What is the classic form of frontotemporal dementia? Hint: It is associated w/ ALS

Back 35

Pick's Dz

Front 36

Pt's w/ Pick's dz are socially ______ and experience personality changes along with _______ behaviors.

Back 36

-disinhibited
-compulsive (ex: hyperorality)

Front 37

Unlike in ______, visuospatial fxn is preserved in Frontotemporal dementia.

Back 37

AD

Front 38

____ % of pts w/ PD have dementia by the time they reach _____.

Back 38

-50
-85

Front 39

T or F:
PD dementia effects executive function more than language or visuospatial processing.

Back 39

TRUE!

Front 40

What could be a cause of dementia in PD pts other than demetia from the disease process itself?

Back 40

Drugs being given to treat PD can cause psychosis, so always reduce dosage and see if dementia is corrected b/f dxing PD dementia!

Front 41

What is the dementia that is caused by a subacute, dementing, transmissible (prion) illness?

Back 41

Creutzfeldt-Jakob Disease induced dementia

Front 42

What is the age of onset of CJD?

Back 42

40-75 yo

Front 43

What are the 4 forms of CJD.

Back 43

1. Sporadic (80-85%)
2. Familial (15%)
3. Iatrogenic
4. Variant

Front 44

What dz's pathological process includes spongiform degeneration in widespread areas of the cortex and may have a very long incubation period?

Back 44

CJD
*may take years to develop

Front 45

Visual agnosia, extrapyramidal hyperkenesias, and predominance of cerebellar symps are used to distinguish variants of _____.

Back 45

CJD

Front 46

90% of CJD pts have _________.

Back 46

Myoclonic fasciculations

Front 47

T or F
Not all forms of CJD have relentless progression of dementia and personality changes.

Back 47

FALSE!
All form of CJD have relentless progression of demetia and personlity changes! :-(

Front 48

The transmissible agent in CJD is a ____.

Back 48

Prion protein

Front 49

What bodily fluid can be tested for the presence of the protein 14-3-3 in suspected CJD?

Back 49

CSF

Front 50

Risk factors for CJD are greatest in _____ and _____.

Back 50

-Butcher
-Medical Office Staff

Front 51

What transplanted tissue may be contaminated with CJD?

Back 51

-Corneal transplants, cadaveric growth hormone

Front 52

T or F?
There is no specific treatment for CJD.

Back 52

TRUE!

Front 53

How does HIV get into the CNS?

Back 53

-Monocytes and the Microglial system

Front 54

HIV dementia is characterized by _____ and ______.

Back 54

-Bradyphrenia
-Bradykinesia

Front 55

Patients with HIV dementia have ______ dysfunction, impaired ______, poor concentration, and ____.

Back 55

-executive
-memory
-apathy
*Sounds like we are all getting HIV dementia! ;-)

Front 56

T or F:
Treatment of HIV may slow the progression of dementia

Back 56

TRUE of course!

Front 57

What is the "triad" of symps in Normal-Pressure Hydrocephalus?

Back 57

-Subcortical Dementia
-Gait Instability
-Urinary Incontinence
(Under "Normal Pressure" you would "DIG!" D=Dementia, I=Incontinence (urine), G=Gait Instability)

Front 58

In ______ dementia, pt walks w/ feet stuck to floor, doesn't lift knees, and has a broad base.

Back 58

Normal-Pressure Hydrocephalus

Front 59

In Normal-Pressure Hydrocephalus ventricular enlargement is out of proportion to __________ in the presence of dementia.

Back 59

Cortical Atrophy

Front 60

What is the most important test in dxing Normal-Pressure hydrocephalus dementia?

Back 60

LP removing large amounts of CSF (30-40ml). Then asses pt's gait and cognitive function for improvement w/in minutes to hours.