Tag: Dementia

Dementia

DEMENTIA

Q. 1

Dermatitis, diarrhoea and dementia are seen in deficiency of :

 A

Thiamine

 B

Riboflavin

 C

Niacin

 D

Methionine

Q. 1

Dermatitis, diarrhoea and dementia are seen in deficiency of :

 A

Thiamine

 B

Riboflavin

 C

Niacin

 D

Methionine

Ans. C

Explanation:

The early symptoms of pellagra include loss of appetite, generalized weakness and irritability, abdominal pain, and vomiting.
Bright red glossitis then ensues, followed by a characteristic skin rash that is pigmented and scaling, particularly in skin areas exposed to sunlight.
This rash is known as Casal’s necklace because it forms a ring around the neck; it is seen in advanced cases.
Vaginitis and esophagitis also may occur. Diarrhea (in part due to proctitis and in part due to malabsorption), depression, seizures, and dementia are also part of the pellagra syndrome—the four Ds: dermatitis, diarrhea, and dementia leading to death.
 
Ref:Russell R.M., Suter P.M. (2012). Chapter 74. Vitamin and Trace Mineral Deficiency and Excess. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison’s Principles of Internal Medicine, 18e.

 


Q. 2

Pseudo dementia is seen in:

 A

Alcoholism

 B

Depression

 C

Schizophrenia

 D

Mania

Q. 2

Pseudo dementia is seen in:

 A

Alcoholism

 B

Depression

 C

Schizophrenia

 D

Mania

Ans. B

Explanation:

B i.e. Depression 

Pseudo-Dementia (Depression related cognitive dys functions) is found in depressionQ. They have past h/o depression. Have more insight into their symptoms – i.e. themselves complaints of memory impairment, difficulty in sustaining attention & concentration; & reduced intellectual capacity. In contrast, a patient of dementia does not c/o these disturbance.


Q. 3

True about dementia is A/E

 A

Hallucination are not common

 B

Clouding of consciousness is common

 C

Nootropics have limited role

 D

All

Q. 3

True about dementia is A/E

 A

Hallucination are not common

 B

Clouding of consciousness is common

 C

Nootropics have limited role

 D

All

Ans. B

Explanation:

B i.e. Clouding of consciousness is common

  • Clouding of consciousness is a characteristic feature delirium & is helpful in differentiating it from dementiaQ.
  • Two most common causes of dementia are Alzheimer’s & multi infarct; both of which are irreversible.

Quiz In Between


Q. 4

Characteristic feature of subcortical dementia is

 A

Memory loss

 B

Aphasia

 C

Dyslexia

 D

Tactile agnosia

Q. 4

Characteristic feature of subcortical dementia is

 A

Memory loss

 B

Aphasia

 C

Dyslexia

 D

Tactile agnosia

Ans. A

Explanation:

A i.e. Memory loss

Aphasia, Agnosia, Dyslexia are characteristic features of cortical dementia. So we are only left with memory loss for sub cortical dementia.


Q. 5

Subcortical dementia is seen in all except :

 A

Parkinsonism

 B

Alzheimer’s disease

 C

Wilsoms disease

 D

Huntingtons Chorea

Q. 5

Subcortical dementia is seen in all except :

 A

Parkinsonism

 B

Alzheimer’s disease

 C

Wilsoms disease

 D

Huntingtons Chorea

Ans. B

Explanation:

B i.e. Alzheimer’s disease


Q. 6

Dementia is seen in all except:

 A

Schizophrenia

 B

Alzheimer’s disease

 C

Huntington’s chorea

 D

Pick’s ds

Q. 6

Dementia is seen in all except:

 A

Schizophrenia

 B

Alzheimer’s disease

 C

Huntington’s chorea

 D

Pick’s ds

Ans. A

Explanation:

A i.e. Schizophrenia

Quiz In Between


Q. 7

Most common cause dementia in adult:

 A

Alzheimer’s

 B

Multiinfrct

 C

Pick’ disease

 D

Metabolic cause

Q. 7

Most common cause dementia in adult:

 A

Alzheimer’s

 B

Multiinfrct

 C

Pick’ disease

 D

Metabolic cause

Ans. A

Explanation:

A i.e. Alzheimer’s


Q. 8

One of the following is a reversible cause of dementia :

 A

Toxic dementia

 B

Alzheimer’s ds.

 C

Multi – infarct dementia

 D

Pick ds

Q. 8

One of the following is a reversible cause of dementia :

 A

Toxic dementia

 B

Alzheimer’s ds.

 C

Multi – infarct dementia

 D

Pick ds

Ans. A

Explanation:

A i.e. Toxic


Q. 9

Reversible cause of dementia is

 A

Multi infarct

 B

Senile Dementia

 C

Post Encephalitis

 D

Hutington’s chorea

Q. 9

Reversible cause of dementia is

 A

Multi infarct

 B

Senile Dementia

 C

Post Encephalitis

 D

Hutington’s chorea

Ans. C

Explanation:

C i.e. Post Encephalitis

Quiz In Between


Q. 10

Vascular dementia is characterized by

 A

Disorientation

 B

Memory deficiet

 C

Emotional liability

 D

All

Q. 10

Vascular dementia is characterized by

 A

Disorientation

 B

Memory deficiet

 C

Emotional liability

 D

All

Ans. D

Explanation:

Ans. D. All

  • These all are features of dementia
  • Dementia is characterized by multiple cognitive defects that include impairment in memory, without impairment in consciousnessQ.
  • The cognitive functions that can be affected in dementia include general intelligence, learning & memory, language, problem solving, orientation, perception, attention & concentration, judgement & social abilities (key words : think about a very old man who is unable to learn new things, concentrate, judge & solve problems with poor personal care, general intelligence, social abilities & communication skills.)
  • Vascular dementia characteristically presents with – sudden onset in early age, stepwise & patchy progression with focal neurological signs & symptomsQ & greater preservation of personality.

Q. 11

Dementia of Alzheimer’s type is not associated with one of the following :

 A

Depressive symptoms

 B

Delusions

 C

Apraxia and aphasia

 D

Cerebral infarcts

Q. 11

Dementia of Alzheimer’s type is not associated with one of the following :

 A

Depressive symptoms

 B

Delusions

 C

Apraxia and aphasia

 D

Cerebral infarcts

Ans. D

Explanation:

D i.e.Cerebral infarcts


Q. 12

The term “Dementia precox” was coined by

 A

Freud

 B

Bleuler

 C

Kraepelin

 D

Schneider

Q. 12

The term “Dementia precox” was coined by

 A

Freud

 B

Bleuler

 C

Kraepelin

 D

Schneider

Ans. C

Explanation:

C i.e., Kraepelin 

  1. Benedict Morel used term demence precoce (in french) for deteriorated patients whose illness began in adolescence.
  2. Emil Kraeplin translated it into dementia. PrecoxQ i.e. dementia = deteriorated cognitive process & precox = early onset
  3. Eugen Bleuler coined term schizophreniaQ
  4. Kahlbaum described catatoniaQ, Hacker decribed hebephrenia

Quiz In Between


Q. 13

Presenile dementia is defined as that which occur below the age of ……. years :

 A

50

 B

55

 C

60

 D

65

Q. 13

Presenile dementia is defined as that which occur below the age of ……. years :

 A

50

 B

55

 C

60

 D

65

Ans. C

Explanation:

C i.e. 60


Q. 14

True about dementia is: 

Karnataka 07

 A

Alzheimer’s disease is due to multiple small strokes in the cerebral cortex

 B

Dementia is the loss of distant memory

 C

Dementia due to atherosclerosis does not progress like Alzheimer’s

 D

Alzheimer’s disease is associated with an increase in ACh release in the cerebral cortex

Q. 14

True about dementia is: 

Karnataka 07

 A

Alzheimer’s disease is due to multiple small strokes in the cerebral cortex

 B

Dementia is the loss of distant memory

 C

Dementia due to atherosclerosis does not progress like Alzheimer’s

 D

Alzheimer’s disease is associated with an increase in ACh release in the cerebral cortex

Ans. B

Explanation:

Ans. Dementia is the loss of distant memory


Q. 15

All are reversible causes of dementia except ‑

 A

Hypothyroidism

 B

Hydrocephalus

 C

Meningoencephalitis

 D

Alzheimer’s disease

Q. 15

All are reversible causes of dementia except ‑

 A

Hypothyroidism

 B

Hydrocephalus

 C

Meningoencephalitis

 D

Alzheimer’s disease

Ans. D

Explanation:

Ans. is ‘d’ i.e., Alzhimer’s disease

Reversible causes of dementia

  1. 1)      Surgically treatable :- Normal pressure hydrocephalus, brain tumors (frontal lobe tumor), meningioma, subdural hematoma due to head injury, hydrocephalus.
  2. 2)     Medically treatable :- Depression, hypothyroidism, alcohol abuse, vitamin B n/folate/Niacin deficiency, any metabolic or endocrine disturbance, neurosyphilis, Hashimoto’s encephalopathy, Wilson’s disease, celiac disease, whipple’s disease, chronic meningoencephalitis, drugs and toxin (toxic dementia).

Irreversible causes of dementia :

  • Alzheimer’s disease, vascular (multi-infarct) dementia, Parkinsonism, Huntington’s chorea, Lewy body dementia, Pick’s disease.

Quiz In Between


Q. 16

All are true regarding Fronto-temporal dementia except: 

 A

Stereotypic behavior

 B

Insight present

 C

Age less than 65 years 

 D

Affective symptoms

Q. 16

All are true regarding Fronto-temporal dementia except: 

 A

Stereotypic behavior

 B

Insight present

 C

Age less than 65 years 

 D

Affective symptoms

Ans. B

Explanation:

Ans. b. Insight present (Ref Kaplan and Sadocks 9/e p1194-1198; Harrison 19/e p2602, 18/e p3309-3311) Fronto-Temporal Dementia:

  • Insight is absent in Fronto-temporal dementia.
  • FTD often begins in the 5′hto 7th decades.
  • Patients with FTD often show an absence of insight into their condition.
  • Common behavioral features include apathy, disinhibition, weight gain, food fetishes, compulsions, and emotional distance or loss of empathy.
Fronto-Temporal Dementia

FTD often begins in the 5′ to 7′ decades’)

More common in menu

Unlike in Alzheimer’s disease (AD), behavioral symptoms predominate in the early stages of FTD°

Family history of dementia is common° 

MC autosomal dominantly inherited mutations causing FTD involve the MAPT or GRN genes, both on chromosome 17.

Clinical features:

Early symptoms are divided among behavioral, language, and sometimes motor abnormalities, reflecting degeneration of the anterior insular, frontal, and temporal regions, basal ganglia, and motor neurons.

Cognitive testing typically reveals spared memory but impaired planning, judgment, or language°.

Poor business decisions and difficulty organizing work tasks are common, and speech and language deficits often emerge.

Patients with FTD often show an absence of insight into their condition.

Common behavioral features include apathy, disinhibition, weight gain, food fetishes, compulsions, and emotional distance or loss of empathy.

Diagnosis:

Distinguishing anatomic hallmark of FTD: Focal atrophy of frontal, insular, and/or temporal cortex, which can be visualized with neuroimaging studies (MRI)° 

Microscopic findings seen across all patients with FTD include gliosis, microvacuolation, and neuronal loss°

 


Q. 17

Incorrect about dementia pugilistica 

 A

Seen in boxers

 B

Difficulty in gait

 C

Decreased cognition

 D

Nystagmus

Q. 17

Incorrect about dementia pugilistica 

 A

Seen in boxers

 B

Difficulty in gait

 C

Decreased cognition

 D

Nystagmus

Ans. D

Explanation:

Answer- D. Nystagmus

Dementia Pugilistica (DP), otherwise known as’punch-drunk syndrome’or’boxer’s dementia,” is a form of dementia that originates with repeated concussions or other traumatic blows to the head.

Symptoms of Dementia Pugilistica

  • Progressively declining cognitive ability
  • Physical tremors
  • Difficulty in speech
  • Pathological feelings of jealousy or paranoia
  • Short-term memory loss
  • Loss of physical coordination
  • Changes in gait

Q. 18

Which of the following dementia is associated with visual hallucinations?

 A

Lewy body dementia

 B

AIDS related Dementia

 C

Huntington’s disease

 D

Mixed dementia

Q. 18

Which of the following dementia is associated with visual hallucinations?

 A

Lewy body dementia

 B

AIDS related Dementia

 C

Huntington’s disease

 D

Mixed dementia

Ans. A

Explanation:

Ans. A.  Lewy body dementia –

  • Lewy body dementia, also known as dementia withLewy bodies, is the second most common type of progressive dementia after Alzheimer’s disease dementia.
  • Protein deposits, called Lewy bodies, develop in nerve cells in the brain regions involved in thinking, memory and movement (motor control).

Quiz In Between



Dementia

DEMENTIA


DEMENTIA

Introduction:

  • Defined as a progressive impairment of cognitive functions in absence of any disturbances of consciousness.

Prevalence:

  • Increases with age.
  • 5% in population older than 65 years; 20-40% in older than 85 years. 

Symptoms:

1. Cognitive impairment:

  • Characterized by 4 A’s: amnesia, aphasia, apraxia & agnosia.

Amnesia: 

  • Memory impairment.
  • Can be episodic (memory for events) & semantic (memory for facts rules, words and language) & visuospatial deficits.

Aphasia: 

  • Disturbances of language function.

Apraxia: 

  • Inability to perform learned motor functions.
  • Eg: Difficulties in functions like buttoning the shirt or combing the hair.

Agnosia:

  • Inability to interpret sensory stimulus.
  • Most common disturbance -‘prosopagnosia” – Inability identifing face.

Other cognitive impairments:

  • Disturbances in executive functioning (i.e. planning, organizing, sequencing & abstracting).

2. Behavioral & psychological symptoms:

  • Personality changes, hallucinations & delusions, depression, manic & anxiety symptoms, apathy, agitation, aggression, wandering circadian rhythm disturbances, catastrophic reaction.
    • Catastrophic reaction – Subjective awareness of intellectual deficits in stressful situation result in emotional outburst in dementia patient.

3. Focal neurological signs & symptoms:

  • Seen in vascular dementia (multi-infarct dementia) corresponding to site of vascular insults.

Types:

1. Depending on reversibility – Reversible dementia (15% patients) & Irreversible dementia.

Causes of reversible dementia:

  • Neurosurgical conditions (subdural hematoma, normal pressure hydrocephalus, intracranial tumors, intracranial abscess).
  • Infectious causes (meningitis, encephalitis, neurosyphilis, lyme disease).
  • Metabolic causes (vitamin B12 or folate deficiency, niacin deficiency, hypo and hyperthyroidism, hypo & hyperparathyroidism).
  • Others (drugs and toxins, alcohol abuse, autoimmune encephalitis).

2. Depending on involvement of area of brain:

  • Cortical & Sub-cortical (As to area affetced by dementing process first).

Cortical dementias: 

Clinical features: 

  • Characterized by early involvement of cortical structures & hence, early appearance of cortical dysfunction.
  • Amnesia, apraxia, aphasia, agnosia & acalculia (impaired mathematical skills) indicating cortical involvement.

Subcortical dementia: 

Clinical features

  • Early involvement of subcortical structures (basal ganglia, brain stem nuclei & cerebellum).
  • Characterized by early presentation of motor symptoms (abnormal movements like tics, chorea, dysarthria).
  • Significant disturbances of executive functioning.
  • Prominent behavioral & psychological symptoms (apathy, depression, bradyphrenia (slowness of thinking).

Conditions associated: 

  • Parkinson’s disease, Wilson’s disease, Huntington’s disease, multiple sclerosis, progressive supranuclear palsy, normal pressure hydrocephalus.

Other types of dementia:

  • Vascular dementia (multi-infarct dementia), lewy body disease (dementia with lewy body), HIV related Dementia, frontotemporol dementia (FTD) & pseudodementia

1. Vascular dementia (multi-infarct dementia):

  • 2nd most common type of dementia.
  • History of stroke.

Causes:

  • Occurrence of multiple cerebral infarction (due to occlusion of cerebral vessels by arteriosclerotic plaques or thromboemboli) → progressive deterioration of brain functions →  dementia.
  • Acute exacerbations corresponding to new infarcts → Stepwise deterioration of symptoms (step-ladder pattern).

Treatment: 

  • Management of risk factors & cholinesterase inhibitors.

2. Binswanger’s disease:

  • Also referred as “subcortical arteriosclerotic encephalopathy”.
  • Characterized by multiple small white matter infarctions —> Result in subcortical dementia symptoms.

3. Lewy Body Disease (Dementia with Lewy Body):

  • Clinical features similar to Alzheimer’s disease.

Pick’s dlsease: 

  • One pathological variant of FTD. 
  • Characterized by presence of pick’s bodies.
  • Earlier onset (45-65 years).
  • Presents with behavioral symptoms & change in personality with relative memory preservation.

7. Pseudodementia:

  • Depression in elderly patients mimicing dementia symptoms.

Management for dementia:

  • mini mental status examination (MMSE):
    • Screening test.
    • Evaluation of cognitive functions.
    • Score of less than 24 (out of a maximum 30) – Suggestive of dementia.

Medications:

  • Cholinesterase inhibitors  – Donepezil, rivastigmine, galantamine & tacrine.
  • NMDA receptor antagonist – Memantine.
  • Symptomatic treatment – For behavioral & psychological symptoms of dementia.
    • Includes antidepressants, antipsychotics & benzodiazepines.

Exam Important

  • Cognitive impairment in dementia is characterized by 4 A’s: amnesia, aphasia, apraxia & agnosia.
  • Catastrophic reaction is subjective awareness of intellectual deficits in stressful situation result in emotional outburst in dementia patient.
  • Reverslble causes of dementia includes subdural hematoma, normal pressure hydrocephalus, intracranial tumors, intracranial abscess.
  • Alzheimer’s disease is the prototype of cortical dementia.
  • Binswanger’s disease is also known as subcortical arteriosclerotic encephalopathy.
  • Pick’s dlsease is one pathological variant of FTD characterized by earlier onset & presence of pick’s bodies.
  • Depression in elderly patients may mimic symptoms of dementia and hence is known as pseudodementia.
  • The evaluation of cognitive tunctions in dementia is done using screening test of mini mental status examination (MMSE).
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