87 Questions
Which of the following is a symptom of Alzheimer's Disease?
Forget whole experiences
What is the number one risk factor for Alzheimer's Disease?
Age
Which protein is responsible for plaque formation in Alzheimer's Disease?
Beta amyloid
What is the impact of plaque formation on the brain in Alzheimer's Disease?
Formation of neurotoxic plaque
What is the impact of Alzheimer's Disease on acetylcholine and nerve conduction in the brain?
No neurotransmitter production
Where do tangles develop in Alzheimer's Disease?
Cytoplasm of neurons
What is the impact of tangles on the cells of the brain in Alzheimer's Disease?
Neuron cell death
Where does Alzheimer's Disease typically start and how does it progress in the brain?
Hippocampus - memory impairment
What is the definitive diagnostic test for Alzheimer's Disease?
Autopsy
What is the mechanism of action of cholinesterase inhibitors in the treatment of Alzheimer's Disease?
Increase acetylcholine neurotransmitter
What is the genetic basis for Huntington's Disease?
Chromosome 4
Which of the following is an early symptom of vascular cognitive impairment (VCI)?
Memory loss
Which region of the brain does Huntington's Disease primarily affect?
Motor control regions
What is the role of MRI in the diagnosis of VCI?
To detect lacunar infarctions
What is the main consequence of foam cell rupture in atherosclerosis?
Narrowing of the artery
What is the characteristic age of onset for Huntington's Disease?
Between 30 and 50 years
What is the main effect of Huntington's Disease on physical abilities?
Stumbling and clumsiness
What is the underlying cause of neurodegeneration in Huntington's Disease?
Breakdown of nerve cells
What is the consequence of ischemic brain tissue progressing to necrosis?
Dementia
What is the primary cause of altered perfusion in atherosclerosis?
Plaque formation
Which of the following best defines dementia?
Impairment of memory, abstract thinking, judgment, and personality
Which of the following is an etiology for dementia/chronic confusion?
Alzheimer's Disease
What is the main difference between dementia and confusion?
Dementia is irreversible and confusion is reversible
What is the etiology of Lewy Body Dementia?
Build-up of Lewy bodies in brain tissues
Which of the following is NOT an etiology for dementia/chronic confusion?
Anemia
What percentage of cases of dementia/chronic confusion are attributed to Alzheimer's Disease?
60%
Which of the following is a characteristic of dementia?
Changes in personality and significant interference in work or social activities
What is the work-up for acute confusion primarily aimed at identifying?
Underlying medical conditions or factors contributing to confusion
Which of the following is NOT a factor that can contribute to acute confusion?
Intracranial pathos
What is the main difference between dementia and confusion in terms of reversibility?
Dementia is irreversible and confusion is reversible
A person experiences an altered level of consciousness, disoriented to time, person, or place; disturbed mental status. Differentiate ______ from confusion.
dementia
______ is the impairment of memory, abstract thinking, judgment, and personality, and other higher cognitive functions, resulting in changes in personality and significant interference in work or social activities.
Dementia
Dementia is more permanent and irreversible, all have ______. Confusion is more reversible and helps correct the situation that has resulted in confusion since not all cases of confusion have dementia.
confusion
Hypothyroidism: Side effect drugs Heart Failure: Myocardial infarction: Depression: Dehydration & electrolyte imbalance Alcohol abuse Infections in the elderly: Anemia: Renal failure: ______: Liver disease: Malnutrition Intracranial pathos Describe etiologies for dementia/chronic confusion.
Liver disease
Lewy Body Dementia (LBD) is a progressive brain disorder. The neuron has trouble processing alpha-synuclein protein fragments. Lewy bodies build up in the Brain tissues. There is a ↓ in the neurotransmitter Acetylcholine. Bottom Line: problems in areas of the brain that regulate behavior, cognition, and ______.
movement
______ Alzheimer’s Disease
60%
AD means neuron cell ______.
death
Less acetylcholine is available at the ______.
synapse
Give a drug to block ______.
cholinesterase
More acetylcholine at neuron ______.
synapse
Strength of impulse transmission is ______.
improved
Increase ability to send messages to various parts of the ______.
brain
May slow the cognitive decline of the ______.
disease
Decrease ______- Increased release-neurotoxic.
glutamate
Vascular cognitive impairment (VCI) - is a decline in thinking skills caused by a condition that ______ or reduce arterial blood flow to the brain.
blocks
Vascular cognitive impairment (VCI) is characterized by difficulty concentrating, memory lapses, depression, stumbling and clumsiness, and mood swings. These ______ are a result of altered perfusion in the brain.
signs and symptoms
______ is an inherited disorder that causes nerve cells in parts of the brain to gradually break down and die. It primarily attacks motor control regions of the brain.
Huntington's Disease
The genetic basis for Huntington's Disease is located on ______ and follows an autosomal dominant inheritance pattern.
chromosome 4
In Alzheimer's Disease, ______ impacts the brain by disrupting normal neuronal function and leading to cognitive decline.
plaque formation
______ is an early symptom of vascular cognitive impairment (VCI).
Memory loss
The main consequence of foam cell rupture in atherosclerosis is the ______ of the vessel (artery), leading to decreased blood flow and ischemic tissues.
narrowing
MRI plays a role in the diagnosis of VCI by providing ______ of the brain, allowing for the detection of multiple small cerebral infarctions and lacunar infarctions.
detailed images
The characteristic age of onset for Huntington's Disease is often between the ages of ______.
30 and 50
______ is a progressive decline in cognitive function, characterized by memory loss, confusion, and impairment in daily activities.
Dementia
______ plays a significant role in the development of Alzheimer's Disease, with chromosome 19 and 21 being implicated in early-onset and late-onset cases, respectively.
Genetics
The etiology of Lewy Body Dementia is the ______ of abnormal protein deposits called Lewy bodies in the brain.
accumulation
Where does Alzheimer's Disease typically start and how does it progress in the brain?
Starts: Hippocampus - (Memory) Impairment is an early symptoms. Up over and around the brain. Goes to the frontal lobe - problem solving, judgment. Limbic systemic - emotions - angry.
______ is a characteristic of vascular cognitive impairment (VCI).
Memory loss
______ is the genetic basis for Huntington's Disease.
Chromosome 4
______ is an early symptom of Huntington's Disease.
Memory lapses
______ affects the basal ganglia and mental capabilities in Huntington's Disease.
Deterioration of physical ability
______ is an inherited disorder that causes nerve cells in parts of the brain to gradually break down and die.
Huntington's Disease
______ is the main consequence of foam cell rupture in atherosclerosis.
Narrowing of the vessel (artery)
______ is a decline in thinking skills caused by a condition that reduces arterial blood flow to the brain.
Vascular cognitive impairment (VCI)
______ is the impairment of memory, abstract thinking, judgment, and personality, and other higher cognitive functions, resulting in changes in personality and significant interference in work or social activities.
Dementia
A person experiences an altered level of consciousness, disoriented to time, person, or place; disturbed mental status. Differentiate ______ from confusion.
dementia
______ Alzheimer’s Disease
60%
______ Vascular (Atherosclerosis)
5%
______ plays a significant role in the development of Alzheimer's Disease, with chromosome 19 and 21 being implicated in early-onset and late-onset cases, respectively.
genetics
Lewy Body Dementia (LBD) is a progressive brain disorder. The neuron has trouble processing alpha-synuclein protein fragments. Lewy bodies build up in the Brain tissues. There is a ↓ in the neurotransmitter Acetylcholine. Bottom Line: problems in areas of the brain that regulate behavior, cognition, and ______.
movement
______ is an inherited disorder that causes nerve cells in parts of the brain to gradually break down and die. It primarily attacks motor control regions of the brain.
Huntington's Disease
______ is the etiology of Lewy Body Dementia.
formation
What are the etiologies for dementia/chronic confusion?
60% Alzheimer's Disease, 15% Lewy Body Dementia, 10% Mixed, 10% Other, 5% Vascular (Atherosclerosis)
Describe the etiology for Lewy Body Dementia.
Lewy Body Dementia (LBD) is a progressive brain disorder. The neuron has trouble processing alpha-synuclein protein fragments. Lewy bodies build up in the brain tissues. There is a decrease in the neurotransmitter Acetylcholine. Bottom Line: problems in areas of the brain that regulate behavior, cognition, and movement.
Differentiate dementia from confusion.
Dementia is more permanent and irreversible, all have confusion. Confusion is more reversible and helps correct the situation that has resulted in confusion since not all cases of confusion have dementia.
What is the workup for acute confusion?
Hypothyroidism, Side effect drugs, Heart Failure, Myocardial infarction, Depression, Dehydration & electrolyte imbalance, Alcohol abuse, Infections in the elderly, Anemia, Renal failure, Liver disease, Malnutrition, Intracranial pathos
Define confusion.
A person experiences an altered level of consciousness, disoriented to time, person, or place; disturbed mental status.
What is the early symptom of vascular cognitive impairment?
Memory loss
Explain the role of MRI in the diagnosis of VCI.
MRI plays a role in the diagnosis of VCI by providing imaging of the brain, allowing for the detection of multiple small cerebral infarctions and lacunar infarctions.
What is the genetic basis for Huntington's Disease?
Huntington's Disease is caused by a genetic mutation on chromosome 4. It is inherited in an autosomal dominant manner.
Explain the rationale for the signs and symptoms of Huntington's Disease.
The signs and symptoms of Huntington's Disease, such as difficulty concentrating, memory lapses, depression, stumbling and clumsiness, and mood swings, are due to the breakdown of nerve cells in the brain and the deterioration of physical and mental capabilities, primarily affecting the basal ganglia.
What is the consequence of ischemic brain tissue progressing to necrosis?
The consequence of ischemic brain tissue progressing to necrosis is the death of brain tissue, leading to permanent damage and loss of function.
Describe the impact of plaque formation on the brain in Alzheimer's Disease.
Plaque formation in Alzheimer's Disease leads to the clumping of beta amyloid fragments, which form neurotoxic plaques. These plaques disrupt normal neuronal function, leading to cognitive decline.
Describe the impact of tangles on the cells of the brain in Alzheimer's Disease.
In Alzheimer's Disease, tangles form in the cytoplasm of brain neurons. These tangles are made up of abnormal tau proteins, which are unable to hold microtubules together. As a result, the microtubules are destroyed and the neurons eventually undergo cell death.
Describe the impact of Alzheimer's Disease on acetylcholine and nerve conduction in the brain.
In Alzheimer's Disease, the terminal axons do not produce enough acetylcholine, a neurotransmitter. This leads to a lack of communication between cells, as they are unable to 'talk' to each other. The overall impact is a disruption of normal brain function.
Describe the altered anatomy of the brain in Alzheimer's Disease, including where it starts and how it progresses.
In Alzheimer's Disease, the pathology starts in the hippocampus, which is responsible for memory. From there, it spreads throughout the brain, affecting regions such as the frontal lobe (problem solving, judgment) and the limbic system (emotions). The progression of the disease leads to cerebral atrophy.
Describe the underlying vascular problem in Vascular Cognitive Impairment (VCI).
Vascular Cognitive Impairment (VCI) is caused by a condition that blocks or reduces arterial blood flow to the brain, leading to a decline in thinking skills. The underlying vascular problem is progressive narrowing of the arteries, often due to atherosclerosis.
Study Notes
Dementia and Brain Confusion
- Dementia is the impairment of memory, abstract thinking, judgment, and personality, and other higher cognitive functions, resulting in changes in personality and significant interference in work or social activities.
- Confusion is an altered level of consciousness, disorientated to time, person, or place; disturbed mental status.
- Dementia is more permanent and irreversible, while confusion is more reversible and helps correct the situation that has resulted in confusion.
- Acute confusion workup: Hypothyroidism, side effect drugs, Heart Failure, Myocardial infarction, Depression, Dehydration & electrolyte imbalance, Alcohol abuse, Infections in the elderly, Anemia, Renal failure, Liver disease, Malnutrition, and Intracranial pathologies.
Etiologies for Dementia/Chronic Confusion
- 60% Alzheimer's Disease
- 15% Lewy Body Dementia
- 10% Mixed
- 10% Other
- 5% Vascular (Atherosclerosis)
Lewy Body Dementia
- Lewy Body Dementia (LBD) is a progressive brain disorder.
- The neuron has trouble processing alpha-synuclein protein fragments.
- Lewy bodies build up in brain tissues.
- There is a decrease in the neurotransmitter Acetylcholine.
- Result of misfolded proteins that collect in cytoplasm of neurons, destroy neurons, and affect communication, dementia, and behavior.
Alzheimer's Disease
- Compare memory issues of normal aging with Alzheimer's Disease:
- Forget whole experiences
- Rarely remember things later
- Gradually unstable to follow written or spoken directions and make choices
- Often get lost in familiar places
- Number one risk factor: Age
- Genetic defect: Chromosome 19
- Plaque formation: Amyloid precursor protein on brain, cut in abnormal location, activates beta amyloid, and increases plaque.
- Impact of plaque formation on brain: Beta amyloids clump together and form neurotoxic plaque.
- Development of tangles: Tau should hold the microtubules together, but something stops that from happening, and they cells get tangled.
- Impact of tangles on brain cells: Tau is abnormal, can't hold cells together, microtubules destroyed, tangles, neuron cell death.
- Impact of AD on acetylcholine and nerve conduction: Terminal axons do not produce acetylcholine, no neurotransmitter, cells can't "talk" to each other, impact on normal brain function.
- Altered anatomy: Starts in Hippocampus, impairment is an early symptom, up over and around the brain, goes to frontal lobe, problem solving, judgment, and limbic system, emotions, anger.
- Diagnosis: Excludes all other etiologies or reasons for confusion or forgetfulness, general physician exam, Mini Mental State Examination, MRI or CT Scan shows cerebral atrophy and enlarged ventricles.
- Definitive diagnostic test: Autopsy (rarely done)
- Pharmacologic treatment: Cholinesterase inhibitors increase acetylcholine neurotransmitter, improve memory, Donepezil.
Vascular Cognitive Impairment (VCI)
- VCI is a decline in thinking skills caused by a condition that blocks or reduces arterial blood flow to the brain, depriving brain cells of O2 and other nutrients.
- Underlying vascular problem: Atherosclerosis, progressive narrowing, sluggish blood clots, vessel injury, tear, neutrophils, monocytes, macrophage, LDL, foam cell, growth factors, intimal thickening, plaque, and ischemic tissues.
- Early symptom: Memory loss
- Role of MRI in diagnosis: Dementia R/T multiple small cerebral infarctions, MRI Lacunar infarction, subcortical (below cerebral infarction).
Huntington's Disease
- Huntington's Disease is an inherited disorder that causes nerve cells in parts of the brain to gradually break down and die.
- Genetic basis: Chromosome 4, autosomal dominant, fetal, breakdown of nerve cells, brain deterioration of physical ability, basal ganglia, and mental capabilities.
- Onset: Often between the ages of 30 and 50.
- Rationale for signs and symptoms: Difficulty concentrating, memory lapses, depression, stumbling, clumsiness, and mood swings.
Test your knowledge on dementia and confusion with this quiz! Learn about the symptoms and effects of these cognitive impairments, and challenge yourself with three brain-teasing questions.
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