DEMENTIA

IDENTIFICATION
______ 1. A 70 ylo woman present with an 8-month history of memory difficulties. She finds it difficult to balance her
checkbooks. She recently lost her job because she shouldnt stay organized. Over the last 7 years her movements have
slowed down a lot which she attributes to aging. She also mentions of worsening tremor over the last 6 years. On PE she
has oscillating tremor at rest that disappears with activity. Her muscles feel stiff. She walks in small shuffling steps. Her arm
do not swing as she walks. On passive flexion and extension, her wrist give way in a series of ratchet-like jerks. MMSE is 22.
What is the most likely diagnosis?
a. Dementia with Lewey Bodies b. Alzheimers Disease c. Parkinsons Disease d. Hypothyroidism
______ 2.The single strongest risk factor for dementia.
a. Increasing age b. family history c. female gender d. repeated head trauma
______ 3.The most common cause of dementia in Western countries, representing more than half of demented patients.
a. Dementia with Lewey bodies b. Vascular dementia c. Alzheimer Disease d. Parkinsons Disease
______ 4. Subtle cumulative decline in episodic memory, is a natural part of aging, that is not so progressive that it impairs
reasonably successful and productive daily fynctioning but is sadly often the source of jokes and humor.
a. Dementia b. Delirium c. Mild Cognitive Impairment d. benign forgetfulness of the elderly
______ 5. During a neurologic examination, asking the patient to describe similarities between a desk and chair, an apple and
an orange is a test of what element of the MSE
a. Level of Consciousness b. fund of information c. insight & judgment d. Abstract thinking
______ 6. Dementia that manifests with resting tremor, cogwheel rigidity, bradykinesia, festinating gait
a. Frontotemporal Dementia b. Cushings syndrome c. Parkinsonian syndrome d. Vit. B12 Deficiency
______ 7. Silver staining, twisted neurofilaments in neuronal cytoplasm that represent abnormally phosphorylated tau
protein and appear as paired helical filaments by electron microspciopy.
a. Langerhans cell b. Neurofibrillary tangles c. AB amyloid d. Chromaffin granules
______ 8. Biochemically, AD is associated with a decrease in the cerebral cortical levels of these neurotransmitters, its
synthetic enzyme, and their nicotinic cholinergic receptors.
a. Serotonin b. catecholamine c. GABA d. Acetylcholine
______ 9. Microtubule associated protein that may function to assemble and stabilize the microtubule that convey cell
organelles, glycoproteins, and other important material throughout the neurons, its ability to bind to microtubule segments is
determined partly by the number of phosphate groups attached to it:
a. Tau proteins b. Amyloid Precursor proteins c. AB peptide d. protein kinase
______ 10. The catabolic enzyme for acetylcholine
a. acetylcholinesterase b. acetilcholinetransferase c. cyclic adenylcyclase d. none
______ 11. Potent centrally acting inhibitor of AChE, attempts to augment the cholinergic function of the brain but side
effects are significant and dose-limiting; abdominal cramping, anorexia, nausea, vomiting, and diarrhea are observed in up to
one-third of patients receiving therapeutic doses, and elevations of serum transaminases are observed in up to 50% of those
treated.
a. galantamine b. donepezil c. nivastigmine d. tacrine
______12.The major area for language comprehension that lies behind the primary auditory cortex in the posterior part of
the superior gyrus of the temporal lobe.
a. angular gyrus b. Wernickes area c. Primary visual area d. Primary motor area
______13.A visual association area, lying mainly in the anterolateral region of the occipital lobe, that feeds visual information
conveyed by words read from a book into Wernickes area, needed to make meaning out of the visually perceived words and
in its absence, a person can still have excellent language comprehension through hearing but not through reading
a. Primary visual area b. Secondary visual area c. prefrontal association area d. angular gyrus area
______ 14. Area found in the temporal lobe, in the ventral portion of the frontal lobe, and in the cingulargyrus that provides
most of the emotional drives for activating other areas of the brain and even provides motivational drive for the process of
learning itself.
a. parieto-occipitotemporal association area b. prefrontal association area
c. limbic association area d. primaty motor area
______ 15. This involves the rate, flow, and melody of speech and the content and use of words; abnormalities include
hesitancies and gaps in the flow and rhythm of words; disturbed inflections, such as a monotone, circumlocutions,
paraphasia.
a. insight b. Fluency c. Affect d. Perception
______ 16.Awareness that symptoms or disturbed behaviors are normal or abnormal; for example, distinguishing between
daydreams and hallucinations that seem real.
a. insight b. perception c. thought content d. orientation
______ 17. During the testing for language impairment asking the patient to follow a one stage command, such as Point to
your ears, the examiner is testing
a. word comprehension b. reading comprehension c. repetition d. naming
______ 18.Assessed by vocabulary , fund of information, abstract thinking, calculations, construction of objects that have two
or three dimensions is used to detect primarily
a. memory impairment b. aphasia c. apraxia d. higher cognitive functions
______ 19. Level of consciousness in which the patients responds by opening their eyes and looking at the examiner slowly
and somewhat confused only after gentle shaking.
a. alert b. lethargic c. obtunded d. stupor e. coma
______ 20.A 60 y/o F was brought to your clinic by her son. She has become increasingly withdrawn. She does not remember
to keep her appointments. She left the stove on 3 times in the last weeks after cooking. This were all noted since her
husbands death 2 months ago. She has told her son a couple of times that she cant wait to be with her husband again.
MMSE is 21.
a. Alzheimer b. Mood disorder c. Parkinsons Disease d. Frontotemporal Dementia

Matching type
A. Alzheimers Disease
B. Frontotemporal Dementia
C. DLB
D. Depression
E. Vascular Dementia
F. CJD
G. Huntingtons Disease
H. None of the above
I. Delirium
______1.Acute or subacute onset of confusion, prominent deficits involve attention, working memory, and executive
function trigger the search for intoxication, infection, or metabolic derangement.
______ 2.Nearly 75% begin with memory symptoms, but other early symptoms include difficulty with managing money,
driving, shopping, following instructions, finding words, or navigating. Early deficits involve episodic memory, category
generation (name as many animals as you can in one minute), and visuoconstructive ability. During its early stages, mild
depressive features, social withdrawal, and irritability or anxiety are the most prominent psychiatric changes. PE is normal
except for possible derangement in MMSE.
______ 3.A personality change, disinhibition, and weight, and weight gain or compulsive eating are the initial manifestation
of this condition. PE reveals by prominent apathy, compulsivity, loss of speech fluency or word comprehension and by a
relative sparing of memory or visuospatial abilities, executive or language (speech or naming) function.
______ 4. The initial symptoms may include the new onset of constellation of resting tremor, cogwheel rigidity, bradykinesia,
festinating gait but often starts with visual hallucinations or dementia. PE reveals more severe deficits in visuospatial function
but do better on episodic memory tasks.
______ 5. This condition present with risk factors of hypertension, atrial fibrillation, peripheral vascular disease, and diabetes.
PE reveals hemiparesis o other focal neurologic deficits, and MSE shows executive and visuospatial deficits, with prominent
psychomotor showing.
______ 6. Cognitive impairments occurring after a recent death of a loved one associated with markedly diminished interest
or pleasure in most activities most of the day, significant unintentional weight, decrease in appetite, insomnia
______ 7.Neuro-imaging: hippocampal atrophy in addition to posterior-predominant cortical atrophy
______ 8.Neuro-imaging reveals focal frontal and/or anterior temporal atrophy may be noted.
______ 9.Neuro imaging demonstrates extensive white matter abnormalities.
______ 10.Neuro-imaging often features less prominent atrophy, with greater involvement of amygdala then hippocampus

Matching Type A
______ 1. Insidious in onset A. Alzheimers Disease
______ 2. Generalized cerebral atrophy on neuro-imaging B. Vascular Dementia
______ 3.Focal neurologic deficit present C. Both
______ 4. Gait disorder is frequent D. None
______ 5. Most common cause of dementia


Matching Type B
______ 1.Acetylcholinesterase inhibitors A. galantamine
______ 2. N-methyl-D-aspartic acid (NMDA) receptor antagonist B. donepezil
______ 3. Competitive inhibitors of AChE C. rivastigmine
______ 4.Acetylcholinesterase inhibitors known for its hepatotoxicity D. tacrine
______ 5. Lead untimely damage of neurons and lead to apoptosis E. Memantine
F. All of the above
G. None of the above
H. A,B,C,D
Matching Type C
A. Level of consciousness
B. Orientation
C. Speech and language
D. Memory
E. Fund of information
F. Insight
G. Judgment
H. Abstract thought
I. Calculations
J. Visuospatial ability
K. Attention
______ 1. Repeat these 3 words pen chair flag. Tell the patient to remember these words. Then after 5 minutes, have
the patient repeat the words.
______ 2. Repeat No, Ifs, Ands, or Buts
______ 3. What do you think about the voices you hear others beside you do not hear?
______ 4. Have the patient draw interlocking pentagons
______ 5. Naming items having the same attributes e.g. a list of four legged animals
______ 6. What would you do if you left your wallet inside a burning building?
______ 7. I write with a den. I color with a drayon
______ 9. What is your full name? Do you know where you are? What is the month, date, year, day of the week, and
time Do you know why you are here?
______ 10. Ask the patient to subtract 7 from 100, then to repeat the task from that response. This is known as serial 7s
Next, ask the patient to spell the word world forward and backward.