, Question 1
A patient with moderate Alzheimer's disease exhibits frequent episodes of
agitation and aggression. Which of the following best reflects the
recommended first-line pharmacological approach according to current APA
guidelines?
A. Scheduled haloperidol
B. PRN lorazepam
C. SSRI antidepressant
D. Cholinesterase inhibitor
Correct Answer: C - SSRI antidepressant
RATIONALE
APA guidelines recommend SSRIs as first-line for
agitation/aggression in Alzheimer's disease due to a better safety
profile compared to antipsychotics. Haloperidol and lorazepam carry
higher risks of extrapyramidal symptoms and paradoxical
disinhibition, respectively. Cholinesterase inhibitors are for cognitive
symptoms, not primarily for agitation.
Question 2
Which neuropathological finding is most characteristic of Lewy body dementia
(DLB) and distinguishes it from Alzheimer's disease?
A. Amyloid-beta plaques
B. Tau neurofibrillary tangles
C. Alpha-synuclein inclusions
D. TDP-43 proteinopathy
Correct Answer: C - Alpha-synuclein inclusions
Page 2
, RATIONALE
Lewy body dementia is defined by alpha-synuclein inclusions (Lewy
bodies) in the cortex and brainstem. Amyloid plaques and tau tangles
are hallmarks of Alzheimer's disease. TDP-43 is associated with
frontotemporal lobar degeneration and ALS.
Question 3
A patient with vascular neurocognitive disorder presents with stepwise
deterioration and focal neurological signs. Which intervention is most critical
to prevent further decline?
A. Administering memantine
B. Aggressive control of vascular risk factors
C. Prescribing an antipsychotic
D. Starting occupational therapy
Correct Answer: B - Aggressive control of vascular risk factors
RATIONALE
In vascular NCD, the primary strategy to slow progression is
managing vascular risk factors (hypertension, diabetes,
hyperlipidemia, smoking). Memantine has limited evidence in
vascular NCD. Antipsychotics are not disease-modifying and carry
risks. OT is supportive but not preventative.
Question 4
Which assessment tool is specifically designed to differentiate delirium from
dementia and is widely used in acute care settings?
A. MMSE
B. MoCA
C. CAM
D. GDS
Correct Answer: C - CAM
Page 3
, RATIONALE
The Confusion Assessment Method (CAM) is a validated tool for
delirium screening, with high sensitivity and specificity. MMSE and
MoCA assess global cognition but do not differentiate delirium. GDS
screens for depression.
Question 5
A patient with advanced dementia develops delirium. Which medication is
most likely to have precipitated this condition?
A. Donepezil
B. Oxybutynin
C. Memantine
D. Sertraline
Correct Answer: B - Oxybutynin
RATIONALE
Oxybutynin is a strong anticholinergic that can cross the blood-brain
barrier and commonly precipitates delirium in older adults. Donepezil
and memantine are cognitive enhancers. Sertraline has low
anticholinergic activity.
Question 6
Which statement best describes the mechanism of action of memantine in
Alzheimer's disease?
A. Inhibits acetylcholinesterase
B. Modulates glutamate via NMDA receptor antagonism
C. Blocks dopamine D2 receptors
D. Enhances GABAergic transmission
Correct Answer: B - Modulates glutamate via NMDA receptor
antagonism
Page 4
A patient with moderate Alzheimer's disease exhibits frequent episodes of
agitation and aggression. Which of the following best reflects the
recommended first-line pharmacological approach according to current APA
guidelines?
A. Scheduled haloperidol
B. PRN lorazepam
C. SSRI antidepressant
D. Cholinesterase inhibitor
Correct Answer: C - SSRI antidepressant
RATIONALE
APA guidelines recommend SSRIs as first-line for
agitation/aggression in Alzheimer's disease due to a better safety
profile compared to antipsychotics. Haloperidol and lorazepam carry
higher risks of extrapyramidal symptoms and paradoxical
disinhibition, respectively. Cholinesterase inhibitors are for cognitive
symptoms, not primarily for agitation.
Question 2
Which neuropathological finding is most characteristic of Lewy body dementia
(DLB) and distinguishes it from Alzheimer's disease?
A. Amyloid-beta plaques
B. Tau neurofibrillary tangles
C. Alpha-synuclein inclusions
D. TDP-43 proteinopathy
Correct Answer: C - Alpha-synuclein inclusions
Page 2
, RATIONALE
Lewy body dementia is defined by alpha-synuclein inclusions (Lewy
bodies) in the cortex and brainstem. Amyloid plaques and tau tangles
are hallmarks of Alzheimer's disease. TDP-43 is associated with
frontotemporal lobar degeneration and ALS.
Question 3
A patient with vascular neurocognitive disorder presents with stepwise
deterioration and focal neurological signs. Which intervention is most critical
to prevent further decline?
A. Administering memantine
B. Aggressive control of vascular risk factors
C. Prescribing an antipsychotic
D. Starting occupational therapy
Correct Answer: B - Aggressive control of vascular risk factors
RATIONALE
In vascular NCD, the primary strategy to slow progression is
managing vascular risk factors (hypertension, diabetes,
hyperlipidemia, smoking). Memantine has limited evidence in
vascular NCD. Antipsychotics are not disease-modifying and carry
risks. OT is supportive but not preventative.
Question 4
Which assessment tool is specifically designed to differentiate delirium from
dementia and is widely used in acute care settings?
A. MMSE
B. MoCA
C. CAM
D. GDS
Correct Answer: C - CAM
Page 3
, RATIONALE
The Confusion Assessment Method (CAM) is a validated tool for
delirium screening, with high sensitivity and specificity. MMSE and
MoCA assess global cognition but do not differentiate delirium. GDS
screens for depression.
Question 5
A patient with advanced dementia develops delirium. Which medication is
most likely to have precipitated this condition?
A. Donepezil
B. Oxybutynin
C. Memantine
D. Sertraline
Correct Answer: B - Oxybutynin
RATIONALE
Oxybutynin is a strong anticholinergic that can cross the blood-brain
barrier and commonly precipitates delirium in older adults. Donepezil
and memantine are cognitive enhancers. Sertraline has low
anticholinergic activity.
Question 6
Which statement best describes the mechanism of action of memantine in
Alzheimer's disease?
A. Inhibits acetylcholinesterase
B. Modulates glutamate via NMDA receptor antagonism
C. Blocks dopamine D2 receptors
D. Enhances GABAergic transmission
Correct Answer: B - Modulates glutamate via NMDA receptor
antagonism
Page 4
