NR 507 Advanced Pathophysiology Week 7
Exam: Neurodegenerative Disorders
(Alzheimer's Disease, Dementia, and
Parkinson's Disease) 100 Questions with
Answers and Rationales Latest 2026/27
SECTION A: Alzheimer's Disease (Questions 1-30)
1. The pathological hallmark of Alzheimer's disease includes:
A) Lewy bodies in the substantia nigra
B) Beta-amyloid plaques and neurofibrillary tangles
C) Demyelination of the central nervous system
D) Neuronal loss in the basal ganglia
Correct Answer: B) Beta-amyloid plaques and neurofibrillary
tangles
Expert Rationale: Alzheimer's disease is characterized by two main
pathological features: extracellular beta-amyloid plaques
(composed of amyloid-beta protein) and intracellular
neurofibrillary tangles (composed of hyperphosphorylated tau
protein). These protein aggregates lead to neuronal dysfunction
and cell death .
2. The primary genetic risk factor for late-onset Alzheimer's
disease is:
A) APOE2 allele
B) APOE3 allele
C) APOE4 allele
D) Presenilin-1 gene mutation
,Correct Answer: C) APOE4 allele
Expert Rationale: The APOE4 allele is the strongest genetic risk
factor for late-onset Alzheimer's disease. It is associated with
increased amyloid-beta deposition and reduced clearance. APOE2 is
protective, and APOE3 is neutral. Presenilin mutations are
associated with early-onset familial Alzheimer's .
3. Which neurotransmitter system is most affected in
Alzheimer's disease?
A) Dopaminergic system
B) Serotonergic system
C) Cholinergic system
D) GABAergic system
Correct Answer: C) Cholinergic system
Expert Rationale: The cholinergic system is most affected in
Alzheimer's disease. There is significant loss of cholinergic neurons
in the basal forebrain, leading to decreased acetylcholine levels in
the cerebral cortex and hippocampus. This underlies many of the
cognitive deficits, particularly memory impairment .
4. Alzheimer's disease typically presents with:
A) Memory impairment and visuospatial deficits
B) Early gait disturbance and falls
C) Hallucinations and delusions
D) Motor weakness and sensory loss
Correct Answer: A) Memory impairment and visuospatial
deficits
Expert Rationale: Alzheimer's disease typically presents with
progressive memory impairment (especially recent memory),
,difficulty with executive function, and visuospatial deficits. Early
gait disturbance is more typical of vascular dementia, and
hallucinations are more common in Lewy body dementia .
5. A patient with Alzheimer's disease is prescribed donepezil.
The mechanism of action of this medication is:
A) NMDA receptor antagonist
B) Acetylcholinesterase inhibitor
C) Dopamine agonist
D) Serotonin reuptake inhibitor
Correct Answer: B) Acetylcholinesterase inhibitor
Expert Rationale: Donepezil is an acetylcholinesterase inhibitor
that increases acetylcholine levels by inhibiting its breakdown. This
helps compensate for the cholinergic deficit in Alzheimer's disease.
It is approved for mild to moderate Alzheimer's disease .
6. Which medication is used for moderate to severe
Alzheimer's disease and acts as an NMDA receptor
antagonist?
A) Donepezil
B) Rivastigmine
C) Memantine
D) Galantamine
Correct Answer: C) Memantine
Expert Rationale: Memantine is an NMDA receptor antagonist that
blocks glutamate-mediated excitotoxicity. It is approved for
moderate to severe Alzheimer's disease, often in combination with
an acetylcholinesterase inhibitor. It helps with cognitive function
and activities of daily living .
, 7. The progression of Alzheimer's disease is associated with:
A) Stepwise deterioration
B) Insidious onset with gradual decline
C) Rapid progression over weeks
D) Recurrent episodes of confusion
Correct Answer: B) Insidious onset with gradual decline
Expert Rationale: Alzheimer's disease has an insidious onset with a
slow, progressive decline over years. The average survival after
diagnosis is 8-10 years. The progression is gradual and continuous,
unlike vascular dementia which has a stepwise pattern .
8. Which imaging finding is characteristic of Alzheimer's
disease?
A) Lacunar infarcts
B) Cerebral atrophy with prominent hippocampal involvement
C) White matter hyperintensities
D) Hydrocephalus
Correct Answer: B) Cerebral atrophy with prominent
hippocampal involvement
Expert Rationale: Alzheimer's disease is characterized by cortical
atrophy, especially in the medial temporal lobe (hippocampus). MRI
may show hippocampal atrophy and enlarged ventricles. White
matter hyperintensities are more characteristic of vascular
dementia .
9. A 65-year-old patient presents with progressive memory
loss, difficulty with executive function, and personality
changes. The most likely diagnosis is:
Exam: Neurodegenerative Disorders
(Alzheimer's Disease, Dementia, and
Parkinson's Disease) 100 Questions with
Answers and Rationales Latest 2026/27
SECTION A: Alzheimer's Disease (Questions 1-30)
1. The pathological hallmark of Alzheimer's disease includes:
A) Lewy bodies in the substantia nigra
B) Beta-amyloid plaques and neurofibrillary tangles
C) Demyelination of the central nervous system
D) Neuronal loss in the basal ganglia
Correct Answer: B) Beta-amyloid plaques and neurofibrillary
tangles
Expert Rationale: Alzheimer's disease is characterized by two main
pathological features: extracellular beta-amyloid plaques
(composed of amyloid-beta protein) and intracellular
neurofibrillary tangles (composed of hyperphosphorylated tau
protein). These protein aggregates lead to neuronal dysfunction
and cell death .
2. The primary genetic risk factor for late-onset Alzheimer's
disease is:
A) APOE2 allele
B) APOE3 allele
C) APOE4 allele
D) Presenilin-1 gene mutation
,Correct Answer: C) APOE4 allele
Expert Rationale: The APOE4 allele is the strongest genetic risk
factor for late-onset Alzheimer's disease. It is associated with
increased amyloid-beta deposition and reduced clearance. APOE2 is
protective, and APOE3 is neutral. Presenilin mutations are
associated with early-onset familial Alzheimer's .
3. Which neurotransmitter system is most affected in
Alzheimer's disease?
A) Dopaminergic system
B) Serotonergic system
C) Cholinergic system
D) GABAergic system
Correct Answer: C) Cholinergic system
Expert Rationale: The cholinergic system is most affected in
Alzheimer's disease. There is significant loss of cholinergic neurons
in the basal forebrain, leading to decreased acetylcholine levels in
the cerebral cortex and hippocampus. This underlies many of the
cognitive deficits, particularly memory impairment .
4. Alzheimer's disease typically presents with:
A) Memory impairment and visuospatial deficits
B) Early gait disturbance and falls
C) Hallucinations and delusions
D) Motor weakness and sensory loss
Correct Answer: A) Memory impairment and visuospatial
deficits
Expert Rationale: Alzheimer's disease typically presents with
progressive memory impairment (especially recent memory),
,difficulty with executive function, and visuospatial deficits. Early
gait disturbance is more typical of vascular dementia, and
hallucinations are more common in Lewy body dementia .
5. A patient with Alzheimer's disease is prescribed donepezil.
The mechanism of action of this medication is:
A) NMDA receptor antagonist
B) Acetylcholinesterase inhibitor
C) Dopamine agonist
D) Serotonin reuptake inhibitor
Correct Answer: B) Acetylcholinesterase inhibitor
Expert Rationale: Donepezil is an acetylcholinesterase inhibitor
that increases acetylcholine levels by inhibiting its breakdown. This
helps compensate for the cholinergic deficit in Alzheimer's disease.
It is approved for mild to moderate Alzheimer's disease .
6. Which medication is used for moderate to severe
Alzheimer's disease and acts as an NMDA receptor
antagonist?
A) Donepezil
B) Rivastigmine
C) Memantine
D) Galantamine
Correct Answer: C) Memantine
Expert Rationale: Memantine is an NMDA receptor antagonist that
blocks glutamate-mediated excitotoxicity. It is approved for
moderate to severe Alzheimer's disease, often in combination with
an acetylcholinesterase inhibitor. It helps with cognitive function
and activities of daily living .
, 7. The progression of Alzheimer's disease is associated with:
A) Stepwise deterioration
B) Insidious onset with gradual decline
C) Rapid progression over weeks
D) Recurrent episodes of confusion
Correct Answer: B) Insidious onset with gradual decline
Expert Rationale: Alzheimer's disease has an insidious onset with a
slow, progressive decline over years. The average survival after
diagnosis is 8-10 years. The progression is gradual and continuous,
unlike vascular dementia which has a stepwise pattern .
8. Which imaging finding is characteristic of Alzheimer's
disease?
A) Lacunar infarcts
B) Cerebral atrophy with prominent hippocampal involvement
C) White matter hyperintensities
D) Hydrocephalus
Correct Answer: B) Cerebral atrophy with prominent
hippocampal involvement
Expert Rationale: Alzheimer's disease is characterized by cortical
atrophy, especially in the medial temporal lobe (hippocampus). MRI
may show hippocampal atrophy and enlarged ventricles. White
matter hyperintensities are more characteristic of vascular
dementia .
9. A 65-year-old patient presents with progressive memory
loss, difficulty with executive function, and personality
changes. The most likely diagnosis is:
