OCCTH 585 Test 2 Questions and
Answers
Dementia is an umbrella term that includes what 4 neurological diseases? - Correct
Answers -Alzheimer's disease
Vascular dementia
Frontotemporal dementia
Lewy Bodies
What are 4 characteristics of Alzheimer's disease (AD)? - Correct Answers -•Not a
process of accelerated brain aging
•Specific characteristics in neurons
•Insidious onset (if someone has changes in a day or 2 it is not AD)
•cognitive and behavioral impairments; personality changes
AD early signs - Correct Answers -- memory loss
- misplacing items often
- mood changes without any stimulation
- should have issues with normal ADL tasks
- vision -- visual tract from frontal, temporal to occipital -- can affect visual tract
(perception) not peripheral vision more the central visual processing
- struggling to communicate (frontal dementia - broca area) -- trouble expressing ideas
- clients still have insight to these changes in the beginning
- poor judgment
- confusion of time and place
- social withdrawal
In people with AD, dendritic changes and neurocortical degeneration is resulting from
what 3 main causes? - Correct Answers -1) Neuritic plaques (Senile plaques) (β-
amyloid) - appears in normal aging - but would expect more in AD
- Develop in the parenchyma of the brain
- Not strictly intraneuronal, extracellular structures
- Extracellular deposits of amyloid beta in the grey matter of the brain
2) Neurofibrillary tangles (tau)
- tau protein
- Strictly intraneuronal
- Lead to the death of neuron
- Specific to AD
3) Due to abnormality in the metabolism of two distinctive proteins
,Beta amyloid plaques - Correct Answers -occurs in normal aging --especially over the
age of 80 -- not a big difference of people with AD vs normal aging brain -- however
may have a lower prevalence rate and lower number of plaques
discrete spherical lesions
consist mostly of beta amyloid peptide or amyloid plaques
how does B-amyloid plaques form? - Correct Answers --Defective breakdown of a
benign substance known as amyloid precursor protein (APP), integral membrane
protein concentrated in the synapses of neurons
(occurs outside of the neurons)
-Produce sticky insoluble shards of β-amyloid plaques -> stick together (form clusters),
form dense plaques, -> damage axons
Which lobe is most severely affected by plaques? - Correct Answers -temporal
Hippocampus volume is reduced by up to ____% in advanced AD (reduced connectivity
of the hippocampus with other brain areas)
And the volume of the Amygdala in Advanced AD is reduced by ____% - Correct
Answers -60%
45%
hippocampus =____________ memory - people with degeneration in the hippocampus
have issues with this and spatial navigation - Correct Answers -episodic
how does Neurofilbrillary tangles occur in AD? - Correct Answers -- for some reason
there is degeneration of the Tau protein that regulates the assembly of microtubules (of
the axon) and stabilizes their structure
- the neurofibers (of the microtubules no longer held together) then start to tangle
together forming a bundle of filaments called a helix or neurofilbrillary tangle
(picture a strand of hair with multiple split ends that forms a messy knot or clump of hair)
In moderate stage of AD, the person will have some confusion from the deterioration of
the _______ and emotional changes due to its affect on the _________ of the limbic
system. - Correct Answers -SCN (Suprachiasmatic nucleus) located in the hippocampus
region and directly above the optic chiasm, controls the circadian clock rhythms (day-
night cycle);
amygdala
In AD, you will see _________ neurons destroyed. These neurons form the track that
sends messages via the neurotransmitter acetylcholine from the Nucleus basalis
,(bottom of frontal lobe) to other cortical areas of the brain. In AD, the Nucleus Basalis is
reduced by 70%! This reduction of neurotransmitter in the brain has an impact on
processing speed and response, etc. - Correct Answers –cholinergic
For visual field deficits you can use __________ ___________ training and
__________ therapy. - Correct Answers -• Visual Scanning Training: pencil-paper tasks,
functional scanning tasks and computerized visual scanning - Need to learn and train an
organized search strategy, such as always starting left to right, anchoring
• Prism Therapy: use prisms to shift images from non-seeing area into the seeing area
For ocular motor dysfunction you can do...
- _________ __________ exercises, such as jump vergences, pencil push ups, Brock
string exercises, and base in/base out stereograms
- _________ for various refractive, accommodative and binocular disorders and prisms
that enable single vision
- ______________ of visual field to minimize impact of diplopia, may be total or partial,
partial = better compliance - Correct Answers -remedial training;
lenses;
Occlusion
For visual neglect, you could use
- ________ __________ training (Lighthouse Strategy: "Imagine you are a lighthouse"
Training patient to laterally rotate head all the way to the shoulder when scanning
environment)
and
- ________ training (use prisms to side opposite of neglect, after adaptation when you
remove prisms, there will be a "rebound" of attention to the affected side).
- ___________ feedback such as mirror therapy
- _____________ glasses and ___________ that occlude vision to unaffected side
(mixed evidence, might help ADLs)
- ____________________ (TENS) applied to the affected side, which can then increase
attention to that side of the body - Correct Answers -- visual scanning training;
- prism therapy;
- Visuomotor;
- hemispatial; eyepatching;
- Transcutaneous Electrical Nerve Stimulation (TENS)
______________ has less treatment research. Treatment for this has first practice
identifying common and familiar objects.
You focus using other sensory systems to identify objects or people. Patient Verbally
describes object (verbal strategy). Train patients to keep objects in relevant locations to
assist in identification (organizational strategy) - Correct Answers -Agnosia
For _____________, you practice whole functional task, do not break down. Start with
simple tasks in familiar environment. Do not allow patient to fail (Errorless learning
, approach). Compensatory strategy training: Verbalizing the sequence during the activity
and viewing pictures that illustrate task sequence. - Correct Answers -Apraxia
What is brain atrophy? - Correct Answers -cortical shrinkage and enlarged ventricles of
the brain causes issues with processing information
- this accelerates as the disease progresses
- not evenly distributed
- mostly in the gyri of association areas
90% of AD is late onset, around the age of ____ and has no known genetic cause -
Correct Answers -65 (risk doubles every 5 years after this age)
History of what 3 things may increase your risk of AD? - Correct Answers -- head injury
(neuronal secretion of amyloid plaques / speed up the production of amyloid protein)
- depression
- ECT treatments
which is the most prevalent form of dementia? least? - Correct Answers -AD = 50-70%
of all cases
VD = 15-20%
Lewy Bodies = 10-20% (75-80 years old)
Frontotemporal = 5%
Frontotemporal Dementia - Correct Answers -As the name suggests, causes
degeneration of the frontal and temporal lobes (i.e. cortico-basal areas, frontal/anterior
temporal lobes, striatum, broca's area = expressive speech, Wernicke's area =
receptive speech).
- It is primarily progressive aphasia and can occur at a young age.
- Plaques are not typically seen in this type.
- Symptoms can include change in character and social conduct (mood swings), speech
problems, Affect changes (poor motivation, indifference, flat affect)
Dementia with Lewy Bodies - Correct Answers -Caused by abnormal deposits of a
protein inside the brain's nerve cells that cause symptoms similar to Parkinsons (can
occur by itself or together with alzheimer's or Parkinson's disease).
- Affects the areas of the brain that involve thinking and movement.
- symptoms: memory issues (early), speech, motor parkinsonism, transient loss of
consciousness, hallucinations and delusions
Answers
Dementia is an umbrella term that includes what 4 neurological diseases? - Correct
Answers -Alzheimer's disease
Vascular dementia
Frontotemporal dementia
Lewy Bodies
What are 4 characteristics of Alzheimer's disease (AD)? - Correct Answers -•Not a
process of accelerated brain aging
•Specific characteristics in neurons
•Insidious onset (if someone has changes in a day or 2 it is not AD)
•cognitive and behavioral impairments; personality changes
AD early signs - Correct Answers -- memory loss
- misplacing items often
- mood changes without any stimulation
- should have issues with normal ADL tasks
- vision -- visual tract from frontal, temporal to occipital -- can affect visual tract
(perception) not peripheral vision more the central visual processing
- struggling to communicate (frontal dementia - broca area) -- trouble expressing ideas
- clients still have insight to these changes in the beginning
- poor judgment
- confusion of time and place
- social withdrawal
In people with AD, dendritic changes and neurocortical degeneration is resulting from
what 3 main causes? - Correct Answers -1) Neuritic plaques (Senile plaques) (β-
amyloid) - appears in normal aging - but would expect more in AD
- Develop in the parenchyma of the brain
- Not strictly intraneuronal, extracellular structures
- Extracellular deposits of amyloid beta in the grey matter of the brain
2) Neurofibrillary tangles (tau)
- tau protein
- Strictly intraneuronal
- Lead to the death of neuron
- Specific to AD
3) Due to abnormality in the metabolism of two distinctive proteins
,Beta amyloid plaques - Correct Answers -occurs in normal aging --especially over the
age of 80 -- not a big difference of people with AD vs normal aging brain -- however
may have a lower prevalence rate and lower number of plaques
discrete spherical lesions
consist mostly of beta amyloid peptide or amyloid plaques
how does B-amyloid plaques form? - Correct Answers --Defective breakdown of a
benign substance known as amyloid precursor protein (APP), integral membrane
protein concentrated in the synapses of neurons
(occurs outside of the neurons)
-Produce sticky insoluble shards of β-amyloid plaques -> stick together (form clusters),
form dense plaques, -> damage axons
Which lobe is most severely affected by plaques? - Correct Answers -temporal
Hippocampus volume is reduced by up to ____% in advanced AD (reduced connectivity
of the hippocampus with other brain areas)
And the volume of the Amygdala in Advanced AD is reduced by ____% - Correct
Answers -60%
45%
hippocampus =____________ memory - people with degeneration in the hippocampus
have issues with this and spatial navigation - Correct Answers -episodic
how does Neurofilbrillary tangles occur in AD? - Correct Answers -- for some reason
there is degeneration of the Tau protein that regulates the assembly of microtubules (of
the axon) and stabilizes their structure
- the neurofibers (of the microtubules no longer held together) then start to tangle
together forming a bundle of filaments called a helix or neurofilbrillary tangle
(picture a strand of hair with multiple split ends that forms a messy knot or clump of hair)
In moderate stage of AD, the person will have some confusion from the deterioration of
the _______ and emotional changes due to its affect on the _________ of the limbic
system. - Correct Answers -SCN (Suprachiasmatic nucleus) located in the hippocampus
region and directly above the optic chiasm, controls the circadian clock rhythms (day-
night cycle);
amygdala
In AD, you will see _________ neurons destroyed. These neurons form the track that
sends messages via the neurotransmitter acetylcholine from the Nucleus basalis
,(bottom of frontal lobe) to other cortical areas of the brain. In AD, the Nucleus Basalis is
reduced by 70%! This reduction of neurotransmitter in the brain has an impact on
processing speed and response, etc. - Correct Answers –cholinergic
For visual field deficits you can use __________ ___________ training and
__________ therapy. - Correct Answers -• Visual Scanning Training: pencil-paper tasks,
functional scanning tasks and computerized visual scanning - Need to learn and train an
organized search strategy, such as always starting left to right, anchoring
• Prism Therapy: use prisms to shift images from non-seeing area into the seeing area
For ocular motor dysfunction you can do...
- _________ __________ exercises, such as jump vergences, pencil push ups, Brock
string exercises, and base in/base out stereograms
- _________ for various refractive, accommodative and binocular disorders and prisms
that enable single vision
- ______________ of visual field to minimize impact of diplopia, may be total or partial,
partial = better compliance - Correct Answers -remedial training;
lenses;
Occlusion
For visual neglect, you could use
- ________ __________ training (Lighthouse Strategy: "Imagine you are a lighthouse"
Training patient to laterally rotate head all the way to the shoulder when scanning
environment)
and
- ________ training (use prisms to side opposite of neglect, after adaptation when you
remove prisms, there will be a "rebound" of attention to the affected side).
- ___________ feedback such as mirror therapy
- _____________ glasses and ___________ that occlude vision to unaffected side
(mixed evidence, might help ADLs)
- ____________________ (TENS) applied to the affected side, which can then increase
attention to that side of the body - Correct Answers -- visual scanning training;
- prism therapy;
- Visuomotor;
- hemispatial; eyepatching;
- Transcutaneous Electrical Nerve Stimulation (TENS)
______________ has less treatment research. Treatment for this has first practice
identifying common and familiar objects.
You focus using other sensory systems to identify objects or people. Patient Verbally
describes object (verbal strategy). Train patients to keep objects in relevant locations to
assist in identification (organizational strategy) - Correct Answers -Agnosia
For _____________, you practice whole functional task, do not break down. Start with
simple tasks in familiar environment. Do not allow patient to fail (Errorless learning
, approach). Compensatory strategy training: Verbalizing the sequence during the activity
and viewing pictures that illustrate task sequence. - Correct Answers -Apraxia
What is brain atrophy? - Correct Answers -cortical shrinkage and enlarged ventricles of
the brain causes issues with processing information
- this accelerates as the disease progresses
- not evenly distributed
- mostly in the gyri of association areas
90% of AD is late onset, around the age of ____ and has no known genetic cause -
Correct Answers -65 (risk doubles every 5 years after this age)
History of what 3 things may increase your risk of AD? - Correct Answers -- head injury
(neuronal secretion of amyloid plaques / speed up the production of amyloid protein)
- depression
- ECT treatments
which is the most prevalent form of dementia? least? - Correct Answers -AD = 50-70%
of all cases
VD = 15-20%
Lewy Bodies = 10-20% (75-80 years old)
Frontotemporal = 5%
Frontotemporal Dementia - Correct Answers -As the name suggests, causes
degeneration of the frontal and temporal lobes (i.e. cortico-basal areas, frontal/anterior
temporal lobes, striatum, broca's area = expressive speech, Wernicke's area =
receptive speech).
- It is primarily progressive aphasia and can occur at a young age.
- Plaques are not typically seen in this type.
- Symptoms can include change in character and social conduct (mood swings), speech
problems, Affect changes (poor motivation, indifference, flat affect)
Dementia with Lewy Bodies - Correct Answers -Caused by abnormal deposits of a
protein inside the brain's nerve cells that cause symptoms similar to Parkinsons (can
occur by itself or together with alzheimer's or Parkinson's disease).
- Affects the areas of the brain that involve thinking and movement.
- symptoms: memory issues (early), speech, motor parkinsonism, transient loss of
consciousness, hallucinations and delusions
