NR 546 FINAL EXAM VERSION 1 AND VERSION 2 NEWEST 2025 ACTUAL EXAM COMPLETE QUESTION NAD ASNWERS

NR546FINALEXAM(NR546ACTUAL)WITHCORRECT A+ m m



GRADED ANSWERS m


IfanADmedicationisdiscontinued: - m


ANSWERthemedicationmaynotbeas effective if restarted
m m m




Currentgoldstandardoftreatmentforcognitivesymptomsincludes: - m


ANSWER pharmacologic management with a cholinesterase inhibitor (ChEIs) a
m m m m m m m m


nd an N- methyl-D-aspartate (NMDA) receptor antagonist.
m m m m m m




FourMajorcausesofDementia-ANSWER_-AlzheimerDisease(AD)
-vasculardementia
-Lewybodydementias(LBD)
-frontotemporaldementia(FTD)


threepathologicalhallmarksofADseeninthebrainatautopsyare:-
ANSWER_(1)amyloid-beta(Aβ),aggregatedintoplaques
(2) neurofibrillarytanglescomposedofhyperphosphorylatedtauprotein
(3) substantialneuronalcellloss


Differential diagnosis, clinical presentation: Vascular dementia - ANSWER_-
m m m m m m m


Impairedabstraction,mentalflexibility,processingspeed,andworkingmemory
m



-Verbalmemoryisbetterpreserved
-Slowercognitivedecline
-Dementiaoccurswithinseveralmonthsofastroke


Differentialdiagnosis,clinicalpresentation:Lewybodydementias(LBD) - m


ANSWER_-Visual hallucinations
m m




-Spontaneousparkinsonism
-Cognitivefluctuations

, NR546FINALEXAM(NR546ACTUAL)WITHCORRECT A+ m m



GRADED ANSWERS m


-Visuospatial,attention,andexecutivefunctiondeficitsareworse
-Memoryimpairmentisnotassevere
-Earlierpresentationofpsychosisandpersonalitychanges
-Rapideyemovement(REM)sleep disturbances


Differentialdiagnosis,clinicalpresentation:Frontotemporaldegeneration(FTD) - m


ANSWER_-
m


Progressive behavioral and personality changes that impair social conduct (apath
m m m m m m m m m


y, disinhibition, etc.)
m m



-Languageimpairment
-Possiblypreservedepisodicmemory


LewyBodyDementias(LBD)-
ANSWER_DementiawithLewybodies(DLB) and the related Parkinson's disease d m m m m m m


ementia (PDD) m



-10-15%ofallcasesofdementia
-abnormalaccumulationofaproteincalledα-synuclein
• aggregatetoformoligomers,eventuallyturninginto"Lewybodies"&Lewy neuri m


tes, as neurons degenerate
m m m




TheAmyloidcascadeHypothesis-
ANSWER_Alzheimerdisease(AD)iscaused bythe accumulationof toxic Aβ, which m m m m m


mforminto plaques, hyperphosphorylation of tau, neurofibrillary tangle formation,
m m m m m m m m


synaptic dysfunction, and ultimately neuron loss with memory loss and dementia
m m m m m m m m m m




riskofdevelopingAD-ANSWER_-
inheritanceoftwocopiesofAPOE4leadstoa tenfold increased AD risk m m m m



-APOE2geneappearstooffersomeprotectionfromAD
-
APOE3gene(themostcommonformoftheAPOEgene)conveysariskthatfalls between AP m m


OE2 and APOE4
m m

,NR546FINALEXAM(NR546ACTUAL)WITHCORRECT A+ m m



GRADED ANSWERS m




Non-pharmacologicaloptionsforbehavioralsymptomsindementia - m


ANSWER_• Address unmet needs (hunger, pain, thirst, boredom)
m m m m m m m




• Identify/modifyenvironmentalstressors
• Identify/modifydailyroutinestressors
• Caregiversupport/training
• Behaviormodification
• Group/individualtherapy
• Problemsolving
• Distraction
• Provideoutletsforpent-upenergy(exercise,activities)
• Avoidbehaviortriggers
• Increasesocialengagement
• Relaxationtechniques
• Reminiscencetherapy
• Musictherapy
• Aromatherapy
• Pet therapy
m




Txdementia-relatedpsychosis–ANSWERPimavanserin
-
hypothetically reduces overactivity in the psychosis network caused by plaques, tangl
m m m m m m m m m m


es, Lewy bodies, or strokes, presumably by lowering the normal 5HT2A stimulationt
m m m m m m m m m m m


osurvivingglutamateneuronsthathavelosttheirGABAinhibitionby neurodegeneration m



-
approvedforthetreatmentofParkinson'sdiseasepsychosis&therearepositive trials in m m m


dementia-related psychosis
m

, NR546FINALEXAM(NR546ACTUAL)WITHCORRECT A+ m m



GRADED ANSWERS m


NeuronalNetworksofAgitationinAlzheimerDisease – m


ANSWERimbalancein "top-down" cortical inhibition with "bottom-
m m m m m


up" limbic and emotional drives
m m m m




Targeting Multimodal Neurotransmitters (Norepinephrine, Serotonin, and Dopam
m m m m m m


ine)fortheSymptomaticTreatmentofAgitationinAlzheimerDisease – m


mANSWER Brexpiprazole m



-serotonin-dopamine-norepinephrineantagonist/partialagonist
-
combinesseveralsimultaneousmechanismstoquelltheexcessiveactivityofthe agitation n m m


etwork in AD m m



-warningforincreasedmortalityindementia-
relatedpsychosis,usingthisagentfor agitation in AD and in doses lower than those gen
m m m m m m m m m m


erally used to treat psychosis in schizophrenia may provide a greater safety margin
m m m m m m m m m m m m




TargetingGlutamatefortheSymptomaticTreatmentofAgitationinAlzheimer Disease m


– ANSWER dextromethorphan-bupropion
m m m



-
The NMDA antagonist dextromethorphan (DXM), in combination with the nor
m m m m m m m m m


epinephrine-
dopaminereuptakeinhibitor(NDRI)bupropion,isintestingasa treatment for agitati m m m


on


Apathy–ANSWERdiminishedmotivationandreducedgoal-
directedbehavior, accompanied by decreased emotional responsiveness
m m m m m



-lackofmotivationisatthecoreofapathy
-affectsapproximately90%ofpatientswithdementia
-oneofthemostpersistentandfrequentsecondarybehavioralsymptomsof dementia m



-showntopredictdisease-worsening
-ifmedneededforapathy:cholinesteraseinhibitorsarefirst -
lineinAD,FTD patients may benefit mor
m m m m