MH701 Final exam Questions And Answers
Verified 100% Correct
What classes of medications may be helpful in frontotemporal dementia? - ANSWER
SSRIs or SNRIs
What do cholinesterase inhibitors do? - ANSWER Increase levels of Ach in the brain by
blocking acetylcholinesterase (the enzyme that breaks down Ach)
What does a score below 12 on MMSE indicate? - ANSWER Severe dementia
What does a score of 18-23 on MMSE indicate - ANSWER Mild cognitive impairment,
dementia
MMSE scoring - ANSWER 24-30 No impairment
18-23 Mild cognitive impairment
0-17 Severe cognitive impairment
What does START stand for in the STOPP/START criteria? - ANSWER Screening Tool
to Alert providers to the Right Treatment list of common conditions and medications that
should be considered
What does STOPP stand for in the STOPP/START criteria? - ANSWER Screening Tool
of Older Person's Prescriptions (STOPP)
list of potentially dangerous medications in older adults
What does the neurotransmitter acetylcholine (Ach) do? - ANSWER Enables learning
and memory
What effect does the protein "Tau" have on the development of Alzheimer's disease
(AD)? - ANSWER Tau is a protein contained within the axons of the nerve cells. In AD,
Tau protein builds up and forms tangles in the areas of the brain important for memory
What happens if excessive glutamate is released? - ANSWER Excess levels contribute
to excitotoxic cell death
What is a brief 30-point questionnaire test that is used to screen for cognitive
impairment? Commonly used to screen for dementia? - ANSWER MMSE
What is a concerning side effect of citalopram (celexa) in older adults? - ANSWER QT
prolongation and arrhythmias (increased risk of AFib)
,What is an acutely disturbed state of mind that occurs in fever, intoxication, and other
disorders, often characterized by restlessness and incoherence of thought, attention,
and speech? - ANSWER Delirium
What is an N-Methyl-D-Aspartate (NDMA) receptor? - ANSWER A receptor site on the
hippocampus that influences the flow of information between neurons
What is Anomia? - ANSWER Loss of the ability to name objects or retrieve names of
people
What is apraxia? - ANSWER misuse of objects due to failure to identify them
What is Agnosia? - ANSWER Inability to recognize familiar objects, taste, sounds and
other sensations
What is Amnesia? - ANSWER partial or total loss of memory
What is Aphasia? - ANSWER inability to express oneself or to understand language
What is glutamates function regarding memory? - ANSWER It is involved in encoding
and consolidation of memories
What is known about Alzheimer's (AD) genetics? - ANSWER Early onset, familial AD:
APP (chromosome 21)
Presenilin 1 (chromosome 14)
Presenilin 2 (chromosome 1)
Late onset, familial AD:
Apolipoprotien E4 (ApoE e4) chromosome 19
What is the amyloid cascade hypothesis? - ANSWER The proposal that Alzheimer's
disease results from accumulation of beta amyloid. this sets off a cascade of events
leading to neuronal cell death and dementia
What is the black box warning for antipsychotic use in dementia? - ANSWER The use
of antipsychotics in older adults with behavioral or psychological symptoms of dementia
will raise the risk of death 2 fold.
What is the first line SSRI for agitation or aggression associated with dementia? -
ANSWER Celexa (citalopram)
What is the mechanism of action (MOA) of an NDMA receptor antagonist? - ANSWER
It blocks the NMDA receptor, preventing overstimulation of the excitatory
neurotransmitter glutamate
,What is the most common dementia? - ANSWER Alzheimer's disease (AD)
What is the polypharmacy RX cascade? - ANSWER 1. Drug #1 is added
2. A side effect occurs
3. This side effect is misinterpreted as a new medical condition
4. Drug #2 is added
ETC.
What is the treatment for delirium? - ANSWER Address underlying cause
Optimize brain condition (O2, hydration, treatment of pain, minimize sensory stimuli,
etc)
Antipsychotics if psychosis or insomnia (esp. haloperidol)
(TADA: Tolerate, Anticipate, Don't Agitate)
What medications can precipitate acute delirium? - ANSWER Sedative/hypnotics
Benzodiazepines
Narcotics
Anticholinergics
Alcohol withdrawl
Anesthesia with surgery
Illness/infection
What occurs in Alzheimer's disease stage 1? - ANSWER Amyloid accumulates in the
brain, but the person remains asymptomatic
What pulmonary risks are increased by cholinesterase inhibitors? - ANSWER May
exacerbate asthma and other pulmonary disease
What symptoms occur in the final stage (stage 3) of Alzheimer's disease? - ANSWER
Signs of dementia:
Amnesia--loss of memory
Aphasia--speech loss
Apraxia--loss of motor function, misuse of objects
Agnosia--recognition loss
Anomia--inability to remember the name of things
What symptoms would make you suspect Lewy body dementia? - ANSWER --No initial
Parkinson's symptoms (may appear after 1 year disease duration)
--Vivid hallucinations (beginning early in the disease)
--Behavioral symptoms
--Insidious onset
--Dramatic severity fluctuations day to date
, What type of dementia manifests initially with changes in personality, social behavior,
disinhibition, and language deficits that progress over time to more global
neurocognitive deficits? - ANSWER Frontotemporal Dementia (Pick's disease) is
associated with pronounced atrophy of the frontal lobe
What would occur if antipsychotic medications were given to someone with Lewy body
dementia? - ANSWER Patients with Lewy body dementia and Parkinson's disease are
extremely sensitive to antipsychotic medications. They can develop life-threatening
extrapyramidal symptoms (EPS).
When is galantamine (Razadyne) contraindicated? - ANSWER In severe liver or kidney
disease
Which acetylcholinesterase inhibitor is available ODT? - ANSWER Aricept (donepezil)
Which benzodiazepine might be used in the treatment of acute delirium with psychosis
and agitation? - ANSWER Lorazepam (Ativan)
Which cholinesterase inhibitor is an inhibitor of the acetylcholinesterase (AChE) and
butyrylcholinesterase (BuChE)? - ANSWER Rivastigmine (Exelon)
Which cholinesterase inhibitor is a reversible, selective inhibitor of acetylcholinesterase
(AChE) with effects on the nicotinic cholinergic receptors? - ANSWER Galantamine
(Razadyne)
Which cholinesterase inhibitor is a reversible, selective inhibitor of acetylcholinesterase
(AChE) without inhibition of BuChE or effect on the nicotinic cholinergic receptors? -
ANSWER Donepezil (Aricept)
Which condition is easy to mistake for dementia in older individuals? - ANSWER
Depression
Which is the only acetylcholesterase (AChE) inhibitor that is also FDA approved for the
treatment of mild to moderate Parkinson dementia? - ANSWER Rivastigmine (Exelon)
Which other antidepressants are also considered to have a high safety profile in the
elderly? - ANSWER Bupropion (Wellbutrin)
Venlafaxine (Effexor)
What psychiatric conditions often co-occur with early dementia? - ANSWER
Depression
Increased risk of suicide
Verified 100% Correct
What classes of medications may be helpful in frontotemporal dementia? - ANSWER
SSRIs or SNRIs
What do cholinesterase inhibitors do? - ANSWER Increase levels of Ach in the brain by
blocking acetylcholinesterase (the enzyme that breaks down Ach)
What does a score below 12 on MMSE indicate? - ANSWER Severe dementia
What does a score of 18-23 on MMSE indicate - ANSWER Mild cognitive impairment,
dementia
MMSE scoring - ANSWER 24-30 No impairment
18-23 Mild cognitive impairment
0-17 Severe cognitive impairment
What does START stand for in the STOPP/START criteria? - ANSWER Screening Tool
to Alert providers to the Right Treatment list of common conditions and medications that
should be considered
What does STOPP stand for in the STOPP/START criteria? - ANSWER Screening Tool
of Older Person's Prescriptions (STOPP)
list of potentially dangerous medications in older adults
What does the neurotransmitter acetylcholine (Ach) do? - ANSWER Enables learning
and memory
What effect does the protein "Tau" have on the development of Alzheimer's disease
(AD)? - ANSWER Tau is a protein contained within the axons of the nerve cells. In AD,
Tau protein builds up and forms tangles in the areas of the brain important for memory
What happens if excessive glutamate is released? - ANSWER Excess levels contribute
to excitotoxic cell death
What is a brief 30-point questionnaire test that is used to screen for cognitive
impairment? Commonly used to screen for dementia? - ANSWER MMSE
What is a concerning side effect of citalopram (celexa) in older adults? - ANSWER QT
prolongation and arrhythmias (increased risk of AFib)
,What is an acutely disturbed state of mind that occurs in fever, intoxication, and other
disorders, often characterized by restlessness and incoherence of thought, attention,
and speech? - ANSWER Delirium
What is an N-Methyl-D-Aspartate (NDMA) receptor? - ANSWER A receptor site on the
hippocampus that influences the flow of information between neurons
What is Anomia? - ANSWER Loss of the ability to name objects or retrieve names of
people
What is apraxia? - ANSWER misuse of objects due to failure to identify them
What is Agnosia? - ANSWER Inability to recognize familiar objects, taste, sounds and
other sensations
What is Amnesia? - ANSWER partial or total loss of memory
What is Aphasia? - ANSWER inability to express oneself or to understand language
What is glutamates function regarding memory? - ANSWER It is involved in encoding
and consolidation of memories
What is known about Alzheimer's (AD) genetics? - ANSWER Early onset, familial AD:
APP (chromosome 21)
Presenilin 1 (chromosome 14)
Presenilin 2 (chromosome 1)
Late onset, familial AD:
Apolipoprotien E4 (ApoE e4) chromosome 19
What is the amyloid cascade hypothesis? - ANSWER The proposal that Alzheimer's
disease results from accumulation of beta amyloid. this sets off a cascade of events
leading to neuronal cell death and dementia
What is the black box warning for antipsychotic use in dementia? - ANSWER The use
of antipsychotics in older adults with behavioral or psychological symptoms of dementia
will raise the risk of death 2 fold.
What is the first line SSRI for agitation or aggression associated with dementia? -
ANSWER Celexa (citalopram)
What is the mechanism of action (MOA) of an NDMA receptor antagonist? - ANSWER
It blocks the NMDA receptor, preventing overstimulation of the excitatory
neurotransmitter glutamate
,What is the most common dementia? - ANSWER Alzheimer's disease (AD)
What is the polypharmacy RX cascade? - ANSWER 1. Drug #1 is added
2. A side effect occurs
3. This side effect is misinterpreted as a new medical condition
4. Drug #2 is added
ETC.
What is the treatment for delirium? - ANSWER Address underlying cause
Optimize brain condition (O2, hydration, treatment of pain, minimize sensory stimuli,
etc)
Antipsychotics if psychosis or insomnia (esp. haloperidol)
(TADA: Tolerate, Anticipate, Don't Agitate)
What medications can precipitate acute delirium? - ANSWER Sedative/hypnotics
Benzodiazepines
Narcotics
Anticholinergics
Alcohol withdrawl
Anesthesia with surgery
Illness/infection
What occurs in Alzheimer's disease stage 1? - ANSWER Amyloid accumulates in the
brain, but the person remains asymptomatic
What pulmonary risks are increased by cholinesterase inhibitors? - ANSWER May
exacerbate asthma and other pulmonary disease
What symptoms occur in the final stage (stage 3) of Alzheimer's disease? - ANSWER
Signs of dementia:
Amnesia--loss of memory
Aphasia--speech loss
Apraxia--loss of motor function, misuse of objects
Agnosia--recognition loss
Anomia--inability to remember the name of things
What symptoms would make you suspect Lewy body dementia? - ANSWER --No initial
Parkinson's symptoms (may appear after 1 year disease duration)
--Vivid hallucinations (beginning early in the disease)
--Behavioral symptoms
--Insidious onset
--Dramatic severity fluctuations day to date
, What type of dementia manifests initially with changes in personality, social behavior,
disinhibition, and language deficits that progress over time to more global
neurocognitive deficits? - ANSWER Frontotemporal Dementia (Pick's disease) is
associated with pronounced atrophy of the frontal lobe
What would occur if antipsychotic medications were given to someone with Lewy body
dementia? - ANSWER Patients with Lewy body dementia and Parkinson's disease are
extremely sensitive to antipsychotic medications. They can develop life-threatening
extrapyramidal symptoms (EPS).
When is galantamine (Razadyne) contraindicated? - ANSWER In severe liver or kidney
disease
Which acetylcholinesterase inhibitor is available ODT? - ANSWER Aricept (donepezil)
Which benzodiazepine might be used in the treatment of acute delirium with psychosis
and agitation? - ANSWER Lorazepam (Ativan)
Which cholinesterase inhibitor is an inhibitor of the acetylcholinesterase (AChE) and
butyrylcholinesterase (BuChE)? - ANSWER Rivastigmine (Exelon)
Which cholinesterase inhibitor is a reversible, selective inhibitor of acetylcholinesterase
(AChE) with effects on the nicotinic cholinergic receptors? - ANSWER Galantamine
(Razadyne)
Which cholinesterase inhibitor is a reversible, selective inhibitor of acetylcholinesterase
(AChE) without inhibition of BuChE or effect on the nicotinic cholinergic receptors? -
ANSWER Donepezil (Aricept)
Which condition is easy to mistake for dementia in older individuals? - ANSWER
Depression
Which is the only acetylcholesterase (AChE) inhibitor that is also FDA approved for the
treatment of mild to moderate Parkinson dementia? - ANSWER Rivastigmine (Exelon)
Which other antidepressants are also considered to have a high safety profile in the
elderly? - ANSWER Bupropion (Wellbutrin)
Venlafaxine (Effexor)
What psychiatric conditions often co-occur with early dementia? - ANSWER
Depression
Increased risk of suicide
