4.1 MTB Step 3 - Dementia (Alzheimer Disease, Frontotemporal Dementia, CJD)

Question 1

ALZHEIMER DISEASE (AD)

PRESENTATION

What is the Typical Presentation of a patient with Alzheimer Disease (AD)?

Answer 1

Older Patient (> 65)

with

Slowly Progressive Loss of Memory

Question 2

ALZHEIMER DISEASE (AD)

DIAGNOSIS

What are (4) Tests that you must order for ALL patients with Memory Loss and which is the ONLY test of the four that will be Abnormal?

Answer 2

1. CT Head = Diffuse, Symmetrical Atrophy
2. Vitamin B12 level = Normal
3. Thyroid Function Testing (T4 / TSH) = Normal
4. RPR or VDRL = Normal

*Alzheimer Disease (AD) is a Diagnosis of Exclusion

Question 3

ALZHEIMER DISEASE (AD)

TREATMENT

Which class of medications are considered the Standard of Care for the treatment of Alzheimer Disease (AD) and what are (3) examples?

Answer 3

Anticholinesterase medications

1. Donepezil
2. Rivastigmine
3. Galantamine

Memantine is a medication from another class with Modest benefit.

Question 4

ALZHEIMER DISEASE (AD)

PREVENTION

What activity helps to decrease dementia progression?

Answer 4

Exercise

Question 5

FRONTOTEMPORAL DEMENTIA (PICK DISEASE)

PRESENTATION

What is the typical Presentation of a patient with Frontotemporal Dementia?

Answer 5

• Personality & Behavior become abnormal first
• Memory is lost afterward
• There is NO movement disorder

Question 6

FRONTOTEMPORAL DEMENTIA (PICK DISEASE)

DIAGNOSIS

How is Frontotemporal Dementia diagnosed and what does it show?

Answer 6

CT or MRI Head

shows Focal Atrophy of the Frontal and Temporal Lobes.

Question 7

FRONTOTEMPORAL DEMENTIA (PICK DISEASE)

TREATMENT

What is the treatment for Frontotemporal Dementia?

Answer 7

Anticholinesterase medications

1. Donepezil
2. Rivastigmine
3. Galantamine

Memantine is a medication from another class with Modest benefit.

**this is the same treatment as for AD, just with less response**

Question 8

CREUTZFELDT-JAKOB DISEASE (CJD)

ETIOLOGY

What is the cause of Creutzfeldt-Jakob Disease (CJD)?

Answer 8

PRIONS

(Transmissible Protein Particles)

Question 9

CREUTZFELDT-JAKOB DISEASE (CJD)

PRESENTATION

What are (3) common Clinical Features of Creutzeldt-Jakob Disease (CJD)?

Answer 9

1. Younger than AD patient
2. Rapidly Progressive Dementia
3. Myoclonus

Question 10

CREUTZFELDT-JAKOB DISEASE (CJD)

DIAGNOSIS

What are the (2) Best INITIAL Tests for Creutzfeldt-Jakob Disease (CJD) and what is the finding for each?

Answer 10

1. MRI Head = Normal
2. EEG = Abnormal

Question 11

CREUTZFELDT-JAKOB DISEASE (CJD)

DIAGNOSIS

What is the Next BEST Test for Creutzfeldt-Jakob Disease (CJD) following MRI Head & EEG and what does it show?

Answer 11

Lumbar Tap

CSF shows 14-3-3 Protein

Question 12

CREUTZFELDT-JAKOB DISEASE (CJD)

DIAGNOSIS

What is the Most ACCURATE Diagnostic Test for Creutzfeldt-Jakob Disease (CJD)?

Answer 12

Brain Biopsy